Health in all policy areas

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Health in all policy areas , also known as intersectoral health policy or with the original English term Health in All Policies ( HiAP ), is a concept that focuses on the importance of political decision-making in the various sectors that influence health, such as transport, agriculture , Land use, housing, public safety and education. HiAP reaffirms the important role of policy programs, structural factors and multi-stakeholder cooperation in the health of the population . Health aspects should be taken into account in all policy areas. The term was first raised to the highest political level in Europe during the Finnish Presidency of the European Union (EU) in 2006 with the aim of enhancing cooperation between sectors to achieve common goals for health and welfare. A similar concept is formulated in the United States with the Ten Principles of Public Health Service .

Overview

The Alma-Ata (1978) Declaration of the World Health Organization (WHO) was the first formal recognition of the importance of intersectoral interventions for health. The spirit of Alma-Ata was further developed in the Ottawa Charter on Health Promotion to "General Health Promotion " as a key area of health promotion (adopted in Ottawa in 1986).

Health across all policies is based on the premise that health is influenced by a variety of factors beyond the direct control of the health sector, such as education, income and the conditions in which people live, work and play. Decisions in other policy areas can have both positive and negative effects on health. HiAP is a policy-making approach that decision-makers in other areas routinely use to assess health outcomes, including benefits, harm and health costs.

HiAP has been described as an essential part of universal service . HiAP can be used at all political levels, but also in the private sector and in non-profit organizations.

history

HiAP builds on the concepts of “overall health promotion” and “cross-cutting measures for health” that have been developed over the past four decades. The spirit of Alma-Ata was carried over to the Ottawa Charter for Health Promotion , adopted in Ottawa in 1986. There “healthy public policy” was identified as a key area of health promotion . At the Second International Conference on Health Promotion in Adelaide , Australia in 1988 , attention grew to the role of non-health sectors in promoting health.

definition

As part of the 8th World Conference on Health Promotion of the WHO, HiAP was defined as "a concept for public policy in all sectors that systematically takes into account the impact of decisions on health and health systems, seeks synergies and avoids harmful effects on health in order to improve health of the population and to improve health equality. " The HiAP approach is based on health-related rights and obligations. It emphasizes the impact of public policies on health-related factors and aims to improve the accountability of policy makers for health effects at all levels of policy making.

Examples of the application of the concept in different countries

Health in All Policies have been introduced in many parts of the world. One of the first countries to adopt the "healthy policies" approach to public health was Finland . The " North Karelia Project " was launched in 1972 with the aim of reducing the effects of coronary heart disease in the Finnish region of North Karelia through the participation of other sectors (e.g. community organizations, milk and meat producers, schools) and the Improve health. The project, supported by the Finnish authorities and the WHO , resulted in a significant reduction in cardiovascular mortality and is seen as a successful model for cross-sectoral cooperation. Finland continued its Health in All program. For example, in 2001 Finland formulated the basis for the implementation of the "Health 2015" cooperation program, which provides a framework for cross-sector health promotion. The goals of this long-term public health strategy are to improve health, to help Finns choose healthy lifestyles and to reduce health inequalities between the different population groups.

In South Australia , the implementation of the HiAP was aimed at positioning it as a core government process "instead of running it through and for the health sector". The South Australian model of HiAP is based on two basic elements: A) central governance and accountability and b) an analytical process focused on health. The 2010 Adelaide Declaration of Health in All Policies describes cases where HiAP is working well and provides tools that can be useful at different stages of policy implementation. While South Australia has formally adopted the concept of common governance for health, critics have pointed out that the country is still a long way from having a "health in all policies" governance system in place.

The ActNow BC program is an example of a Health in All Policies implementation in Canada . The cross-industry strategy aims to improve the health of the people of British Columbia by addressing common risk factors and reducing chronic diseases . By engaging local governments, communities, employers and schools, ActNow BC seeks to help develop and promote programs that encourage people to make healthy choices.

France launched the "French Cancer Plan" in 2003 with the aim of introducing a comprehensive strategy to combat cancer . One of the main goals was to reduce cancer mortality by 20% in 5 years, which was to be achieved by setting targets for a wide range of stakeholders. The evaluation of the plan in 2008 showed that although progress had been made in certain areas, some of the objectives had not been met. The plan's weaknesses included a lack of consideration for social inequalities , access to health care and poor coordination of patient care. In November 2009, the French government launched the 2009–2013 Cancer Plan to address the shortcomings of the 2003 plan and implement the new goals.

Fueled by the reform of the National Health System in 2000, the practice of intersectoral cooperation was encouraged in Thailand by making the use of Health Impact Assessments (HIA) compulsory at all levels of government. Since then, an increasing number of HIAs have been conducted to help address the growing number of health problems caused by air pollution, pesticide exposure, coal-fired power plants, and other environmental hazards. HIAs are seen as a valuable tool to foster cooperation between actors with different interests and to identify approaches for a healthier society.

At the national level in the United States , the US departments of transportation, housing and urban development and the Environmental Protection Agency have worked together in the Partnership for Sustainable Communities since 2009. The three agencies collectively identified six "habitability principles" as priority criteria that were used to assess funding decisions, proposed programs and legislative recommendations. The principles aim to improve affordable housing, environmentally friendly building, mixed use zones, water management and fallow land. Each of these principles supports the tasks of one or more of the bodies, such as efficient transportation, economic development, clean environment, etc. Many of the individual principles also contribute to improved health. Through a growing portfolio of case studies from more than 45 communities in the United States, the partnership has shown that each element of promoting healthy communities can contribute to other policy goals such as greater economic development and the improvement of living conditions.

The concept of Health in All Policies is contained in Section 4001 of the Patient Protection and Affordable Care Act (2010), which provides for the creation of a National Prevention Council, led by the Surgeon General , and the development of a National Prevention Strategy. This was published in June 2011. It calls for increased coordination between government agencies, as well as partnerships with non-profit organizations, businesses, healthcare and other agencies. The National Prevention Strategy prioritizes the tasks around four strategic directions: The creation of healthy environmental conditions in the communities, the empowerment of persons to make healthy decisions, the integration of the preventive services of community services and medical providers and the reduction of health inequalities. This can be achieved, for example, by creating more neighborhoods with better access to fruit and vegetables, active transportation and cleaner air.

California established a Working Group on Health in All Policies in 2010. This was the first formal nationwide step to bring policy makers together to identify and recommend programs, policies and strategies for improving health in a HiAP framework. 19 government agencies work together in the working group. Their 2010 report, titled Health in All Policies Task Force Report to the Strategic Growth Council, identified 34 recommendations, ranging from individual small actions to long-term, multi-agency programs. Transport, housing, affordable healthy food, safe living environments, green spaces and the obligation of decision-makers to consider health consequences when developing policies.

Support from academia and professional associations

The concept has gained support from academia and professional associations in the health sector. The Institute of Medicine (IOM), the American medical science academy, recognizes that actions taken outside of the health sector shape the environment in which people live and the decisions they make. It notes that some public health issues are so complex that they need to be addressed not through traditional health policies, but best through policies and programs that affect the social determinants of health , such as school programs, zoning, food advertising , public transportation, parks, workplaces, mass catering, and tax policies. IOM recommends implementing a HiAP approach to better address the determinants of health, better coordinate cross-sectoral efforts, and more effectively use public funds.

Many health associations have also endorsed the HiAP. The American Public Health Association calls HiAP the "gold standard" and calls for an increase in the HiAP infrastructure at all levels of the state, more funding for HiAP-related research, practice and training, as well as the identification of best practices and the establishment of a formal national research agenda. The National Association of County and City Health Officials (NACCHO) was the first national association to produce a position paper on HiAP. He advocates HiAP as a critical way to promote health and urges local health authorities to introduce best practices to policy makers. The National Network of Public Health Institutions praises HiAP and sees itself and its members as possible mediators for HiAP implementation.

criticism

As an objection to health across all policy areas, it has been suggested that the concept leads to "health imperialism" because it prioritizes health and distracts policy makers from paying attention to other important goals of society. Proponents of the concept have countered that health is not the only area of ​​social welfare that can benefit from interdisciplinary policymaking. Rather than blaming the concept as an attempt to make health the dominant issue, it could be used as a template for concepts such as "economics in all policies" and "education in all policies".

The Institute of Medicine recognizes many fundamental challenges in Health in All Policies. While there are many examples where working together is mutually beneficial, there are also examples where the goals of one area directly conflict with another. For example, public health experts have sought to restrict tobacco sales since the 1950s. This contrasts with the efforts of the tobacco industry to preserve the personal freedom of citizens and a free market environment for cigarette producers. Even non-controversial goals, such as increasing the median income and improving education, can lead to ideological differences over how to achieve these goals.

Some critics question the ability to accurately assess the health impact of policy choices. Collecting data on the initial situation and estimating the possible effects of a decision (or non-decision) on health are difficult. In addition, the training and funding of those who carry out such assessments is a challenge.

Health in all policy areas and health impact assessment

The Health Impact Assessment (HIA) can be an element of the HiAP. It is carried out through a systematic process, using a range of data sources and analytical techniques, and looking at input from stakeholders to determine the potential impact of a proposed policy, planning, program or project on the health of the population and the distribution of that impact across the population . In recent years, there has been emphasis on the need to make a clearer distinction between HIA and HiAP. The HIA is only one component of the HiAP, it is a broader strategy with the goals of better health, a better quality of life and a reduction in health inequalities.

The future of health in all policy areas

In June 2013, the Finnish Ministry of Social Affairs hosted the 8th World Conference on Health Promotion in Helsinki. One of the main objectives of the conference was to analyze the challenges that the implementation of the HiAP concept had to face, to enable the exchange of experiences during implementation, to show the design of effective ways for intersectoral cooperation, and the effects and the Consider promoting health promotion since the first health promotion conference in 1987. The Finnish Ministry of Social Affairs and Health has published a book to contribute to the conference, which provides a global framework for policy makers around the world to implement HiAP.

literature

  • Committee on Public Health Strategies to Improve Health, Institute of Medicine: 4 Intersectoral Action on Health. For the Public's Health: Revitalizing Law and Policy to Meet New Challenges. The National Academies Press, Washington, DC 2011.
  • Health Impact Assessment (HIA): A Tool to Benefit Health in All Policies. American Public Health Association, Washington, DC.
  • Health in All Policies Projects. Human Impact Partners . ( humanimpact.org ( Memento of March 27, 2012 in the Internet Archive ))
  • Health in all policies. European Commission . Jan. 2013. Web .
  • Partnership for Sustainable Communities: Area of ​​Focus for 2012. Sustainable Communities . Web. Jan. 2013. ( PDF ( Memento from February 14, 2013 in the Internet Archive ))
  • Partnership for Sustainable Communities. United States Environmental Protection Agency . Oct. 2010. Web. Jan. 2013 (PDF)
  • Play Fair Farmers Field. Wordpress, February 4, 2013. Web

Individual evidence

  1. ↑ a b c d e f g h K. Leppo, Ollila, E. Health in All Policies: Seizing Opportunities, implementing policies. Ministry of Social Affairs and Health, Finland: Helsinki 2013.
  2. ↑ a b c d e f I. Kickbusch , K. Buckett (editors): Implementing Health in All Policies. Adelaide 2010. Adelaide, South Australia: Department of Health, Government of South Australia 2010.
  3. ^ "Public Health in America." Health.gov | Your Portal to Health Information from the US Government. Public Health Functions Steering Committee, July 1995.
  4. ↑ World Health Organization (WHO): Declaration by Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR, June 6-12. September 1978. WHO, Geneva 1978. PDF ( Memento of February 5, 2012 in the Internet Archive ) English
  5. ↑ a b c d e f Sebastián Peña: Health in All Policies: The emperor's old clothes | Healthy Policies. Healthy Policies | For A Healthier World . Web ( Memento of March 7, 2016 in the Internet Archive ).
  6. ^ A b Healthy People 2020. Department of Health and Human Services, June 7, 2012. Web , accessed February 11, 2015.
  7. ^ "The World Health Report 2008." WHO. World Health Organization, PDF , accessed February 11, 2015.
  8. ^ A b "Health in All Policies." The National Association of County and City Health Officials | NACCHO. Web. Jan. 2013.
  9. ^ A b WHO and the Government of South Australia. (2010) The Adelaide Statement on Health in All Policies: moving towards a shared governance for health and well-being. Health Promotion International .
  10. ↑ 8th World Conference on Health Promotion. Official website ( Memento of the original from June 18, 2013 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. . @1@ 2Template: Webachiv / IABot / www.healthpromotion2013.org
  11. ^ P. Puska, Vartiainen, E. et al.: The North Karelia Project: from North Karelia to National Action. National Institute for Health and Welfare, Finland 2009.
  12. ^ "Health 2015 public health program." Ministry of Social Affairs and Health- Finland . Web ( June 21, 2013 memento in the Internet Archive ). Retrieved February 5, 2013.
  13. ↑ a b Kevin Buckett: Health in All Policies Adelaide 2010 International Meeting. In: Public Health Bulletin SA. 7.2, 2010, pp. 1-60. PDF ( Memento of April 27, 2013 in the Internet Archive ) accessed on January 1, 2013.
  14. ^ Health in All Policies - CIHR. Canadian Institutes of Health Research.  ( Page no longer available , search in web archives ) Jan. 2013.@1@ 2Template: Toter Link / www.cihrirsc.gc.ca
  15. ↑ Haut Conseil de la Sante Publique, Evaluation du Plan Cancer, Rapport Final, 2009 in http://www.sante.gouv.fr/IMG/pdf/rapport_cancer_230209.pdf
  16. ^ Institut National du Cancer, Cancer Plan 2009-2013, 2009 in www.e-cancer.fr/component/.../4787-plan-cancer-version-anglaise
  17. ^ E. Kang, H. Park, J. Kim: Health Impact Assessment as a Strategy for Intersectoral Collaboration. In: Journal of Preventive & Public Health. 44 (5), 2011, pp. 201-209.
  18. ↑ W. Phoolcharoen, D. Sukkumnoed, P. Kessomboon: Development of health impact assessment in Thailand: recent experiences and challenges. In: Bulletin of the World Health Organization. 81 (6), 2003.
  19. ^ A b c National Prevention Council, National Prevention Strategy, Washington, DC: US ​​Department of Health and Human Services, Office of the Surgeon General, 2011.
  20. ↑ Executive Order S-04-10
  21. ^ A b Institute of Medicine: Living well with chronic illness: A call for public health action. The National Academies Press, Washington, DC 2012.
  22. ^ Health in All Policies Task Force Report to the Strategic Growth Council Executive Summary, Sacramento (CA): Health in All Policies Task Force. December 2010.
  23. ^ "Health in All Policies." National Network of Public Health Institutes . Web. Jan. 2013. Web .
  24. ^ A b J. Kemm: Health Impact Assessment: A Tool for Healthy Public Policy. In: Health Promotion International. 16 (1), 2001, pp. 79-85. doi: 10.1093 / heapro / 1/16/79
  25. ^ "Tobacco Litigation: History & Recent Developments." NOLO Law for All . Web accessed Jan. 2013.
  26. ^ A b "Adelaide Recommendations on Healthy Public Policy." World Health Organization . who.int .
  27. ↑ a b c d Barbara A. Rose, Joseph Schuchter, Sarah A. Wylie: Promoting Health Impact Assessment to Achieve Health in All Policies. In: American Public Health Association. Feb. 15, 2012. Web. Jan. 2013  ( page no longer available , search in web archives )@1@ 2Template: Dead Link / www.apha.org
  28. ↑ J. Collins, JP Koplan: Health Impact Assessment: A Step toward Health in All Policies. In: J Am Med Assoc. 302 (3), 2009, pp. 315-317.
  29. ^ "Health Impact Assessment (HIA)." APHA: American Public Health Association . PDF ( Memento from March 18, 2013 in the Internet Archive ).
  30. ^ Institute of Medicine. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press; 2011.
  31. ^ PA Braverman, SA Egerter, RE Mockenhaupt: Broadening the focus: the need to address the social determinants of health. In: Am J Prev Med. 40 (1S1), 2011, pp. S4-S18.