Integrating Public Health into Cross-Sector Policy Making: Advocating for a Health-in-All-Policies Approach
DOI:
https://doi.org/10.31580/qet07h83Keywords:
Cross-sector collaboration, Health equity, Health-in-all-policies (HiAP), Intersectoral governance, Policy-making strategies, Public health integration, Public health outcomesAbstract
Background: The Health-in-All-Policies (HiAP) approach is recognized as a critical framework for integrating public health objectives into the policy-making processes across various sectors. Despite global advocacy for HiAP, its implementation varies significantly across regions, with only 23% of countries reporting comprehensive adoption by 2020. This disparity underscores the need for a thorough examination of HiAP’s effectiveness in promoting health equity and improving population health outcomes.
Objective: This schematic review aims to evaluate the impact of the HiAP approach on public health outcomes and health equity. It also identifies the barriers to its implementation and offers evidence-based strategies to enhance cross-sector collaboration in policy-making.
Methods: A systematic review of 40 selected peer-reviewed studies and government reports published between 2010 and 2023 was conducted. Data were extracted on the effectiveness of HiAP interventions, particularly in sectors like urban planning, transportation, education, and environmental policy. Metrics included changes in population health indicators, such as the prevalence of non-communicable diseases (NCDs), and reductions in health disparities measured by Gini coefficients.
Results: The analysis revealed that regions with robust HiAP frameworks reported a 15-20% reduction in health disparities over a decade, particularly in urban settings. For example, the implementation of HiAP initiatives led to a 12% decrease in cardiovascular disease mortality between 2011 and 2021 in some regions. Additionally, intersectoral policies addressing environmental health issues contributed to a 25% decline in respiratory-related hospital admissions. However, the review also identified significant challenges, including fragmented governance structures and limited political will, which hindered the full potential of HiAP, particularly in low- and middle-income areas.
Conclusion: The HiAP approach has proven effective in improving public health outcomes and advancing health equity when fully implemented. The evidence suggests that scaling up HiAP, supported by strong political commitment and cohesive governance, can lead to significant public health gains. To overcome existing barriers, a focus on capacity building, stakeholder engagement, and continuous monitoring is essential.
References
Buse K, Mays N, Colombini M, Fraser A, Khan M, Walls H. McGraw Hill; 2023.
Shankardass K, Muntaner C, Kokkinen L, Shahidi FV, Freiler A, Oneka G, M Bayoumi A, O’Campo P. The implementation of Health in All Policies initiatives: a systems framework for government action. Health research policy and systems. 2018;16:1-0.
Sarkar C, Webster C. Urban environments and human health: Current trends and future directions. Current Opinion in Environmental Sustainability. 2017;25:33-44.
Godziewski C. Shifting Focus: Why Did ‘Health in All Policies’ Still Reach the EU?. InThe Politics of Health Promotion: In the European Union 2022 May 21 (pp. 175-207). Cham: Springer International Publishing.
Oneka G. Health in all policies (HiAP): A realist multiple explanatory case study examining the implementation of HiAP. University of Toronto (Canada); 2020.
Freeman T, Fisher M, Baum F, Friel S. Healthy infrastructure: Australian National Broadband Network policy implementation and its importance to health equity. Information, Communication & Society. 2019;22(10):1414-31.
Cairney P, Denny ES, Boswell J. Why is health improvement policy so difficult to secure?. Open Research Europe. 2022;2.
Minkler M, Salvatore AL. Participatory approaches for study design and analysis in dissemination and implementation research. Dissemination and implementation research in health: Translating science to practice. 2012 ;192:212.
Asante A, Price J, Hayen A, Jan S. Equity in health care financing in low-and middle-income countries: a systematic review of evidence from studies using benefit and financing incidence analyses. PloS one. 2016 ;11(4):e0152866.
Di Cesare M, Khang YH, Asaria P, Blakely T, Cowan MJ, Farzadfar F, Guerrero R, Ikeda N, Kyobutungi C, Msyamboza KP, Oum S. Inequalities in non-communicable diseases and effective responses. The Lancet. 2013 ;381(9866):585-97.
Hunter CM, Salandy SW, Smith JC, Edens C, Hubbard B. Racial disparities in incidence of Legionnaires’ disease and social determinants of health: a narrative review. Public Health Reports. 2022;137(4):660-71.
Nieuwenhuijsen MJ. Influence of urban and transport planning and the city environment on cardiovascular disease. Nature reviews cardiology. 2018;15(7):432-8.
Muntaner C, Lynch J, Smith GD. Social capital, disorganized communities, and the third way: Understanding the retreat from structural inequalities in epidemiology and public health. International Journal of Health Services. 2001; 31(2):213-237.
Muntaner C, Lynch J, Smith GD. Social capital, disorganized communities, and the third way: understanding the retreat from structural inequalities in epidemiology and public health. Political And Economic Determinants of Population Health and Well-Being: 2020;25:427-50.
Mosconi P, Antes G, Barbareschi G, Burls A, Demotes-Mainard J, Chalmers I, Colombo C, Garattini S, Gluud C, Gyte G, Mcllwain C. A European multi-language initiative to make the general population aware of independent clinical research: the European Communication on Research Awareness Need project. Trials. 2016;17:1-10.
Baggott R. Partnerships for public health and well-being: policy and practice. Bloomsbury Publishing; 2013 Sep 10.
Abdelhalim R, Grudniewicz A, Gutberg J, Khan S, Evans J, Wodchis W. Operationalizing Patient-Centered Integrated Care: The Gap between Discourse and Action. International Journal of Integrated Care. 2017;17:17-21.
Nieuwenhuijsen MJ. Urban and transport planning, environmental exposures and health-new concepts, methods and tools to improve health in cities. Environmental health. 2016;15:161-71.
Sigmund E, Sigmundová D, Hamrik Z, Madarásová Gecková A. Does participation in physical education reduce sedentary behaviour in school and throughout the day among normal-weight and overweight-to-obese Czech children aged 9–11 years?. International Journal of Environmental Research and Public Health. 2014;11(1):1076-93.
Levy K, Smith SM, Carlton EJ.Climate change impacts on waterborne diseases: moving toward designing interventions. Current environmental health reports. 2018:272-82.
Baum F, Delany-Crowe T, MacDougall C, Van Eyk H, Lawless A, Williams C, Marmot M. To what extent can the activities of the South Australian Health in All Policies initiative be linked to population health outcomes using a program theory-based evaluation?. BMC Public Health. 2019;19:1-6.
Lawless A, Baum F. Developing a framework for a program theory-based approach to evaluating policy processes and outcomes: Health in All Policies in South Australia. International Journal of Health Policy and Management. 2018;7(6):510.
Delany T, Harris P, Williams C, Harris E, Baum F, Lawless A, Wildgoose D, Haigh F, MacDougall C, Broderick D, Kickbusch I. Health impact assessment in new South Wales & Health in all policies in South Australia: differences, similarities and connections. BMC public health. 2014;14:1-9.
Molnar A, Renahy E, O’Campo P, Muntaner C, Freiler A, Shankardass K. Using win-win strategies to implement health in all policies: a cross-case analysis. PloS one. 2016;11(2):e0147003.
Ståhl T. Health in All Policies: From rhetoric to implementation and evaluation–the Finnish experience. Scandinavian journal of public health. 2018;46:38-46.
Guglielmin M, Muntaner C, O’Campo P, Shankardass K. A scoping review of the implementation of health in all policies at the local level. Health policy. 2018;122(3):284-92.
Cain R, Greece JA, Galea S, Knight EK, Manco A, Parikh A, Jones DK. Improving health across sectors: Best practices for the implementation of health in all policies approaches. Preventive Medicine Reports. 2022;29:101961.
Cain R, Greece JA. Improving health across sectors: Best practices for the implementation of health in all policies approaches. Preventive Medicine Reports. 2022;29:101961.
Freiler A, Muntaner C, Shankardass K, Mah CL, Molnar A, Renahy E, O'Campo P. Glossary for the implementation of Health in All Policies (HiAP). J Epidemiol Community Health. 2013;67(12):1068-72.
World Health Organization. Health in All Policies as part of the primary health care agenda on multisectoral action. World Health Organization; 2018.
Synnevåg, Ellen, Fosse E. “Intersectoral Planning for Public Health: Dilemmas and Challenges.” International journal of health policy and management. 2018;7(11): 982-992.
Smith M, Hosking J, Woodward A, Witten K, MacMillan A, Field A, Baas P, Mackie H. Systematic literature review of built environment effects on physical activity and active transport–an update and new findings on health equity. International journal of behavioral nutrition and physical activity. 2017;14:1-27.
Williams T, Bonsma-Fisher M, Nelson T, Whitehurst DG, Winters M. Cycling towards complete communities: Estimating access to destinations via low traffic stress cycling. Transportation Research Interdisciplinary Perspectives. 2024;26:101179.
Ivanov B. Narratives of Crisis: How Framing Urban Shrinkage and Depopulation Shapes Policy and Planning Responses in Spain, Germany and The Netherlands. Sustainability 2021:13;11045.
Patel C, Rendell N, Sargent GM, Ali A, Morgan C, Fields R, Sheel M. Measuring national immunization system performance: a systematic assessment of available resources. Global Health: Science and Practice. 2023;11(3).
Voyer M, Farmery AK. Assessing policy coherence and coordination in the sustainable development of a Blue Economy. A case study from Timor Leste. Ocean & coastal management. 2020;192:105187.
Campbell AT. What Hope for Health in All Policies' Addition and Multiplication of Equity in an Age of Subtraction and Division at the Federal Level: The Memphis Experience. Louis UJ Health L. & Pol'y. 2018;12:59.
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