Health In All Policies (HiAP)

An Overarching Health Approach to Public Policy

The COVID-19 crisis has highlighted societies inequities and inequalities, particularly with income and health.  These are challenges that will require new legislation if everyone is going to have a chance at experiencing success in a post-COVID world.  One way to do that might be with an overarching health approach to public policy known as Health in All Policies (HiAP).

What is HiAP?

Although the official term was first used in 2006 by the European Union (EU), the idea behind HiAP was inspired by an international agreement on health in Ottawa, Canada, in November 1986.  It was called the Ottawa Charter for Health Promotion and it was designed to achieve the World Health Organization’s (WHO) goal of “Health For All” by 2000.  It was effective in promoting better health outcomes as international funding increased and many third-world countries began receiving life-saving medicine that we take for granted in the first-world.  However, the EU took the WHO’s primary health care strategy of promoting health, human dignity, and improving quality of life one step further by introducing the concept across all sectors that have the potential to influence health outcomes.

What Does the Application of HiAP Look Like?

A HiAP approach would ensure that any government policy that had the potential to affect population health would be required to carry out health impact assessments.  Historically, that has been a Ministry of Health’s responsibility for health-focused policies in the past, but the HiAP approach would require various non-health ministries to develop health-conscious policies.  This is important, because health is largely determined by factors outside of health care services and affected by various social determinants.

Although the EU was responsible for birthing HiAP, one of the more evident applications of this approach might be in US.  The Center for Disease Control (CDC) was provided with the necessary support to dedicate a department that specifically focused on HiAP.  Their site provides a treasure trove of resources that demonstrate how public health intersects with various geographic factors and across various sectors.

The State that appears to be taking these principles to the next level is California.  The California Department of Public Health worked to bring about a HiAP Task Force that brought together 22 departments, agencies, and offices from across State Government.  Other Non-Governmental Organizations have also championed these ideals and it can be seen in the success that advocacy groups have had with building a network of organizations that support health foods and activity environments, but also with the state introducing legislation in 2016 that allows children under 18 to receive taxpayer-backed health care regardless of their immigration status.  The benefactors of these policies are marginalized minors who are living in poverty or are burdened with an immigration status.

The Critics’ Take

A healthy society is a productive society, but that is not how critics of HiAP see it.  Their argument tends to center around the idea that HiAP prioritizes health above all else.  Additionally, anti-HiAP groups have tried creating counter movements with slogans of “economics in all policies” and “education in all policies”.

The critic’s argument can be difficult to make sense of.  There are real limitations with finite resources, but economics and education are advantages that have already been realized in top countries.  The idea of emphasizing economics or education in all policies might make sense for countries that are playing catch up with the world’s leading economies.  For countries that are already at the top, the lifeblood of top economies are their people, who need to be taken care of.

What is the Status of HiAP Approach in Canada?

Since the Canada Health Act was ratified in 1984 by the Federal government, Canadians have had guaranteed access to healthcare services under a universal Medicare for all plan.  While the Federal government is responsible for a portion of the funding required to make these services accessible to all, it is the provinces that are responsible for setting up the scope of the delivery services.  Almost four decades later, much of the original framework has remained unchanged despite changing health trends and that is where the challenge lays.

The Canadian Medical Association Journal published an article that gives an overview of HiAP and what that would look like for Canada.  Although the authors describe this approach as one that aligns with Canadian values, they cite cooperation from all three levels of government (municipal, provincial, and federal) as a potential challenge, particularly when elected governments might have diametrically opposed approaches to governing.  The most important takeaway is that a person’s health and well-being is affected by factors long before they enter a hospital, factors that have nothing to do with the health care system.