Health In All Policies

“Health in all policies” (HiAP) describes a framework intended to increase public officials’ accountability for health impacts at every level of public policymaking, including the consequences of budget and policy decisions on health systems, environmental sustainability, and social determinants of health — structural and community conditions that play a fundamental role in health outcomes. In order to effectively address these determinants, which include both structural factors, like the inequitable distribution of power and opportunity, and the environments of everyday life — where people are born, live, learn, work, play, worship, and age — HiAP approaches must incorporate an explicit emphasis on health equity. Health equity, as defined by the Robert Wood Johnson Foundation, means that everyone has a just and fair opportunity to be healthy.

A robust governmental commitment to HiAP, then, requires collaboration across sectors to address racial and social inequalities in housing, education, income, wealth, safety, and access to opportunities. Various departments, agencies, and community-based groups may not be accustomed to working with each other and may need to cultivate trust and understanding of the respective constraints under which they operate. Effective policies should include comprehensive guidance for public officials and staff throughout city government, as well as transparent tools for measuring results and accountability. Building on the recognition that the causes of poor health outcomes are multiple, complex, and interrelated, HiAP approaches can identify and remove obstacles to attaining and maintaining good health for historically underserved communities.

See the Prevention Institute and the Public Health Institute for more resources on health in all policies.

• Elected and appointed officials can support the adoption and integration of an approach to health in all policies throughout government.
   
• Public health departments and practitioners can provide important leadership in the process of incorporating health equity considerations into decision-making processes across a wide range of sectors, engaging governmental leaders to assessing the health impacts in all areas of public policy.
   
• Community-based organizations and advocates can identify priority areas impacting residents’ health and well-being, and work with policymakers to develop community engagement mechanisms, measurable goals, and implementation plans.

By incorporating considerations of health equity and sustainability into all aspects of the public policy and decision-making process, health in all policies can become standard operating procedure. Cities seeking to implement HiAP should consider a range of related legal and logistical questions.

• Building effective coalitions: The key to an effective HiAP approach is the collaboration of stakeholders across sectors and issue areas — government officials, community residents, advocates, and the business community all have a role to play in crafting a HiAP strategy and gaining its passage. There is no one perfect approach; all parties should strive to share leadership and responsibility for implementation, finding the structure and process that best meets local needs.
   
• Choosing the right policy approach: A council resolution, ordinance, or executive order mandating the incorporation of health, equity, and sustainability considerations into governmental policy and decision making can signal political will and grant leading agencies the authority to enforce policy priorities guided by a health equity lens.
   
• Community engagement: Meaningful involvement of community residents and leaders throughout a HiAP process is essential to the success of the effort, and community needs should be prioritized.
   
• Monitoring and compliance: HiAP initiatives and policies must be regularly monitored to ensure that agencies are in compliance; evaluation should be undertaken consistently to gauge the impact of the efforts and to make adjustments as needed.
   
• Determining areas of focus: HiAP initiatives can include collaboration between community residents, advocates, and government agencies on a broad range of efforts. Residents and advocates might choose to focus on particular results, such as adjusting local budgets to increase opportunities for physical activity in low-income neighborhoods, improving educational outcomes for target populations (e.g., migrant communities or communities of color), or reducing incarceration rates and improving employment options for low-income youth and people of color.

The goal of a health in all policies framework is to help community stakeholders and government decision makers work together to address all of the factors that affect health, including transportation, job creation, economic development, education, and land use.

• In Nashville, the Metropolitan Planning Organization rather than a health agency is leading an effort to take health impacts into account in the policymaking process. The group uses criteria based on health considerations in determining which transportation projects will be funded, significantly shifting the emphasis to projects that contain pedestrian and cycling features. The Metro Public Health department now uses health impact assessments to analyze the potential health consequences of proposed policies, plans, and projects. These assessments can also guide policymakers in revising current processes to account for the ways in which public policies impact the health and quality of life of residents.
   
• In Boston, the Public Health Commission formed a HiAP task force that includes city agencies and community organizations. The task force has participated in the development of “complete streets” guidelines and supported the incorporation of health impact assessments into redevelopment and land-use planning decisions.
   
• The average life expectancy for Kansas City residents is 77 years but it is only 69 years for residents living in zip codes with predominantly people of color and there is a 15.5 year gap between the zip codes with the highest and lowest life expectancy. In response to this inequity, in 2019, Kansas City launched the Community Health Improvement Plan, which has allowed the Parks Department to offer a free, annual recreation pass to anyone who lives in one of the six zip codes with the lowest life expectancies. This new policy also offers recipients access to fitness classes, as well as a leadership training program.