Healthy Public Policy

Abstract

Healthy public policy (HPP) became an important idea in the 1980s. The concept can be traced primarily to Nancy Milio, who produced a now hard-to-find book, Promoting Health through Public Policy (Philadelphia: Davis, 1981), and was subsequently cemented in the WHO’s Ottawa Charter for Health Promotion as a strategy to use in promoting, protecting, and maintaining the health of populations. HPP is not, however, a modern phenomenon. Historically HPP was embedded in the 16th-century Poor Laws and passed through to 19th- and early-20th-century public health activity and legislation. Across this history is the recognition that improving public health requires addressing the social and economic (and environmental) conditions created by public policy. It follows, as explained by many, that public health practice is inherently political. This bibliography introduces the large literature that falls under the broad pantheon of HPP. Definitions, as this bibliography will show, do matter. Central is the often underrealized truth that “healthy public policy” fundamentally concerns how public policy influences the health of populations. This, in turn, necessitates that HPP practice is interdisciplinary. For knowledge, this means much of the theory and evidence underpinning HPP is to be found in other disciplines that have public policy at their core, political science being the most obvious (public administration another). It is through HPP that societies in general and public health researchers and practitioners in particular seek to create social and economic and environmental conditions for whole populations. Attention thus moves “upstream” to policies and institutions rather than “downstream” to behaviors or health services. Not all healthy public policy is generated with the intention to influence population health directly. Nor are all public policies that impact on the health of populations generated by the health sector, although many are. A core goal of HPP is reducing inequities in health. These inequities are what the 2008 WHO Commission on the Social Determinants of Health named as a “toxic mix of poor social policies, unfair economic arrangements and bad politics.” Just as policy actors are responsible for policies that have created inequalities, so too are they responsible for developing and implementing policies in that overcome the unfair and unjust distribution of the resources necessary for good health and well-being. Public policies are formed through “contests for power” between the various actors involved in policy-making in part because they are value-laden. The choices actors make are influenced by powerful structures and ideas that are not always explicit. HPP, therefore, can never be “atheoretical” just as it cannot be divorced from a normative position (what is believed “should” happen) concerned with changing political conditions for the betterment of the health of the population in general and disadvantaged in particular. In recent years there has been some confusion (see Oxford Bibliographies article Health in All Policies) whether HiAP replaces HPP as a concept and method. This article errs on the side of history by suggesting HiAP, with intersectoral action, is one recent strategy to achieve HPP.