Health In All Policies Approach Research Articles

Nurse Advocacy: Adopting a Health in All Policies Approach

Policy advocacy and committed resources are essential to address social factors that shape population health. In this article, we discuss nurse advocacy to advance public health and health equity through targeted social determinants, particularly on behalf of poor and disadvantaged persons. We discuss components of the right social policies and consider evidence-based policies that have linked improvements in social and economic conditions with increased physical, emotional, and mental health outcomes among poor and disadvantaged social groups. With a partnership perspective, select social determinants of health (SDOH) and mitigating policies focus nurses' social policy advocacy to improve the health of disadvantaged populations and reduce health inequities. We suggest nurses engage in multisectoral partnerships and adopt a Health in All Policies (HiAP) approach to address social and health needs of concern. The conclusion offers resources and strategies to promote nurse engagement in health policy.

Intersectoral Planning for Public Health: Dilemmas and Challenges.

Background: Intersectoral action is often presented as essential in the promotion of population health and health equity. In Norway, national public health policies are based on the Health in All Policies (HiAP) approach that promotes whole-of-government responsibility. As part of the promotion of this intersectoral responsibility, planning is presented as a tool that every Norwegian municipality should use to integrate public health policies into their planning and management systems. Although research on implementing the HiAP approach is increasing, few studies apply a planning perspective. To address this gap in the literature, our study investigates how three Norwegian municipalities experience the use of planning as a tool when implementing the HiAP approach. Methods: To investigate planning practices in three Norwegian municipalities, we used a qualitative multiple case study design based on face-to-face interviews. When analysing and discussing the results, we used the dichotomy of instrumental and communicative planning approaches, in addition to a collaborative planning approach, as the theoretical framework. Results: The municipalities encounter several dilemmas when using planning as a tool for implementing the HiAP approach. Balancing the use of qualitative and quantitative knowledge and balancing the use of structural and processual procedures are two such dilemmas. Other dilemmas include balancing the use of power and balancing action and understanding in different municipal contexts. They are also faced with the dilemma of whether to place public health issues at the forefront or to present these issues in more general terms. Conclusion: We argue that the dilemmas experienced by the municipalities might be explained by the difficult task of combining instrumental and communicative planning approaches because the balance between them is seldom fixed.

Researching Healthy Public Policy: Navigating the 'Black Box' Means Thinking More About Power Comment on "Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia".

Lawless et al provide a valuable narrative of using program logic to develop an evaluation of Health in All Policies (HiAP) in South Australia. In this commentary I argue that the paper and analysis is an extremely useful example of navigating the supposed black box of policy-making. However the original makes the reader work too hard and is distracting from the main narrative of explaining the logic behind the HiAP approach in South Australia. My response covers avoiding epistemological traps and weighing up the pragmatics of collaborative policy research with more complex institutional policy issues like power

Health in All Policies (HiAP) governance: lessons from network governance

The Health in All Policies (HiAP) approach requires formal and sustained governance structures and mechanisms to ensure that the policies of various non-health sectors maximize positive and minimize negative impacts on population health. In this paper, we demonstrate the usefulness of a network perspective in understanding and contributing to the effectiveness of HiAP. We undertook an exploratory, qualitative case study of a HiAP structure in Iran, the Kerman province Council of Health and Food Security (CHFS) with diverse members from health and non-health sectors. We analyzed relevant policy texts and interviewed 32 policy actors involved in the CHFS. Data were analyzed using within-case analysis and constant comparative methodology. Our findings suggest that CHFS governance from a network perspective drew in practice on elements of two competing network governance modes: the network administrative organization (NAO) and the lead organization mode. Our results also show that a shift from a hierarchical and market-based mode of interaction to a network logic within CHFS has not yet taken place. In addition, CHFS suffers from large membership and an inability to address complex 'wicked problems', as well as low trust, legitimacy and goal consensus among its members. Drawing on other HiAP studies and commentaries, insights from organization network theory, and in-depth findings from our case study, we conclude that a NAO may be the most effective mode of governance for tackling complex social problems in HiAP structures. Since similar studies are limited, and our single case study may not be transferable across all contexts, we suggest that further research be undertaken to explore HiAP structures from a network perspective in different institutional and cultural settings. With increasing emphasis given to HiAP approaches in national and international health policy discourse, it is important that comparative knowledge about the effectiveness of HiAP governance arrangements be developed.

Health in All Policies: Working Across Sectors in Cooperative Extension to Promote Health for All

A Health in All Policies approach engages cross-sector stakeholders to collaboratively improve systems that drive population health. We, the members of the Extension Committee on Organization and Policy (ECOP)’s Health in All Policies Action Team, propose that adopting a Health in All Policies approach within the national Cooperative Extension System will better prepare us to contribute meaningfully to improving the nation’s health. We first explain the Health in All Policies approach and argue for why and how it is relevant for Extension. We then present insights gathered from Extension Family and Consumer Sciences program leaders and state specialists to assess whether national and state leadership are poised to adopt a Health in All Policies approach within their affiliated programs. Although participant leaders saw the value of the approach in contributing to population health improvement, they generally saw the Extension system as having lower levels of readiness to adopt such an approach. Six themes emerged as ways to increase Extension’s engagement in Health in All Policies: a paradigm shift within Extension, professional development of competencies, transformational leaders and leadership support, continued and new partnerships, information access for all levels and disciplines of Extension.

\u201cOne program that could improve health in this neighbourhood is ____?\u201d using concept mapping to engage communities as part of a health and human services needs assessment

BackgroundThis paper presents the findings of a rapid needs assessment conducted at the request of the local health authority responsible for health care services, the Toronto Central Local Health Integration Network (Ontario, Canada), to inform health and social service planning.MethodsWe utilized concept mapping methodology to facilitate engagement with diverse stakeholders–more than 300 community members and service providers–with a focus on hard to reach populations. Key informant interviews with service providers were used to augment findings.ResultsParticipants identified 48 unique services or service approaches they believed would improve the health of residents in the area, including those addressing health care, mental health and addictions, youth, families, people experiencing homelessness, seniors, general social services, and services targeting specific populations. While service providers consistently identified a critical need for mental health and addiction services, community members placed greater importance on the social determinants of health including access to housing, job placement supports and training and service accessibility. Both groups agreed that services and programs for seniors and people experiencing homelessness would be highly important.ConclusionOur study provides a unique example of using concept mapping as a tool to aid a rapid service gap analysis and community engagement in a metropolitan area. The findings also reinforce the importance of working cross-sectorally, using a Health in All Policies approach when planning services for underserved populations.

Addressing the social determinants of health at the local level: Opportunities and challenges.

The gradient in health inequalities reflects a relationship between health and social circumstance, demonstrating that health worsens as you move down the socio-economic scale. For more than a decade, the Norwegian National government has developed policies to reduce social inequalities in health by levelling the social gradient. The adoption of the Public Health Act in 2012 was a further movement towards a comprehensive policy. The main aim of the act is to reduce social health inequalities by adopting a Health in All Policies approach. The municipalities are regarded key in the implementation of the act. The SODEMIFA project aimed to study the development of the new public health policy, with a particular emphasis on its implementation in municipalities. In the SODEMIFA project, a mixed-methods approach was applied, and the data consisted of surveys as well as qualitative interviews. The informants were policymakers at the national and local level. Our findings indicate that the municipalities had a rather vague understanding of the concept of health inequalities, and even more so, the concept of the social gradient in health. The most common understanding was that policy to reduce social inequalities concerned disadvantaged groups. Accordingly, policies and measures would be directed at these groups, rather than addressing the social gradient. A movement towards an increased understanding and adoption of the new, comprehensive public health policy was observed. However, to continue this process, both local and national levels must stay committed to the principles of the act.

AB010. Developing an intervention for optimizing end of life care in any setting

The gold standards of care created within the hospice setting are not always effectively influencing national, regional or local policy. This struggle is something which the public health sector has successfully contended with. In particular an approach known as Health in All Policies (HiAP) has been developed to lay down the rules of engagement and guide the exchange between organisations from all sectors. This synergy allows for an exploration of the possibilities of utilising HiAP within end of life care. In particular this study will look at how the HiAP can be adapted to better integrate end of life care throughout the population. Objectives are: (I) to investigate HiAP as an intervention; (II) to develop a framework for implementing a HiAP approach to end of life care; (III) to evaluate the possible impacts of changing the manner in which end of life care integrates within England. This presentation aims to unpick how HiAP guide exchanges between organisations from all sectors. Using this it then explores how we could use this to optimise end of life care.

Health Promotion Challenges in Healthy Lifestyles: Can We Transfer Lessons Learned Across Contexts?

This article argues that multi-level and contextual approach, including evidence-informed approach with needs assessment, is needed for sustainable lifestyle change. Examples are given of older and newer whole of community approaches with health in all policies approach as well as on targeting those at increased risk of diabetes type 2. At their best, these approaches empower local people and creates ustainable community structures and policies for healthy life. The commentary further argues that this kind of needs-based and tailored interventions can be transferred across contexts and cultures. To enable this, we need to pay attention to the intervention context as well intervention process characteristics instead of focusing on the contents of the intervention.

School Siting and Walkability: Experience and Policy Implications in California

Author(s): Vincent, Jeffrey M.; Miller, Ruth; Dillon, Lianne | Abstract: Active School Commuting (ASC) and K-12 school siting policies and practices have garnered increased attention in recent years from the planning and public health fields. Of central concern is that, too often, new school siting choices contribute to sprawl and inhibit active transportation to school because they are located far from where students live and/or lack surrounding pedestrian-oriented street characteristics. California has made state policy strides in actively promoting healthy communities, which has included an interest in ensuring communities and school sites are more walkable. To inform this policy area, this study measures the walkability around a sample of schools sited and constructed in six high-growth counties in California from 2003-2011. As California looks to implement a Health in All Policies approach into state decision making (Executive Order S-04-10), and weave health, equity, and environmental sustainability into more policies, a better understanding of the relationship between school siting and walkability is needed, particularly considering that the state provides funds to school districts for new school construction projects. Amidst these state health-promoting efforts, there is not clarity on how walkable newly sited schools are. Our research with this study addresses this gap. Our findings show that the proportion of new schools sited in our study period in California that could be considered objectively walkable by American urban standards is small. Thus, it does seem that state policy actions that would increase the number of walkability around schools may be needed to realize broader healthy community objectives. Local inter-agency and inter-jurisdictional collaboration can likely realize co-benefits that lead to healthy, sustainable communities with improved educational opportunities. Clarity in state policies, guidance, and funding priorities would likely improve collaborative local planning for better outcomes in health, education, and sustainability, which, in turn, maximize investments across sectors. We add to these findings a discussion of recent policy efforts to improve school siting outcomes in California such that they are promoting health and walkability.

Health in all policies and urban green spaces: the baseline study of the GREENH-City project

Health in all policies (HiAP) is a key strategy for tackling social inequalities in health (SIH) and contributes to act on health determinants, among which environmental determinants play a major role. In France, cities have levers to act on environmental determinants such as green spaces. This communication aims to present the baseline study of the GREENH-City interventional participatory project (INCa n°2017-003). The general goal of the project is to identify the most promising interventions to operationalize HiAP at the city level and act on the social inequalities in health through green space policy in urban area. The baseline study will contribute to analyze the HiAP approach among the cities of the French Healthy Cities Network. The objective of this presentation is to provide profiles of the cities regarding the degree of maturity of the HiAP approaches. Methods Drawing on the HiAP analytical framework, a qualitative analysis will be conducted among 80 cities of the French Healthy Cities Network by using an online survey addressed to elected official and technicians from public health departments in the cities. Items will rely on the degree of maturity of HiAP approaches regarding the modes of collaborations between sectors, the consideration of health, social inequalities in health and green spaces accessibility equity. Results The survey will identify profiles of cities regarding their style of HiAP. These results, crossed with SIH indicators and green space indicators will define 6 cases. Conclusions The six cases should enable us to profile the cities in terms of their HiAP approaches and how they address social inequalities in health as part of their policies and interventions on green spaces.

The GREENH-City interventional research protocol on health in all policies

BackgroundThis paper presents the research protocol of the GoveRnance for Equity, EnviroNment and Health in the City (GREENH-City) project funded by the National Institute for Cancer (Subvention N°2017–003-INCA). In France, health inequities have tended to increase since the late 1980s. Numerous studies show the influence of social, economic, geographic and political determinants on health inequities across the life course. Exposure to environmental factors is uneven across the population and may impact on health and health inequities. In cities, green spaces contribute to creating healthy settings which may help tackle health inequities. Health in All Policies (HiAP) represents one of the key strategies for addressing social and environmental determinants of health inequities. The objective of this research is to identify the most promising interventions to operationalize the HiAP approaches at the city level to tackle health inequities through urban green spaces. It is a participatory interventional research to analyze public policy in real life setting (WHO Healthy Cities).Method/designIt is a mixed method systemic study with a quantitative approach for the 80 cities and a comparative qualitative multiple case-studies of 6 cities. The research combines 3 different lens: 1/a political analysis of how municipalities apply HiAP to reduce social inequities of health through green space policies and interventions 2/a geographical and topological characterization of green spaces and 3/ on-site observations of the use of green spaces by the inhabitants.ResultsCity profiles will be identified regarding their HiAP approaches and the extent to which these cities address social inequities in health as part of their green space policy action. The analysis of the transferability of the results will inform policy recommendations in the rest of the Health City Network and widely for the French municipalities.Discussion/conclusionThe study will help identify factors enabling the implementation of the HiAP approach at a municipal level, promoting the development of green spaces policies in urban areas in order to tackle the social inequities in health.

Ideas, actors and institutions: lessons from South Australian Health in All Policies on what encourages other sectors\u2019 involvement

BackgroundThis paper examines the extent to which actors from sectors other than health engaged with the South Australian Health in All Policies (HiAP) initiative, determines why they were prepared to do so and explains the mechanisms by which successful engagement happened. This examination applies theories of policy development and implementation.MethodsThe paper draws on a five year study of the implementation of HiAP comprising document analysis, a log of key events, detailed interviews with 64 policy actors and two surveys of public servants.ResultsThe findings are analysed within an institutional policy analysis framework and examine the extent to which ideas, institutional factors and actor agency influenced the willingness of actors from other sectors to work with Health sector staff under the HiAP initiative. In terms of ideas, there was wide acceptance of the role of social determinants in shaping health and the importance of action to promote health in all government agencies. The institutional environment was initially supportive, but support waned over the course of the study when the economy in South Australia became less buoyant and a health minister less supportive of health promotion took office. The existence of a HiAP Unit was very helpful for gaining support from other sectors. A new Public Health Act offered some promise of institutionalising the HiAP approach and ideas. The analysis concludes that a key factor was the operation of a supportive network of public servants who promoted HiAP, including some who were senior and influential.ConclusionsThe South Australian case study demonstrates that despite institutional constraints and shifting political support within the health sector, HiAP gained traction in other sectors. The key factors that encouraged the commitment of others sectors to HiAP were the existence of a supportive, knowledgeable policy network, political support, institutionalisation of the ideas and approach, and balancing of the economic and social goals of government.

Public health terminology: Hindrance to a Health in All Policies approach?

National public health policies in Norway are based on a Health in All Policies (HiAP) approach. At the local level, this means that public health, as a cross-sectional responsibility, should be implemented in all municipal sectors by integrating public health policies in municipal planning and management systems. The paper investigates these local processes, focusing on the use of public health terminology and how this terminology is translated from national to local contexts. We ask whether the terms 'public health' and 'public health work' are suitable when implementing an HiAP approach. A qualitative case study based on analyses of interviews and planning documents was performed in three Norwegian municipalities. The results present dilemmas associated with using public health terminology when implementing an HiAP approach. On the one hand, the terms are experienced as wide, complex, advanced and unnecessary. On the other hand, the terms are experienced as important for a systematic approach towards understanding public health ideology and cross-sectional responsibility. One municipality used alternative terminology. This paper promotes debate about the appropriateness of using the terms 'public health' and 'public health work' at the local level. It suggests that adaptation is suitable and necessary, unless it compromises knowledge, responsibility and a systematic approach. This study concludes that the use of terminology is a central factor when implementing the Norwegian Public Health Act at the local level.

No single intervention will solve the obesity epidemic – RACP physicians and paediatricians exploring points in the life cycle to prevent and manage obesity for children and families

Obesity is at epidemic levels in New Zealand and Australia. However, no single intervention will solve the obesity epidemic because there is no single causal factor. We do know that obese children are more likely to be obese adults, and adults with obesity are at greater risk of developing non-communicable diseases (NCDs). Obesity in people of all ages contributes to Type 2 diabetes, musculoskeletal difficulties, respiratory illnesses, and psychological conditions including depression and anxiety. The RACP educates and trains physicians and paediatricians to interact with people across their life journey, from preconception, antenatal, childhood, adolescence, adulthood and older age. We consider that 20,000 RACP physicians and paediatricians, working across more than 40 medical specialties in New Zealand and Australia, are in a unique position to influence these key points in the life course to prevent and reduce the impact of childhood obesity through its strategy to educate, advocate and innovate. Elements of an RACP approach to preventing and managing obesity The RACP is building on its existing knowledge and skill base, and working with others to support prevention and management activity to reduce the impact of obesity across the life course. Because obesity is a complex public health issue, exacerbated by obesogenic environments, and affected by environmental, social, economic, cultural, behavioural and biological factors interacting across the life course. We are focusing on pinch points in the life cycle as the main focus of our work. 1. Equity is paramount The prevalence and distribution of childhood obesity shows significant socioeconomic and ethnic disparities, for New Zealand children living in the most deprived areas, being four times more likely to be obese than children living in the least deprived. We are developing to grow strength from within family/whānau by supporting physicians and paediatricians to provide culturally safe and relevant care. 2. Educate: the life course Life course approaches are used to implement interventions that support parents and families/whanau to help their children. There are many opportunities for preventative actions at significant points in growth and development – particularly in infancy and childhood. Our physicians and paediatricians are supported with resources to provide care that supports health and wellness, and in particular healthy growth, development, physical activity and nutrition in the first five years. 3. Advocate: obesogenic environments Information is an integral part of the RACP’s advocacy and approach to raising awareness of improvement opportunities. Our advocacy actions to prevent obesogenic environments are based on a Health in All Policies approach to improving people’s health and wellbeing. We develop shared resources for clinicians to increase their understanding of healthy eating and activity. 4. Innovation: integrated care Physicians and paediatricians are actively engaged in integrated care initiatives crossing communities, District Health Boards, public health, primary care, community and families/whānau. Innovation in learning and improvement is integral to our approach. We are collaborating in existing programmes to support and involve parents/caregivers and families/whānau.

A Practice-Grounded Approach for Evaluating Health in All Policies Initiatives in the United States.

To address the social determinants of health, an increasing number of public health practitioners are implementing Health in All Policies initiatives aimed at increasing cross-sectoral collaboration and integrating health considerations into decisions made by "nonhealth" sectors. Despite the growth in practice nationally and internationally, evaluation of Health in All Policies is a relatively new field. To help inform evaluation of Health in All Policies initiatives in the United States, this study sought to develop a practice-grounded approach, including a logic model and a set of potential indicators, which could be used to describe and assess Health in All Policies activities, outputs, and outcomes. Methods included (a) a review of the literature on current Health in All Policies approaches, practices, and evaluations; and (b) consultation with experts with substantive knowledge in implementing or evaluating Health in All Policies initiatives. Feedback from experts was obtained through individual (n = 11) and group (n = 14) consultation. The logic model depicts a range of potential inputs, activities, outputs, and outcomes of Health in All Policies initiatives; example indicators for each component of the logic model are provided. Case studies from California, Washington, and Nashville highlight emerging examples of Health in All Policies evaluation and the ways in which local context and goals inform evaluation efforts. The tools presented in this article synthesize concepts present in the emerging literature on Health in All Policies implementation and evaluation. Practitioners and researchers can use the tools to facilitate dialogue among stakeholders, clarify assumptions, identify how they will assess progress, and implement data-driven ways to improve their Health in All Policies work.

Policy integration: mapping the different concepts

ABSTRACTA growing number of studies have examined the collaboration of actors from two or more policy domains in order to integrate aims and concerns derived from one policy domain into another. In our literature review, we refer to this empirical phenomenon as ‘policy integration’, exemplified by the Health in All Policies approach. Despite the wealth of literature on the subject, the scientific community only has access to a portion of the insights that have come out of this field of research, due primarily to the fact that policy integration is discussed using a variety of different terms, which tend to be specific to the policy domain under investigation. To facilitate a more inclusive scientific debate on policy integration, we provide a comprehensive overview of the different terminologies associated with policy integration and analyse the recurring themes in the respective literature strands. What is the motivation for policy-makers to promote policy integration? What is the design of the instruments used for policy integration? How does policy integration affect the policy-making process? And how well does policy integration perform? These are the four questions guiding our study.

Health in All Policies utilization by municipal governments: scoping review.

The aim of this scoping review was to examine the utilization of a Health in All Policies (HiAP) approach in municipal government settings. Specific objectives included: to review peer reviewed and grey literature, to identify common themes from the literature, and to highlight gaps in the evidence base for HiAP. An iterative scoping review method was used. Documents were identified through searches of academic databases, reference lists and journal indices, and the World Wide Web. Included documents focused on HiAP in the local or municipal government context, published in English, between 2006 and 2015. Data were extracted and analyzed using descriptive statistics and a narrative thematic method. As of June 2015, 26 documents met the inclusion criteria. A lack of research studies examining HiAP in the municipal government context was identified. Three broad themes were abstracted from analysis of the documents: the conceptualization of HiAP, the adoption of HiAP, and the implementation of HiAP. The focus on a HiAP approach at the municipal level of government is growing. A majority of the existing documents provide narrative evidence and recommendations for implementing a HiAP approach at the municipal level. Research is needed in the areas of conceptualization, implementation, adoption and evaluation of a HiAP approach in municipal settings.

Collaborating for Health: Health in All Policies and the Law

This article introduces and defines the Health in All Policies (HiAP) concept and examines existing state legislation, with a focus on California. The article starts with an overview of HiAP and then analyzes the status of HiAP legislation, specifically addressing variations across states. Finally, the article describes California's HiAP approach and discusses how communities can apply a HiAP framework not only to improve health outcomes and advance health equity, but also to counteract existing laws and policies that contribute to health inequities.

Developing an Environmental Public Health Surveillance System for England

Introduction: The preventable environmental burden of disease estimated for the UK is 14%. To support primary prevention of non-communicable disease, robust information leading to actions that reduce environmental hazard exposures is required, that could support an environmental public health service and a Health in All Policies approach. In England, no comprehensive population-based surveillance exists that integrates environmental hazard and health information. Public Health England (PHE) decided to develop an Environmental Public Health Surveillance System (EPHSS), with a first phase to build capabilities for surveillance of acute incidents, and a second phase to extend to datasets relevant to chronic exposures. Methods: A governance system was established with representation across PHE groups. EPHSS development started from consultation of stakeholders in public health service, government, academia and NGOs. In 2014 user requirements were identified for phase one leading to development of software as a web-based system capturing information on environmental events and exposures of interest to public health and to be shared across contributing agencies. In 2015, 106 stakeholders were consulted for phase two, and user priorities and requirements related to chronic exposure were documented, with related software development expected for 2017-18. Results: EPHSS software for Phase one is expected to be completed in 2016, several topics were identified of interest to specific users, who are expected to pilot applications of acute incident information surveillance on topics including poisonings, housing-related chemical hazards, and exposures from waste sites. Phase two stakeholder consultation highlighted several priority topic areas. Conclusions: EPHSS has developed a tool expected to lead to improved intelligence across a range of sectors and thus support public health practitioners aiming to prevent acute and chronic exposures and related health effects.