Governance

HiAP follows a long tradition in Europe of addressing the social determinants of health. HiAP is closely related to other terms with similar agendas such as “health public policies” and “intersectoral action for health”, developed under the auspices of the World Health Organisation (WHO) as part of the “Health for All” agenda. HiAP follows in the same spirit but with an extra emphasis on governance. 

While HiAP is about population health and health determinants, it also concerns addressing policies in the context of policy-making at all levels of governance, including international, national, regional and local levels of policies and governance. 

These two aspects of HiAP (population health and policy making) are of core relevance as they imply that the focus of this approach extends beyond individual factors and lifestyles to addressing how these are influenced by public policies.

HiAP emphasises the governance tools and frameworks that can help to establish dialogue with other ministries.

The broad definition of health and its underlying values highlighted through the WHO Health for All (HFA) policy are, in principle, widely accepted. Reviews of national health policies in Europe, progress in the WHO Healthy Cities project and in health impact assessment (HIA) indicate that the following values and principles are generally accepted.

• Equity in health – Differences in health status and health determinants, which are considered unfair and avoidable, should be reduced, with the aim of everyone reaching their full health potential.
• Solidarity in health – A sense of collective responsibility ensuring the protection of the vulnerable.
• Participation in decision-making – By those who may be affected.
• Sustainability – Policies should be sustainable over time and not endanger the health of future generations.

Whatever the motivation for action, it is essential to find potential allies and partners sharing common or converging values and objectives, or to find acceptable trade-offs when conflicting interests are unavoidable. In order to do this, the health sector must:

• be clear in its own health arguments
• ensure a holistic understanding of health
• clearly define its own values and their policy implications, and
• highlight the possible impact of ignoring these values.