Strategies

Intersectoral action (ISA)

Nowadays health aspects are an inherent part of policy-making in many sectors. Intersectoral action has its main focus on increasing administrative co-operation within the public administration. Great advances in health have indeed been acquired through policies in sectors such as education, environment, water and sanitation, planning, labour, housing, traffic, and agriculture and nutrition.

A substantial number of health policies have been promoted in other sectors, as they make sense from the perspective of these sectors as well. For example, nutritious food at school and also sports activities also help with learning. Increasing cycling and walking is good for both environment and health.  

Specific health concerns have been tackled through intersectoral action. Heart health has been improved through changes in policies, legislation and regulation in other sectors that has resulted in improved quality food, decreased smoking and increased physical activity.

In addition to advances and opportunities, there are emerging challenges and risks. Sectors have their own priorities, and these are not always easily compatible with the aims of advancing health and health equity through understanding health determinants.

HiAP approach in policy making

There are three main pillars in the HiAP approach: A solid information and resource base with a critical mass of capacities, appropriate public health and health policy expertise, and knowledge of policy making structures and political legitimacy.

Minimum requirements

HiAP can be applied in many different policy making contexts and while it cannot be stated exactly what policy structures will work best, it is possible to elaborate what could be called the minimum requirements of a HiAP approach.

These include:

i) legitimacy in terms of legislative acts that enable a continuation of HiAP or its implementation beyond a voluntary context and the enthusiasm of individuals; 
ii) an organizational structure (e.g. board, network, committee etc.) that enables the creation of focal or contact points for intersectoral action in other sectors, and 
iii) a knowledge base and analytical capacity within the health sector on current conditions for applying the HiAP approach. This is simply so as to be able to claim the existence of an approach, to contact people in this context and to have capacity to explain what is meant by the approach.  

While HiAP would preferably be part of political decision-making processes in the future, in practice a main part of its current implementation is based on intersectoral action and administrative co-operation.

Mutual gain vs. conflict of interest

Intersectoral action as a means for HiAP is often meaningful where there are mutual goals and policy aims across sectors.  This can result in a so-called win-win policy prospect, which is based on co-operation and mutual gains. On the other hand, intersectoral action is less favourable where mutual interests are lacking or where there are conflicts of interests in policy aims and objectives. 

In some instances, however, the values and objectives of the various policy intentions can be incompatible, and negotiation to find feasible compromises is needed. This is where political accountability is of more importance in requiring thorough assessments, as is the case in the context of Health Impact Assessments. 

In particular the  challenge is how to address health policy implications and the social determinants of health while developing competitiveness and economic, commercial and industrial policies.

Public sector responsibilities

HiAP is an approach and means for public policy-making. The HiAP approach stresses  that responsibility for health lies not just with the health sector, but as part of broader public policies. Indeed to achieve health gains, responsibility for promoting and protecting health needs to be shared with  various actors, agencies or the government as a whole. 

In order to ensure sufficient human resources for HiAP, it is necessary to ensure that it is included as part of performance requirements, tasks, and targets that define priorities, as well as being taken into account during the allocation of working-time and resources. HiAP is not expensive, but requires investment, human resources and time.  These need to be apportioned, with processes for monitoring, evaluation and revision established so as to secure sufficient staff time, knowledge and capacities to take the issue further.