Introduction
Strategic policy making tool
Many of the decisions and policies of different government sectors can impact positively or negatively on the health and well-being of citizens. For this reason, health needs to be considered as a basic resource in all policy making.
HiAP is a strategic tool for policy makers and administrators in all sectors to help identify and minimize negative and maximise positive health impacts. HiAP has the potential to contribute significantly to population health by positively affecting the determinants of health. HiAP focuses on impacts on citizens' health, but it can also be used to anticipate how policies can affect the financing and regulation of health systems.
Health determinants
Health determinants are factors that influence health, for better or worse. Determinants include the social, economic and physical environment, as well as individual characteristics and behaviours. Examples of determinants are education, housing, social exclusion, employment status, poverty, psychosocial stress, etc.
Health determinants have a significant and complex role in many major health issues, such as heart disease, mental disorders, diabetes, child health, nutrition, alcohol, unintended pregnancy, tobacco, violence, and unintended injury, to name a few. Health determinants are shaped by policies in other sectors, affecting the the potential of individuals to make positive lifestyle choices.
Shared responsibilities
The HiAP approach emphasizes that recognizing, protecting, and developing the health and well-being of citizens is a shared responsibility of all sectors of society and government. Indeed, health is a human right was well as being a key benefit to society economically.
Positive health impacts through specific policies have already been shown as a result of collaboration between health and other sectors, in such domains as education, housing, traffic, agriculture, environment, nutrition, employment, urban planning, and water and sanitation. However, a mechanism that makes collaboration much more systematic, comprehensive and sustained is needed before we can fully realise the benefits that a 'full-health' society can bring.
Accountability in governance
HiAP can take further the utilisation of such mechanisms at the level of political decision-making-giving accountability to governments-as well as through co-operation within an administration. While mechanisms and means to address HiAP need to be specific to the policies in question and the pathways through which these affect health, HiAP denotes a commitment and accountability for addressing health in all policies.
Coherent policy at all levels
In recent decades, policy-making has shifted increasingly to national and international arenas in policies areas such as industry, finance, trade, and agricultural, but implementation of health care is carried out more and more at local and regional level.
HiAP is seen to operate horizontally across sectors, but it can also operate vertically, to bridge local, regional and national actors engaged in policy making and implementation.
Enhancing public participation or engaging with intersectoral work is often easiest at local level. However, in order to serve its purpose the HiAP approach has to take place at the level where key policy decisions are made in other sectors. The strength of HiAP is that it can be used to support, inform and improve political decision-making and the accountability for health.
Evidence-based approach
HiAP's approach is solidly rooted in public health. As a result, it builds on a secure information base that supports monitoring, investigating and reporting on the effectiveness of existing or proposed policies in addition to exploring new forms of policy action in sectors beyond health.
Health equity
Many policy decisions have a particularly detrimental effect on the health of lower socioeconomic groups, with many health determinants and vulnerabilities being unevenly distributed among populations. A focus of HiAP has therefore particularly on how to achieve health equity.
