A glossary of terms for understanding political aspects in the implementation of Health in All Policies (HiAP)

Abstract

Health in All Policies (HiAP) is a strategy that seeks to integrate health considerations into the development, implementation and evaluation of policies across various non-health sectors of the government. Over the past 15 years, there has been an increase in the uptake of HiAP by local, regional and national governments. Despite the growing popularity of this approach, most existing literature on HiAP implementation remains descriptive rather than explanatory in its orientation. Moreover, prior research has focused on the more technical aspects of the implementation process. Thus, studies that aim to 'build capacity to promote, implement and evaluate HiAP' abound. Conversely, there is little emphasis on the political aspects of HiAP implementation. Neglecting the role of politics in shaping the use of HiAP is problematic, since health and the strategies by which it is promoted are partially political.This glossary addresses the politics gap in the existing literature by drawing on theoretical concepts from political, policy, and public health sciences to articulate a framework for studying how political mechanisms influence HiAP implementation. To this end, the glossary forms part of an on-going multiple explanatory case study of HiAP implementation, HARMONICS (HiAP Analysis using Realist Methods on International Case Studies, harmonics-hiap.ca), and is meant to expand on a previously published glossary addressing the topic of HiAP implementation more broadly. Collectively, these glossaries offer a conceptual toolkit for understanding how politics explains implementation outcomes of HiAP.

Ideas for Extending the Approach to Evaluating Health in All Policies in South Australia Comment on "Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia"

“…Future work to understand these strategies and mechanisms unearthed by the authors will benefit from transdisciplinary approaches that integrate other ideas from the policy and political sciences. 9 , 10 For example, political economy theories can capture major international trends (eg, globalization and financialization) shaping national and local political contexts and the ability of policy-makers to implement HiAP (eg, 11 ). This can facilitate an understanding of tensions between actors and sectors integral to HiAP implementation, including relatively well-resourced sectors, such as a health ministry, more poorly-resourced sectors, such as a housing ministry.…”

“…The authors highlight their distinction between program theory and implementation theory, and their interest in learning about mechanisms of HiAP activities inasmuch as they lead to longer-term outcomes. This is akin to an impact evaluation 13 ; yet, the process of implementing HiAP initiatives is itself challenging in terms of technical and political processes that must be managed, 9 , 10 so we have argued that a focus on HiAP implementation as an end in itself is needed to better understand how and why HiAP works in the context of unique HiAP approaches (ie, governance structures, strategies and tools) in diverse settings. 14 Therefore, more methods for process evaluation – perhaps that also integrate program theory – are needed.…”

Promoting Intersectoral Collaboration Through the Evaluations of Public Health Interventions: Insights From Key Informants in 6 European Countries

“…A wider interpretation of this point is that the design of a designated body for evaluating PHIs needs to take account of the realities of the policy-making process. [64][65][66] Among the key design features that interviewees emphasized were a clearly defined mandate, and membership with a multi-sectoral and multi-disciplinary background. With respect to intersectoral collaboration, these 2 features speak to insights generated from theories and empirical research from political science and public administration that indicate the value of securing a designated body authority and ability to convene inclusive processes that engage across sectors.…”

Evaluating Health in All Policies Comment on "Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia"

“…16 Politics, political will and resources have been highlighted as major determinants of HiAP in other reports and have received more attention in other evaluations, such as the HARMONICS framework. 4 , 17 …”