Moving Beyond Health in All Policies: Exploring How Policy Could Front and Centre the Reduction of Social Inequities in Health

Abstract

In recent years there has been a proliferation of concepts to describe intersectoral health policies. Much of this work orients around the promise of Health in All Policies (HiAP), an intersectoral approach that promotes addressing the social determinants of health (SDH) and social inequities in health. However, in practice, questions of health equity are often marginal or unattainable. Based on a conceptual critique of HiAP, we explore some of the problems involved when trying to effectively design and implement policies with the explicit goal of reducing social inequities in health. We find that the intersectoral approaches to policymaking and implementation of health equity policies should be seen as distinct from Health in All Policies. Using the example of intersectoral health policies seeking to reduce smoking, we argue that they have been relatively ineffective at reducing social inequities in smoking. We suggest that the capability approach (CA) could provide the basis of a policy framework for guiding more effective intersectoral policy action to reduce social inequities in health.

“It reflects the society in which we live, except now everything is accentuated”: youth, social inequities, and the COVID-19 pandemic

“…Our study also turns the spotlight on the important intersections that should be reinforced between education and health in Quebec’s provincial policymaking and academia. While Health in All Policies (HiAPs) have been proposed as an intersectoral approach to addressing the social determinants of health and social inequities in health (de Leeuw, 2015 ; Hancock, 1985 ; Kickbusch & Buckett, 2010 ), questions of health equity are often considered marginal or unattainable (Holt & Frohlich, 2022 ). HiAP is sometimes referred to as an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity (WHO, 1986 ).…”

Active Citizenship as an Integrating Axis between Health in All Policies and the Well-being Economy

“…Health leaders must not miss this opportunity to build a common language of goals and solutions to compare trade-offs within and across sectors to address current and upcoming challenges, as well as to encourage institutions to synthesise, build and share knowledge about which health policies work and which do not, rather than trying to duplicate actions [21]. We start from a conception of Health in all Policies as a management model characterised by a sequence of integrated and sustainable public policies, the product of multisectoral and transdisciplinary processes of social mediation to ensure that all members of society have fair and equitable opportunities to participate in decisions that allow changes in the determinants of health inequities and, therefore, in the conditions and quality of life of the population, Mandl Stangl J [22]; In this sense, a promising option is strong citizen participation, political will for intersectoral action in favour of health and equity, strong leadership and policy development that includes communities, political and institutional actors, truly capable of undertaking the actions and activities they wish to carry out in order to promote social and health benefits in a fairer society [23,24].…”