Health in All Policies: A Ripple Effect for Health

Apr 21, 2016 | About Stakeholder Health, Stakeholder Health Resources | 0 comments

health in all policies

By Marice Ashe, Dora Barilla, Eileen Barsi and Stephanie Cihon

This is adapted from the upcoming book Stakeholder Health: Insights From New Systems of Health, edited by Teresa Cutts and James Cochrane.

 

The newly emerging concept of “Health in All Policies” helps us understand how to address the social determinants of health so that our efforts are likely to be the most effective in creating positive ripple effects throughout entire systems. In brief, Health in All Policies is a systems approach to improving the health of a community by incorporating health, equity and sustainability considerations into decision-making across sectors and policy areas.

A growing understanding of the social determinants of health has led to a call for public policy that shapes our social, physical, and economic environments in ways that are more conducive to health. The Health in All Policies approach takes us far outside of traditional hospital systems, and even outside of public health agencies. The policies that determine whether a person has access to healthy food, clean water , clean air, safe places for play and physical activity, affordable, quality housing, jobs, and schools, are typically developed and implemented by agencies other than health departments, including planning, transportation, social services, education, economic development, fire, police, sanitation, and public works. Community Development Finance Institutions can play an important intermediary role, too. To achieve a vision for healthier communities, we need such an approach, one in which every part of government, as well as non-governmental sectors like business, faith, and community based organizations play an active role. That is the idea behind Health in All Policies.

To achieve Health in All Policies, hospitals and all the other leading sectors in civic life must adopt a new approach to decision-making. The new approach requires the various stakeholders, including community and its assets, to understand how their policies and actions affect health. They need to recognize that they are part of an interrelated system and that every part of the system has a direct impact on the community’s health outcomes. The stakeholders need to learn to share information and organizational goals and to collaborate to coordinate their efforts.

health in all policies

Effective Health in All Policies initiatives are developed by and for a particular community; there is no “one size fits all” approach. An initiative’s overarching focus must resonate with everyone involved, including public agencies, community leaders and residents. These efforts can be framed around health, wellness, equity, sustainability, or some other core value as defined by a community. While there is variation in local Health in All Policies initiatives, they usually share the same fundamental principles, with an inherent goal of building and nurturing trust among all stakeholders:

• Create an ongoing collaborative forum to help stakeholders and sectors to work together to improve public health;

• Advance specific projects, programs, laws, and policies that enhance public health while furthering stakeholders’ core missions; and

• Embed health-promoting practices in the organizational practices of all stakeholders.

Systems thinking shifts the “mind from seeing people as helpless reactors to seeing them as active participants in shaping their reality, from reacting to the present to creating the future”. We know through systems thinking that if we take short cuts – such as failing to identify or address fundamental causes of problems, or failing to engage with community and neighborhood leaders – our actions could jeopardize the ultimate success of the social changes being attempted.

Failure to Address Fundamental Causes: Oftentimes, short-term “solutions” are used to correct a problem with seemingly
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positive immediate results. But if action is taken without regard to how a short-term solution affects the entire system, only isolated results will be attained and more fundamental long-term corrective measures will be missed. Systems thinking urges stakeholders to focus on fundamental solutions rather than simply addressing short-term symptoms.

Failure to Release the Existing Energy and Assets of the Community: So often the most powerful stakeholders such as hospitals and government agencies – emboldened by the best of intentions and employing deep expertise from their areas of specialty – try to solve complex problems without engaging with and winning the trust of members of the community most affected by systemic problems. We all know that working with community groups can be unpredictable, volatile and contentious. Historic inequities are felt in real time, anger can surface and trust may be low. Sometimes we don’t know which community leaders to trust, and consensus on how best to move forward can seem elusive. Yet, if the very hard work of deep community engagement is glossed over or ignored, those most affected by health inequities battle to deal with problems themselves. Instead of fully engaging and utilizing their own existing community assets and intelligence, community members may remain passive “recipients” of well-intentioned programs or efforts led by so-called “professionals”, and the system will never achieve real change.

 

“Latvia Countryside”, Ricardo Liberato, Creative Commons

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