Health in All Policies (HiAP) is an increasingly common approach to address the social determinants of health, recognizing that the determinants of health are affected by sectors well beyond health care and so, the implications for health must be embedded in policy development and implementation across different government ministries. Finland has been one of its leading proponents. A recent article published in the Scandinavian Journal of Public Health outlines Finland’s national level development towards a HiAP approach over the past forty years.
As outlined in an earlier blog, to get any real traction, a successful HiAP approach must be grounded in the fiscal and political pressures, accountability regimes, incentives for decision makers, and accountability systems that actually drive the ways governments work. Finland’s HiAP approach has been increasingly successful over the past four decades because it has been effectively aligned with the workings of government.
The article illustrates how the key success conditions work in practice when using the HiAP approach:
- legislative, regulatory or policy directives are essential in making participation mandatory across government departments – the reformation of the Finnish Constitution in 1999 and the Public Health Act in 2006 and 2010 imposed specific obligations on local authorities in large-scale health promotion, and a law on public health reports required all administrative sectors to provide the Ministry of Social Affairs and Health (MSAH) with information of their work in the area of health
- requirements from departments and agencies must be matched with explicit deliverables and targets – as seen in the 1985 health policy report, the first document to acquire high-level approval on 24 separate targets with respect to health and sectors outside health care, and the Health 2015 Programme, that set eight broad quantitative targets and indicators to measure them, as well as 36 plans for action
- targets must include transparent reporting on progress – such as the evaluation of the 1985 health policy report and Health 2015 Programme by a group of experts set up by the WHO’s Regional Office in Europe
- support and leadership from central agencies are important – the adoption of a cross-sectoral health promotion policy program during the 2007-2011 government term was under the coordination of the Prime Minister’s Office
- active participation and knowledge sharing enhances the ability to solve health issues – Finland and the World Health Organization (WHO) worked together to develop cross-sectoral health policies, and, the MSAH, the National Institute for Health and Welfare, and the Institute of Occupational Health have developed greater expertise in different areas of health by connecting with international networks
- Health Impact Assessment (HIA) or Health Equity Impact Assessment (HEIA) is a key tool – although studies show that HIA plays a small role in Finland’s legislative proposals, HIA is an essential part of some ministry’s work even if there is no legal basis for it, such as in the Ministry of Transport and Communication
The social determinants of health are complex and require changes and action in many departments outside of health. The work in Finland has shown that HiAP is an appropriate approach to take, and ultimately, that HiAP can actually work in practice.
Along the lines of exploring strategies in Europe to better health outcomes, look for our paper Learning from Others: Comprehensive Health Equity Strategies in Europe.