Health in All Policies: From rhetoric to action

Aims: The fact that health is largely constructed outside the remits of the health sector has been known for a long time. However, implementing intersectoral health policies is difficult. The aim of this article is to study possibilities for strengthening the implementation of Health in All Policies (HiAP) approach. Methods: The article analyses earlier efforts in intersectoral health policy-making and adapts Kingdon's theory on policy change for exploring opportunities and challenges for strengthening HiAP approach. Results: Opportunities for HiAP can be identified by analysing possibilities for amending health determinants on the one hand, and by analysing policy trends, proposals, and actors, especially in fields other than health, on the other. Four basic strategies for HiAP are identified, namely: health strategy, win-win strategy, cooperation strategy, and damage limitation strategy. Their strengths in various situations are explored. Using an adaptation of Kingdon's framework, possibilities for creating opportunities for HiAP by raising health issues on the agenda, developing appropriate tools and by creating conducive momentums are discussed. Conclusions: It is concluded that systematic efforts of experts in public health, health policy, and international health are important in identifying and prioritising the needs for HiAP, in analysing health implications of policies and policy proposals and making these understood by the policy-makers, as well as in suggesting feasible solutions. Improving health literacy of the public, the policy-makers, and the media is key for improved understanding on health implications of policies. Participatory and transparent approaches to policy-making are prerequisites for strengthening HiAP.