Examining Whether the Health-In-All-Policies Approach Promotes Health Equity

Overview

Richard L. Hall and Peter Jacobson of the University of Michigan Research Hub published an article in Health Affairs on the relationship between Health in All Policies (HiAP) and health equity. They conducted 65 semi-structured interviews with state and local officials in five states where HiAP initiatives were underway, with a goal of examining whether and how policymakers and advocates use the framework to elevate health equity as a policy concern across sectors and jurisdictions.

Findings

Three main themes emerged from the analysis:

1. HiAP reinforces attention to health equity. All respondents identified cross-sector collaboration as an integral part of HiAP. Likewise, in almost all cases, the social determinants of health were identified as the main target of the HiAP approach.
2. The connection between HiAP and health equity is issue-dependent. Rather than working to implement policies that broadly promote health equity, respondents from most sites discussed working on health equity within very specific issues and settings.
3. Health equity is emphasized strategically. Respondents reported that health equity is emphasized selectively and strategically based on the value that other actors in the political environment place on it. This includes taking into account the ideological leanings of elected officials, constituents, non-governmental organizations, and federal agencies.

Implications for Policy and Practice

This study showed no consistent evidence that the application of the HiAP approach has resulted in broad policy change or actual reductions in health disparities. However, most practitioners believe that HiAP can be a useful tool in achieving both objectives. Although more work is needed to understand how the framework may ultimately impact health outcomes, the interviews did reveal several ways that HiAP can be used to shift the conversation in non-health departments to address social disparities in health:

1. Proponents of HiAP and health equity approaches should anticipate and proactively respond to likely political obstacles within their communities. This may involve avoiding the use of loaded terms and framing discussions around specific outcome goals.
2. Practitioners should not wait for the adoption of sweeping HiAP mandates to begin incorporating health equity into programs and practices.
3. Promoting equity through HiAP requires resources. Practitioners should leverage grants, technical assistance opportunities, and other forms of support to help implement and evaluate HiAP approaches.