Friday, May 4, 2012

[EQ] Getting Started with Health in All Policies: A Resource Pack

Getting Started with Health in All Policies: A Resource Pack

Health in All Policies: A Snapshot for Ontario

Scoping Review of the Literature

Prepared by the Centre for Research on Inner City Health (CRICH) in the Keenan Research Centre of the Li Ka Shing
Knowledge Institute of St. Michael's Hospital

Lead Authors: Shankardass K, Solar O, Murphy K, Freiler A, Bobbili S, Bayoumi A, O'Campo P.

Research Team: O'Campo P, Laupacis A, Dhalla I, Kirst M, Lofters A, Murphy K, Perrier L, Shankardass K.

2011 - Report to the Ministry of Health and Long-Term Care (Ontario) Canada

Available online PDF [88p.] at:

 "Health in All Policies" refers to formal, sustained, "wholeofgovernment" (read: crosssectoral and coordinated) policy initiatives aimed to improve population health. In some cases, health inequities are targeted specifically in "Health in All Policies" initiatives.

A scoping review identified literature describing international examples of health equityfocused "Health in All Policies". A total of 4833 scholarly articles and 501 sources of grey literature were gathered based on a keyword search.

Following screening and sorting, 163 articles were retained, and intersectoral health activities were described in 43 countries. Further screening identified 16 jurisdictions that have implemented a "Health in All Policies" approach, specifically.

Scoping Review of "Health in All Policies" Literature: Findings

                        Wholeofgovernment, "Health in All Policies" approaches focused on health equity have been implemented in 16 countries or subnational areas worldwide: Australia, Brazil, Cuba, England, Finland, Iran, Malaysia, New Zealand, Northern Ireland, Norway, Quebec, Scotland, Sri Lanka, Sweden, Thailand, and Wales.

                        In every case, a formal, wholeofgovernment "Health in All Policies" approach was preceded by intersectoral initiatives that were less formal and broadreaching.

                        Governmentwide Health Impact Assessment (HIA) or a variant thereof to measure health outcomes/health needs was instituted in almost all jurisdictions.

                        "Health in All Policies" strategies were usually aimed to improve working/living conditions, or to target individual behavior change. Improving access to health care was also stressed. Fewer than a third of cases involved wealth redistribution to address health inequities.

                        By definition, "Health in All Policies" approaches have a broader focus than vulnerable populations only. Most jurisdictions combined attention to vulnerable populations and universal policy initiatives. The preponderance of policy activity related to vulnerable groups.

                        "Health in all Policies" involved a high degree of interaction and interdependence across sectors, and limited individual sectors' autonomy. "Health in All Policies" was not supported through simple informationsharing.

                        Mechanisms for supporting "Health in All Policies" included formal intersectoral committees (e.g. cabinet committees, interdepartmental committees), joint budgets, and evaluation and monitoring tools. In most jurisdictions a mix of horizontal and vertical integration management strategies was used to manage policy implementation. ………."

Table of Contents


Executive Summary

1. Introduction

2. Background


2.1 Reducing Health Inequities in Ontario

2.2 What is a Realist Scoping Review

2.3 Defining "Health in All Policies

2.4 Five Stage Scoping Review and the Identification of "Health in All Policies" Cases

3. Scoping Review Results


3.1 "Health in All Policies" Jurisdictions Around the World

3.2 Information Collected and Compiled About "Health in All Policies" Approaches

3.3 Case Summaries

4. Getting Started with "Health in All Policies": Conceptual Framework and Core Concepts


5. Understanding "Health in All Policies"
Initiation and Implementation: A Descriptive Comparison of Empirical Cases, Using the Conceptual Framework


5.1 Understanding the Context of Initiation: Relevance of Welfare State Profile, Timing, and International Influences

5.2 Understanding Implementation Mechanisms: Patterns of Interaction between Health Care and Other Sectors, Tools, and Government Structures Influencing Interactions, and Health Impact and Health Equity Impact Assessment Tools

5.3 Understanding Intervention Design: Entry Points, Equity Lens and Management and Control of Interventions

6. Relevance to Ministry of Health and Long Term Care and Options for Further Study


6.1 Getting Started with "Health in All Policies: Resources Produced and How they Can be Used

6.2 Further Investigation of "Health in All Policies" that may be Relevant to the Ministry of Health and LongTerm Care

6.3 Conclusion




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