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One of the major challenges facing many organisations across Scotland is how to effectively adapt the way they work to deliver a step change in public health. While many aspects of reform are already underway, Dr Margaret Douglas, Master of Public Health Programme Co-Director, University of Edinburgh argues that to realise success we have to lay solid foundations at the very start…

“Public Health Reform is an exciting opportunity to make a greater impact and achieve the vision of ‘a Scotland where everybody thrives’. Realising this vision means creating the social, economic and physical environments that support good health at national and local level. ‘Health in All Policies’ (HiAP) is a preventative public health approach that aims to achieve this.

But what do we mean by Health in All Policies? It’s an ‘approach to public policies across sectors that systematically takes into account the health implications of decisions’. It requires public health specialists to work outside ‘health’ policies and make time to engage with colleagues in partner organisations who are developing plans or strategies across a range of policy areas that can affect health.  

Most partnership work in public health focuses on a specific issue such as physical activity or mental health. The starting point for HiAP differs because we start with proposed policy or a policy area. HiAP means building a holistic understanding of all the ways that policy might affect health. So, for example, work on transport policy would include its effects on physical activity, air quality, injuries, social capital, access and inclusion. These impacts may be positive or negative and intended or unintended. The aim is to influence the policy to gain the best overall health outcome, not just focus on one outcome.

There are tools already available, such as Health Impact Assessment, which can be used to support this. Many of the skills and evidence needed are similar to other areas of public health practice. But it needs more than technical skills and evidence. Most importantly, HiAP requires public health specialists to invest the time to build relationships and develop a deeper understanding of ways of working, language, constraints and opportunities in other policy areas. We need to recognise our partners’ expertise and be clear about where we can (and cannot!) add value to policies and plans.

Public Health Scotland can support HiAP in several ways. Firstly, by building on its relationships with national partners to apply HiAP to national policies that are likely to impact on health. PHS can work to create a culture for health, recognising the shared responsibility to ensure that everyone in Scotland lives and works in social, economic and physical environments that support good health. This fits well with the National Performance Framework, which identifies increased wellbeing as a central purpose that all the national outcomes contribute to. PHS will play an important role in supporting capacity building and can develop resources that show evidence of the links between health and particular policy areas. PHS can also bring together and support colleagues at local level to apply a health in all policy approach. HiAP cannot just be ‘owned’ by or in PHS – it’s a collective approach that requires shared leadership and commitment across sectors.

Implementing HiAP more widely in Scotland means investing public health time and capacity to develop the approach and shared public sector leadership to support it. This has great potential to improve the ‘upstream’ social, economic and environmental determinants of health and health inequalities in Scotland.”

More information on Health in All Policies and Health Impact Assessment is available from the Scottish Health and Inequalities Impact Assessment Network here.


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