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Rural Health Information Hub

Health in All Policies Approaches

Health in All Policies (HiAP) is a formal process for integrating health considerations into policies across multiple sectors with the goal of addressing the many social determinants of health (SDOH) that influence health outcomes. The National Prevention Strategy describes the need for this cross-sector approach to meet the goal of increasing the number of Americans who are healthy at every stage of life.

Key elements of HiAP include:

  • Defining goals that provide benefits to many sectors and stakeholders.
  • Engaging a range of stakeholders, including community members who will be affected by the policies under discussion.
  • Creating permanent changes to the way that agencies make decisions in order to ensure that commitments addressing health are sustained over time.
  • Recognizing the ways that inequity contributes to negative health outcomes, and incorporating equity considerations into policymaking.

Sectors that could be involved in a HiAP approach include:

  • Agriculture – Relevant policies could involve food production and access to healthy food. Rural communities may also focus on the environmental implications of agricultural production and the health of farmers and farmworkers.
  • Planning – Policies could involve land use decisions that affect SDOH, including zoning and density of residential housing, access to and preservation of open spaces, and bicycle- and pedestrian-friendly developments.
  • Energy – Policies related to heating and energy usage could affect indoor and outdoor air quality.
  • Housing – Housing policies can affect the location and availability of affordable housing, as well as the quality and safety of rural housing stock.
  • Natural Resources – Policies could address the environmental effects of key industries in rural communities, including fishing and hunting. Policies could also involve management of water quality.
  • Transportation – These policies could address the safety of pedestrians, drivers, and cyclists. Equitable access to transportation can also connect underserved populations to economic opportunities, healthcare services, healthy food, recreation, and other necessities.

Examples of Rural HiAP Programs Addressing SDOH:

  • The State of Vermont provides a wealth of relevant resources for rural communities and states considering HiAP. Vermont's HiAP Task Force recognizes that many HiAP models have been developed and replicated in urban communities, and offers guidance for promoting cross-sector action from the perspective of a rural state.
  • Monterey County in California is using HiAP to address persistent income and health inequities, particularly in the agricultural community. As part of the HiAP initiative, the Monterey County Health Department has identified key SDOH affecting community members and worked with the County Planning Department to incorporate health equity assessment tools into decision-making processes for land use.
  • The Chatham County Public Health Department in North Carolina worked with Chatham County Planning, the Chatham County Board of Health, and the Chatham Health Alliance to implement a HiAP approach to updating the county's comprehensive plan. The final plan includes considerations for improving health through multiple sectors, including housing, neighborhood development, and transportation.

Implementation Considerations

When HiAP involves multiple sectors and collaborators, public health agencies can play key roles in creating awareness of health considerations in existing policies and opportunities to promote health equity in future policy development. The World Health Organization describes the need for building capacity to implement HiAP frameworks in their 2014 HiAP Framework for Country Action plan. Rural health professionals may need to both build their own policy analyses and communication skills and train other stakeholders in HiAP principles and tools.

Rural communities may find that Health Impact Assessments (HIAs) are useful tools to guide HiAP initiatives. HIAs help measure the health effects of proposed policies or projects. Module 4: Implementation Considerations provides additional examples of tools used to assess SDOH, including HIAs.

HiAP approaches can involve considerable time and investment. HiAP champions may need to plan for the resources required to inventory existing health-related policies across sectors, build collaborative partnerships across multiple agencies, create the infrastructure to monitor progress, and evaluate the results of the initiative.

Resources to Learn More

Health in All Policies
Includes resources related to HiAP, including fact sheets, reports, and policies that have been enacted by states, counties, and cities across the country.
Organization(s): National Association of County and City Health Officials

Health in All Policies: Collaborating Across Sectors to Improve Health
Lists resources to help communities implement their own HiAP approaches, including a toolkit with step-by-step HiAP strategies, a roadmap for HiAP, and model policies.
Organization(s): ChangeLab Solutions

Health in All Policies: Improving Health through Intersectoral Collaboration
Describes lessons learned from the California Health in All Policies Task Force. Discusses benefits of and considerations for building cross-sectoral partnerships.
Author(s): Rudolph, L., Caplan, J., Mitchell, C., Ben-Moshe, K., & Dillon, L.
Organization(s): Public Health Institute, Institute of Medicine Roundtable on Population Health Improvement
Date: 9/2013

A Practice-Grounded Approach for Evaluating Health in All Policies Initiatives in the United States
Describes evaluation considerations for HiAP approaches. Includes a logic model, example indicators, and case studies.
Author(s): Gase, L., Schooley, T., Lee, M., Rotakhina, S., Vick, J., & Caplan, J.
Citation: Journal of Public Health Management and Practice, 23(4), 339-347
Date: 2017