Abstract
Health in All Policies (HiAP) is a cross-sectoral approach aiming to strengthen the links between health and other policies. This concept finds its origin in public health initiatives including the Declaration of Alma-Ata (1978), the Ottawa Charter (1986), and public health policies (1988). Promoted by the World Health Organization, HiAP aims to ensure that health, equity, and well-being issues are taken into account when developing policies in all sectors. It promotes understanding by non-health-related sectors of the consequences of their decisions on the determinants of health, and therefore on the determinants that influence the population’s state of health and well-being. The main idea is to hold policy makers, in all sectors and at all decision-making levels, accountable for the population’s health and health equity (1).
The HiAP is part of a greater desire to place health at the center of society’s development objectives and actions. It is based on a common vision and shared objectives between the health sector and other sectors, as well as a win–win strategy to help engage various sectors. All sectors must benefit from it. This approach offers a new role to the health sector: on the one hand, that of supporting the other sectors in achieving their objectives; and, on the other hand, of helping them to understand that these objectives are not without impact on health. The health sector, including health promotion stakeholders, must adopt a truly collaborative approach and its contribution must be seen by other sectors as a real added value.
The COVID-19 pandemic that has hit the entire world since the beginning of 2020 has revealed the fragility of our health system. Governments have focused on reducing viral transmission to drive down hospitalizations in order to protect the healthcare system. From this perspective, response measures to COVID-19 have been taken, affecting the whole of society and requiring collaboration between the health sector and other sectors (2) (for example, the economy, employment, education, transport, security, culture, leisure, etc.). The two years that have passed since the beginning of the health crisis have shown us that the management of this pandemic cannot be the business of a government alone, even less so a health department. It requires a set of stakeholders coming together for a common purpose — to contain the pandemic and manage its negative impacts. As such, we are witnessing unprecedented cross-sectoral collaboration at different levels to deal with COVID-19. The silos in the way many administrations operate have been broken down during this crisis.
Throughout the pandemic, health has been elevated to political and societal levels like never before. It has obtained legitimacy to intervene in the policies and actions of all sectors and at all levels of decision making. The public health response has been a multi-sectoral one. The COVID-19 crisis has highlighted the link between the economy, health, and well-being. Political decision makers have repeatedly reminded us that decision making in this context of health crisis was guided by science and evidence. Everything is scrutinized through the prism of COVID-19.
However, this pandemic has highlighted an exacerbation of pre-existing social and health inequalities. As such, Richard Horton, editor-in-chief of British journal, The Lancet, affirmed that two categories of disease interact in the population against the backdrop of a social and economic context marked by profound inequalities: COVID-19 and a certain number of noncommunicable diseases such as, for instance, diabetes, cardiovascular diseases, chronic respiratory diseases, and cancers. In Horton’s view, this context aggravates the effects of each disease, and he therefore considers that COVID-19 is not a pandemic but a syndemic (3).
It would be a mistake to think that the COVID-19 pandemic is only a health crisis linked to infection by the virus. Admittedly, this infection had a direct effect on the health of the population, but its repercussions, like the measures taken to stop the spread of the virus, affected individuals differently depending on, among other things, their socioeconomic status. A social divide has been created between people who have the possibility of respecting the lockdown measures and the others, due in particular to their socioeconomic profile, housing conditions, type of job, age, gender, etc.
Significant sums have been invested by governments to deal with the health crisis. The pressure will be significant for post-COVID-19 recovery, particularly in terms of the economy to balance budgets. And in this context, cross-sectoral approaches such as HiAP will be very relevant to address the long-term impacts of this pandemic on health, mental health, and inequalities, and to ensure a recovery that is not only focused on the economy but which places health and well-being at the heart of its efforts. The same is true for health impact assessment (HIA), which has been identified on several occasions as one of the tools capable of promoting and enabling the implementation of the HiAP concept. HIA enables systematic consideration of health concerns in decision making. This tool has been used during the COVID-19 pandemic in several countries, such as Wales (4), Scotland (5), and Austria (6), to assess the impacts of COVID-19 response measures taken in the context of a health emergency on the health of the population. HIA is therefore a tool that could be useful to decision makers to predict the potential future effects of post-COVID-19 recovery policies on the health and well-being of the population, and to identify actions to minimize the negative effects and maximize the positive effects of these policies before they are implemented (7).
COVID-19 has highlighted the importance of having a strong health system and the need for cross-sectoral collaboration to protect the population’s health and promote equity. For post-COVID-19 recovery, we should move from a logic of health protection to a logic of prevention and health promotion in all policies. In addition, the question that arises is the maintenance of the various cross-sectoral collaborations initiated during the crisis. From this perspective, research should focus on studying the cross-sectoral approaches mobilized during the pandemic, and analyzing the sustainability of these for post-COVID-19 management.
We must also not forget that before this health crisis, we had the climate crisis and that of noncommunicable diseases, the risk factors of which are linked to, among other things, our way of life and our environment. These crises will remain after COVID-19, and cross-sectoral approaches such as HiAP (8) are effective ways to deal with these complex issues and better prepare for managing future crises. We must draw upon the lessons learned during this crisis in terms of cross-sectoral collaboration, and maintain the momentum of this collaboration at government level to rebuild society for the better. This will be a major challenge for the health sector, including researchers and health promotion practitioners, but we must seize the opportunity offered by the COVID-19 pandemic to try to achieve it.