14 April 2010

A Different Kind of Health Reform: Health in All Policies

While everyone is debating the details of the Australian Government’s final position on health reform and next Monday’s Council of Australian Governments meeting another, quieter debate is underway. A conference organised by the World Health Organization and the South Australian Government is debating how to ensure that health is considered in all government policies.

This approach, known as Health in All Policies, seeks to make ensuring health and wellbeing a shared goal across government. Increasingly the issues that health systems and governments face worldwide are complex and lie beyond the direct control of health ministries. These are issues like ageing populations, sustainability of financing, rising rates of chronic disease, pandemics, and an increasing recognition of the importance of early childhood in determining health throughout a person’s life.

Heal in All Policies recognises this and seeks to make health not only a feature of joined-up government but also the driving force for it. As South Australian Premier Mike Rann noted when he opened the conference, health expenditure will account for the entire South Australian Government budget by 2030 unless bold steps are taken.

Health in All Policies originated from Finland as a major initiative under its Presidency of the European Union in 2006. In Australia, the South Australian Government has led the charge. It has built Health in All Policies into South Australia’s Strategic Plan and health lens analyses are undertaken on policies across government.

Health in All Policies is not an entirely new idea. Twenty-two years ago another Adelaide WHO conference developed Recommendations on Healthy Public Policy that emphasised the important role of all government policy in ensuring people’s health. There has been intersectoral action for health since then, but it hasn’t necessarily resulted in lasting changes to the way health ministries relate to other government agencies.

The impetus for re-focusing on the role of intersectoral policy now is that we face a number of “wicked problems” in health that have implications across government. These are issues such as rising rates of obesity that involve a complex array of stakeholders, a lack of agreement about what the nature of the problem actually is, interlocking constraints and constraints on resources. Wicked problems can’t be solved, only managed.

Health in All Policies is not a panacea but it does represent an important shift from the health sector describing the importance of the determinants of health to working constructively across government on them. It’s an ambitious vision to make health an explicit goal of all of government, rather than a silo to be maintained.

This activity is not without risk however. Having failed to reorient health systems to prevention are we now going to fail spectacularly to reorient the whole of government?

There is some cause for hope however. Reform is in the air, and increasing health costs are providing a renewed focus on a broader prevention agenda. South Australia, whilst still in the early days of its Health in All Policies agenda, has demonstrated that high-level action is possible in Australia.

More Information on HiAP

Health in All Policies – South Australian Department of Health

Health in All Policies – European Union

Ben Harris-Roxas is participating in the Health in All Policies Conference and his views don’t represent the organisers’.