Health is influenced by a wide range of factors, many of which fall outside the health care delivery sector. These determinants of health include, for example, the characteristics of how people live, work, learn, and play. Decision and policy making in areas such as transportation, housing, and education at different levels of government, and in the private sector, can have far-reaching impacts on health. Throughout the United States there has been increasing dialogue on incorporating a health perspective into policies, programs, and projects outside the health field, including a recent Institute of Medicine (IOM) report that calls for government and the private sector to adopt a “Health in All Policies” approach (IOM, 2011) as well as a report on health impact assessments produced by the National Research Council (NRC, 2011).
On September 19, 2013, the IOM Roundtable on Population Health Improvement convened a public workshop to foster cross-sectoral dialogue and consider the opportunities for and barriers to improving the conditions for health in the course of achieving other societal objectives (e.g., economic development, efficient public transit). The roundtable
1 This workshop was organized by an independent planning committee whose role was limited to identification of topics and speakers. This workshop summary was prepared by the rapporteur as a factual summary of the presentations and discussion that took place at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the Institute of Medicine or the roundtable, and they should not be construed as reflecting any group consensus.
Statement of Task
An ad hoc committee will plan and conduct a public workshop featuring presentations and discussion of health-in-all-policies approaches. Health in all policies refers to giving consideration for potential health effects in policy making in many relevant domains, such as education, transportation, and housing. The committee will identify specific topics to be addressed, develop the agenda, select and invite speakers and other participants, and moderate the discussions.
engages members, outside experts, and stakeholders on three core issues: supporting fruitful interaction between primary care and public health; strengthening governmental public health; and exploring community action in transforming the conditions that influence the public’s health. The need for action is clear and well-documented, said roundtable co-chair, George Isham, senior advisor at HealthPartners, Inc., and senior fellow, HealthPartners Institute for Education and Research. According to a 2013 NRC and IOM report, for example, Americans have worse health than people in other high-income countries, and health disadvantage is pervasive across age and socioeconomic groups in the United States (NRC and IOM, 2013).
The workshop planning committee was chaired by Pamela Russo, senior program officer at the Robert Wood Johnson Foundation, and included Terry Allan, Dawn Alley, Marice Ashe, James Knickman, Phyllis Meadows, Martin Sepúlveda, and Aaron Wernham. The committee’s charge is described in Box 1-1.
The workshop, titled Applying a Health Lens to Decision Making in Non-Health Sectors, consisted of a keynote presentation on how social policies shape health (Chapter 2), and three panels with presentations and discussion. As described by Russo, the first two panels were designed to provide examples of successful health-oriented interagency collaborations at the federal, state, and local levels from speakers representing those sectors (Chapters 3 and 4). She noted that the United States has been slower to address intersectoral engagement for health than, for example, Australia, Canada, England, the countries of Northern Europe, or the World Health Organization. Although examples of collaboration have grown exponentially in the United States over the past decade, they
remain “points of light” rather than a nationwide approach to Health in All Policies (HiAP). The third panel aimed to outline issues and strategies for working across sectors to improve health, such as tools (e.g., health impact assessments), interagency relationships (backed by legislation and funding), and combining the goals of health with other goals such as sustainability or a stronger economy (Chapter 5). In the closing session, roundtable members were asked to offer their observations on the main themes that emerged from the workshop sessions and their perspectives on how to move forward (Chapter 6).
Russo encouraged participants to keep four questions in mind as they listened to the discussions. First, are some policy goals or topics easier to advance through action at different levels of government? (For example, smoking bans started in local communities and grew to be state-level policies.) Second, what are the challenges agencies and organizations face in incorporating health considerations in their policies and programs, and are there best practices for achieving benefits that can be shared? Third, should the focus of HiAP be exclusively on incorporating health considerations in policies, or would combining health with, for example, equity and sustainability be more likely to improve population health, by also reducing disparities and addressing upstream causes of poor health? Fourth, what can be done to increase attention to the impact of social and economic policies on health, as the majority of intersectoral attention and action thus far has been on the physical determinants of health?