Rethinking the politics and implementation of health in all policies

Abstract

In Europe, successful health policies have contributed to a continued decline in mortality. However, not all parts of Europe have benefited equally and the sustainability of achievements cannot be taken for granted since health policies vary widely even among neighbouring countries. Furthermore, there are a number of remaining public health challenges such as food and alcohol polices. We argue that if we are to make further progress we need to rethink the politics and implementation of Health in All Policies. Commenting on an article analyzing the roll out and early implementation of Israel's National Programme to Promote Active, Healthy Lifestyles provides an opportunity to thrash out four issues. First, intersectoral structures are key transmission belts for Health in All Policies between ministries and sectors and we need to exploit their specific uses and understand their limitations. Second, our analytical perspective should focus on what it takes to introduce policy change instead of assuming an idealized policy cycle. This includes a reconsideration of interventions which may not be very effective but help to raise the standing of health on the political agenda, thus providing a stronger basis for policy change. Third, we need to better understand variations in context between and within countries, e.g. why do some countries adopt Health in All policies but others don't, and why is it that in the same country compliance with some health policies is better than with others. Finally, we will need to better understand how a diverse set of actors from other sectors can internalize health as an intrinsic value.