Health in All Policies approach at Community and Public Health

Health in All Policies (HiAP) is a structured approach to working across sectors and with communities on public policies. It promotes trusting relationships and engages stakeholders to systematically consider the implications of decisions. HiAP seeks synergies to improve societal goals, population health and health equity.

Our health and wellbeing are shaped by many factors that lie beyond the health sector. These factors include where we work, live and play, income, housing, education and employment – and all impact health and wellbeing. These factors are the ‘social determinants of health’ and weave a complex web around individuals and communities – as illustrated in the diagram below.

Often health and wellbeing outcomes are not specifically considered in policy work outside the health sector. The health sector must work collaboratively with other sectors to achieve better outcomes – by examining the positive and negative health implications of their plans and policies. Organisations need to work in partnership towards shared goals that promote health, wellbeing and equity.

Health in All Policies works best when a combination of elements are in place:

• development of strong and sound partnerships based on co-design, co-delivery and co-benefits;
• good governance;
• dedicated capacity and resources; and
• the use of evidence and evaluation.

Health in All Policies is an international approach

HiAP has its roots in the Word Health Organisation declaration of Alma-Ata (1978) and the Ottawa Charter (1986). These documents focus on healthy public policy and the social determinants of health. The concept of HiAP has been refined in a series of statements:

• The Adelaide Statement on Health in All Policies (2010) outlined how all sectors need to work together to improve health outcomes and advance sustainability and equity.
• The Helsinki statement on Health in All Policies (2013) further defined HiAP and called on government to ensure that health considerations are taken into account in policy-making.
• The Adelaide Statement II (2017) provides new direction for Health in All Policies within our current global political climate and the Sustainable Development Goals (SDGs).

Health in All Policies in Canterbury

The HiAP team at Te Mana Ora | Community and Public Health works towards fostering strong partnerships and collaborating with other sectors to impact health and wellbeing for the people of Waitaha Canterbury, South Canterbury, the Te Tai Poutini West Coast, and the Chatham Islands.

The HiAP team is dedicated to incorporating health, wellbeing, sustainability, and equity issues in all policy, planning, and decision-making processes. Its goal is to enhance health outcomes and mitigate health disparities through this approach.

“The regional council’s work is very much about human health and wellbeing – working to make sure that people throughout Canterbury have a strong and healthy environment and economy, and cultural and social opportunities. We have found through working together that a joined up approach considering health is more than a planning process and we’re starting to see our staff explicitly factor these determinants of health into their everyday work.” – Bill Bayfield, former Chief Executive, Environment Canterbury.

Work at Te Mana Ora | Community and Public Health aims to reflect the concepts of Determinants, Equity, Evidence and Te Tiriti (DEET). So our work is guided by a social determinants approach that promotes fairness and justice, is informed by evidence and is framed by the Te Tiriti o Waitangi.

HiAP is compatible with the holistic nature of Māori perspectives of health and wellbeing, by recognising the importance and interconnections between determinants of health. Tools associated with HiAP can be used to assess and address the inequitable health outcomes experiences by Māori.

• Find out how Te Mana Ora applies a Health in All Policies approach.

Working in partnership in Canterbury

Te Mana Ora | Community and Public Health has been working in a HiAP way in Canterbury for many years, including with local government and iwi. This work is supported by a network of formal and informal relationships with partner agencies.

Waka Toa Ora (Healthy Greater Christchurch) is a formal Canterbury DHB-led cross-sector partnership that has enabled collaborative HiAP work in Canterbury since its initiation in 2005. Over 200 signatories agree to work collaboratively with the understanding that “all sectors and groups have a role to play in creating healthy cities, whether their specific focus is recreation, employment, youth, environmental enhancement, transport, housing or any other aspect of city life.” Signatories include government agencies, businesses, not for profits, voluntary sector groups, networks and residents associations.

Joint Work Plans are in place with the Christchurch City Council (CCC) and Environment Canterbury Regional Council (ECan). These are used to plan and monitor collaborative work. The Joint Work Plans cover six main focus areas covering a diverse range of topics, from strengthening communities, to transport, and supporting healthier homes and environments.

The Greater Christchurch Partnership (GCP) is a collaboration between Community and Public Health, councils, government agencies and iwi. The Partnership is focused on planning and managing the impacts of growth and development on the Greater Christchurch area, including towns in the Selwyn and Waimakariri Districts. The collaboration is based upon of series of key planning documents, including the Greater Christchurch Urban Development Strategy and the Resilient Greater Christchurch Plan.
The World Health Organisation included the Greater Christchurch Urban Development Strategy in their case study book – highlighting Canterbury’s  success as a national and international leader in HiAP.

• Progressing the Sustainable Development Goals through Health in All Policies (World Health Organisation 2017).

Other recent joint projects include:

• The Canterbury Wellbeing Index is an online tool providing information on the wellbeing of the population of greater Christchurch across more than 80 indicators, including 19 that reflect a Māori view of wellbeing. The Index was initially developed by the Canterbury Earthquake Recovery Authority (CERA) and has been produced by Community and Public Health with the support of a number of agencies since 2014.
• The Christchurch Alcohol Action Plan (CAAP) was developed in response to community concern about alcohol-related harm. It provides a collective vision, strategies and actions aimed at achieving a sustained reduction in alcohol-related harm across Christchurch. The Plan is supported by the Christchurch City Council and the NZ Police.
• The Accessibility Charter gives organisations an opportunity to lead the implementation of best practice accessible design in their communities. Te Whatu Ora Waitaha Canterbury (formerly the Canterbury DHB) is a foundation signatory, and is working both internally and externally to reduce barriers to accessibility.
• Healthy Commute Programme supports interested Te Whatu Ora Waitaha Canterbury staff to reduce their private car use and increase their use of other modes of transport (such as walking, cycling, bussing and car sharing).
  Watch a video on the Healthy Commute Challenge and see who gets to the hospital the quickest.

Documents

• Working together for equity and healthier populations sustainable multisectoral collaboration based on Health in All Policies approaches (World Health Organisation 2023).
• A fair chance for all: Breaking the cycle of persistent disadvantage (NZ Productivity Commission 2023).
• A “bottom up” Health in All Policies program: Supporting local government wellbeing approaches (Chantal Lauzon, Anna Stevenson, Kirsty Peel, Sandy Brinsdon 2023 – in Health Promotion Journal of Australia).
• Principles for healthy urban development (Ministry of Health 2022).
• Te Tapeke Fair Futures in Aotearoa: Spotlight on poverty (Royal Society Te Apārangi 2021).
• An integrated approach to assessing health impacts (Chantal Lauzon 2021 – in New Zealand Association for Impact Assessment: Impact Connector 13).

• Health in All Policies: Seizing opportunities, implementing policies (European Observatory on Health Systems and Policies 2013).
• Health in All Policies: A Guide for State and Local Government (American Public Health Association and Public Health Institute 2013).
• The Health Equity Assessment Tool: A User’s Guide (Ministry of Health 2008).
• Whanau Ora Health Impact Assessment (Ministry of Health 2007).
• Te Pae Mahutonga Implementation Planning Guide (Ministry of Health 2004).

Links

• Christchurch City Health Profile (Waka Toa Ora – previously known as Healthy Christchurch).
• Sustainable Development Goals (World Health Organisation).

Get the latest on Health in All Policies in Canterbury

The Canterbury Health in All Policies Newsletter is produced by the Policy Team at Community and Public Health. It features HiAP approach in action in Canterbury as well as useful resources and links.

• View the latest Canterbury Health in All Policies Newsletter.
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