Health in All Policies: Ways of Working

There are many ways to apply the Health in All Policies (HiAP) approach to ensure health, wellbeing, sustainability and equity issues are explicitly addressed through policies or decision making.

Complex problems need innovative solutions. The essence of the Canterbury HiAP approach is to identify shared societal goals, and strengthen the link between health and non-health sectors – making improving population health a shared priority. HiAP is an evolving and ongoing process, that works at both strategic and operational levels – for example:

• through assessments;
• by developing formal partnerships; or
• by collaborating on plans and policies.

The HiAP team at Community and Public Health has advisors and a public health specialist based at Community and Public Health. The team also develops resources to suit the unique challenges of the region, and looks to build capacity within and outside the health sector to understand:

• the social determinants of health; and
• the ways policies and plans can be adapted to create places that promote good health and wellbeing for all.

• View a timeline summarising HiAP work and relationships in Canterbury – updated June 2022 [151KB].

HiAP tools developed by Community and Public Health

A number of tools and frameworks are available for use to ensure that health and wellbeing are explicitly considered and addressed in plans and policies. The HiAP team at Community and Public Health have developed some tools purpose-fit for the local environment – in partnership with other local organisations – for planners, designers, policy analysts, developers and others.

• Integrated Planning Guide for a healthy, sustainable and resilient future – Version 3.2 features an updated section on integrating Māori perspectives into this work, promoting that all sectors are responsible for achieving equitable health outcomes for Māori (Te Mana Ora | Community and Public Health 2022).
• The Pandemic Supplement to the Integrated Planning Guide provides additional questions and considerations to those in the Integrated Planning Guide Version 3.0 across key dimensions of health specific to planning during recovery from a pandemic or to build ongoing resilience to public health emergencies (Community and Public Health 2020).
• Integrated Planning Guide for a healthy, sustainable and resilient future – Version 3 expanded the focus beyond recovery and provides a versatile tool to help integrate outcomes thinking relevant to health, wellbeing and sustainability into policy and plan making (Community and Public Health 2019).
• Planning for Positive Outcomes gives a summary of concepts related to the social determinants of health, HiAP and integrated planning (Community and Public Health 2012).
• Integrated Recovery Planning Guide: for a healthy, sustainable and resilient future – Version 2 was developed in response to the 2010 and 2011 earthquakes using the dimensions of health introduced in HPSTED (Community and Public Health 2011).
• Health Promotion and Sustainability Through Environmental Design: A guide for planning (HPSTED) was designed to assist planning staff to explicitly integrate outcomes thinking relevant to health, wellbeing and sustainability in their policy making (Christchurch City Council and Community and Public Health 2008).

Examples of HiAP Tools in action

• Ōtākaro Avon River Corridor Recovery: Integrated Assessment (2017 – 2018);
• Waimakariri District Council Red Zone Recovery Plan: Integrated Assessment (2016);
• Waimakariri District Council Red Zone Recovery Plan: Evaluation of the Integrated Assessment (2016); and
• Environment Canterbury’s Air Plan: Health Impact Assessment (2014).

• Get a more detailed list of Community and Public Health’s involvement in local plan and policy development since 2006 [439KB].

Working in partnership in Canterbury

Health in All Policies in Canterbury is supported by a network of formal and informal relationships between the Canterbury District Health Board (DHB) and 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 Healthy Greater Christchurch 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.

Canterbury DHB also has Joint Work Plans 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 another way that Canterbury DHB is involved in inter-sectoral action.  This collaboration between councils, government agencies and iwi focuses 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.  While wellbeing is weaved throughout the plans, the GCP also has an explicit Community and Health committee at the implementation level.  Healthy Greater Christchurch was identified as the mechanism to deliver on the community and health aspects of the plans.

Other recent joint projects include:

• The Canterbury Wellbeing Index is now an online tool providing information on the wellbeing of the population of greater Christchurch across 85 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 Canterbury DHB, 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. The Canterbury DHB is a foundation signatory, and is working both internally and externally to reduce barriers to accessibility.
• Healthy Commute Programme supports interested Canterbury DHB 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.

Building local capacity in Health in All Policies practices

Spreading the word about the determinants of health and building capacity in HiAP practices are important elements of the HiAP approach in Canterbury.   The team have developed and delivered a number of presentations and workshops to support understanding and implementation of HiAP.

Broadly Speaking is a free interactive workshop delivered by Community and Public Health staff that aims to develop a greater understanding of those factors, beyond the health sector, that impact on the health of populations. It is delivered three times per year to a mix of CDHB and external participants. Over 200 people have attended so far.

• Download an information sheet about the Broadly Speaking short course – now with 2023 dates. [434KB]

Other workshops and resources to build capacity

• An online workshop was hosted by Community and Public Health for colleagues working in HiAP related public health roles across New Zealand (5th July 2022). Participants had the opportunity to reflect and discuss existing strengths within public health in relation to HiAP, how this mahi relates to Te Tiriti o Waitangi and consider the new opportunities for HiAP in the transition to a National Public Health Service.
• Integrated Assessment: A Guide is a Canterbury-developed impact assessment tool that helps to assess the potential outcomes of draft strategies, policies and plans. Community and Public Health have supported early uses of the tool with local projects.
• A Reflective Practice Day and Conference Day was held to acknowledge and celebrate the significant achievements of 10 years of HiAP in New Zealand (30th April and 1st May 2015). The Conference featured presentations by Professor Sir Peter Gluckman, Henare Ngaera O’Keefe, Rob Quigley, and Professor Paul Dalziel.
• A two-day HIA training course at Community and Public Health was delivered by Dr Anna Stevenson working with Martin Ward and Rob Quigley (2014). The course provided an introduction to the determinants of health and provided practical training on HIA and wider HiAP approaches.
• Training for using the IRPG was delivered internally within the Canterbury DHB as well as externally to partner agencies (2011/2012).
• The Christchurch City Health and Wellbeing Profile (2010 with a update in 2012) provides a snapshot of the city’s population, factors that influence their health and what people valued about life in Christchurch.

Presentations by the HiAP Team

The HiAP team present at a number of conferences across NZ and internationally. Here is a sample of presentations not available elsewhere:

• United National Convention of the Rights of Persons with Disabilities as a Health in All Policies goal to create an inclusive, accessible Christchurch (Presented at Disability Matters Conference – Making the Convention Real, Dunedin 2017).
• HiAP in Canterbury (Presented at 15th World Congress on Public Health, Melbourne 2017).
• Land Use Recovery Plan –  How an impact assessment process engaged communities in recovery planning (Presented at People in Disasters Conference, Christchurch 2016).

Making submissions to impact the determinants of health

Submissions are an important way to influence the decisions of other organisations and promote public health in decision making – since most factors that affect the health and wellbeing of Cantabrians lie outside of the health system.

Health in All Policies Advisors have a strong focus on having input very early on in policy development (especially for Long Term Plans or District Plans). They also coordinate and prepare submissions on many issues on behalf of the Canterbury DHB, with the assistance of other public health staff and the wider organisation.

• View recent public health submissions by the Canterbury DHB.

Working towards an accessible and inclusive Christchurch

Community and Public Health (through Healthy Christchurch) is supporting planning for a healthy city including healthy urban design. This includes working towards an accessible and inclusive Christchurch.

• View a video on an Accessible Christchurch with subtitles.
• Find out how urban design impacts everyone through the Building for All Portal.