Selected Tools to Facilitate the Integration of Health in All Policies
The intent of this briefing note is to introduce some tools developed in recent years to facilitate the integration of health issues into the decision-making processes of sectors whose primary concern is not population health. It is not the product of a comprehensive review of the various support instruments for health-related decision making, but rather a review of tools associated with the HiAP approach that have been the subject of publications. Most of them are aimed at the municipal decision-making level and are mainly intended for use in urban areas.
The scope of the health determinants considered by each of these tools varies. Some, such as rapid HIA, the Health Matrix and the health lens approach, are more holistic and apply to all types of policies. Thus, they are perfectly aligned with the spirit of HiAP insofar as they make it possible to examine the structural determinants of health affecting health equity. Others were designed to support a particular focus, such as the practice of physical activity or sustainable transportation, or for specific areas of action, such as urban development, an area where the concept of the built environment is increasingly gaining the attention of public health actors.
However, their common characteristic is their focus on the determinants of health rather than on specific health issues. The determinants approach is more likely to bring about sustainable change in the way public policies are analyzed, through the internalization of health concepts in the decision-making system (Peters, Harting, Van Oers, Schuit, De Vries, & Stronks, 2014), whereas the attention focused on a particular health topic can vary over time, depending on government preferences and priorities.
We have sought to present tools that are easy to use, and are most likely to be incorporated in the decisional processes of the typical administrative framework, where recourse to experts is not required (Sheate et al., 2001). In the long term, one could say that their goal is to become obsolete and useless, which would reflect a real change in governance processes in favour of health.
Finally, it is important to remember that decision support tools are not an end in themselves. They are part of a process characterized by a firm commitment to take health issues into account in government decisions and, as such, they assist in the concrete realization of this goal. In addition to fulfilling this role, they can also serve as a vector for the development of a shared understanding among stakeholders, along with common goals and values. This is an important function because policy decisions are not based solely on scientific knowledge but also on the values and interests of the parties involved.