Health in All Policies (HiAP) is formally defined as: “an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity” (World Health Organization [WHO] & Finland Ministry of Social Affairs and Health, 2014, p. 7, 2014, p. 7). This approach comes with unique goals and mandates dependent on the specific national and subnational policy contexts in which it is developed.

As an outgrowth of the interest in HiAP expressed by participants at a pan-Canadian event organized by the National Collaborating Centre for Healthy Public Policy in the fall of 2019, this paper is intended for public health professionals involved in health promotion and prevention across Canada, analysts and managers of health and social policy in federal, provincial and territorial (FPT) governments and in regional health authorities, as well as their intersectoral and community partners. It seeks to develop a better understanding of HiAP and to clarify what can be expected (or not) of a HiAP approach in Canada’s policy context. It explores some of the unique roles and opportunities for FPT governments with regard to adopting or reinforcing HiAP in their jurisdictions, and covers three main facets: 1) what is HiAP?; 2) an overview of HiAP implementation in Canada’s provinces; and 3) unique opportunities for FPT governments.

The analysis shows that HiAP as a concept is expansive and potentially radical; however at the empirical level, it is implemented in a limited, adaptable way to foster change from within existing government structures. Based on the experience of two provinces, the analysis suggests that HiAP in Canada’s policy context can be seen as a policy instrument which articulates a broad vision with multiple dimensions of health prevention and promotion extending beyond health care, and which supports coordinated action across sectors to improve the social determinants of health. As such, FPT governments could adopt or reinforce HiAP as an overarching policy framework to:

• Ensure the macro-social determinants of health and positive health outcomes receive more systematic consideration from policymakers across sectors;
• Influence policy development in relevant areas;
• Support action at the local level across sectors;
• Support decision makers in proactively responding in a health-equity-informed manner to the COVID-19 pandemic recovery;
• Foster a more systematic integration of the social determinants of health and health equity into planning to face future collective crises;
• Serve as a vigilant reminder, in policymaking processes across sectors, of the impacts of all policymaking on population health; and
• Guide incremental decisions on resource allocation and government priorities over time.

In light of these findings, it is not suggested that HiAP represents a stand-alone policy solution able to ensure population health. Nevertheless, FPT governments might want to consider designing a HiAP strategy primarily as an additional policy lever to facilitate the governance of population health, with a view to improving the synergy between pre-existing public policies and programs. They may also want to incorporate tools and processes as part of a HiAP strategy, to draw more systematic attention to the effects on population health of policymaking by non-health sectors.

For HiAP to be appropriate, respectful and relevant for Indigenous peoples living in Canada, there is a need to work with First Nations, Métis and Inuit communities to identify whether the implementation of HiAP could support their priorities. A culturally sensitive approach would need to proceed from the recognition by all parties that different health paradigms exist, and that they reflect differences between western and First Nations, Métis and Inuit views and beliefs about health and its determinants.