This document discusses Health in All Policies (HIAP) in the context of the UN Sustainable Development Goals (SDGs). It provides a brief history of HIAP and examines how the SDGs support and relate to the HIAP approach on international and national (German) levels. While the SDGs provide an opportunity to promote HIAP, health has less prominence than issues like climate change and the environment. Bringing health and environmental policies closer together through expanded HIAP makes sense given their often synergistic nature.

1. UniversitätsKlinikum Heidelberg
2017 Global Health Forum in Taiwan
“Inspiration, Action, and Movement (IAM): Implementation of SDGs”
Health in All Policies in the SDG context
Prof. Albrecht Jahn
University of Heidelberg

2. Key issues
• How did HIAP evolve?
• Are the SDGs and the Agenda 2030 supportive for the HIAP approach
• on international level
• on national level (example Germany)
• Health and Environment: Are we moving towards Health and
Environment in all Policies?
• Conclusions

3. A brief history of Health in All Policies (HIAP)
• 1848 Rudolf Virchow: "Medicine is a social science, and politics nothing
but medicine at a larger scale"
• 1986: Ottawa Charter for Health Promotion: “Healthy Public Policy”
• 1998: WHO Europe: The social determinants of health: The solid facts
(Editors Wilkinson and Marmot)
• 2000: ….. little recognition of HIAP in the SDGs
• 2006: Finnish EU-presidency proposes HIAP
• Health in All Policies: Prospects and potentials
• Later on adopted as EU policy and included in the European Treaty
• Taken up by WHO and many countries
• 2013 Health in all policies: Helsinki statement and framework for
country action at the 8th Global Conference on Health Promotion

4. The 2013 consensus definition of HiAP
• Health in All Policies is 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.
• It improves accountability of policymakers for health impacts at all levels of
policy-making.
• It includes an emphasis on the consequences of public policies on health
systems, determinants of health and well-being (WHO 2013).

6. https://ec.europa.eu/health/indicators/docs/poster_echi_a0_2oct_white.pdf

7. The view of WHO

8. Means of implementation for SDG 3 (Health):
3.a Strengthen the implementation of the World Health Organization Framework
Convention on Tobacco Control in all countries, as appropriate
3.b Support the research and development of vaccines and medicines for the
communicable and non-communicable diseases that primarily affect developing
countries, provide access to affordable essential medicines and vaccines, in
accordance with the Doha Declaration on the TRIPS Agreement and Public Health
and IPR, …, and, in particular, provide access to medicines for all
3.c Substantially increase health financing and the recruitment, development,
training and retention of the health workforce in developing countries, especially
in least developed countries and small island developing States
3.d Strengthen the capacity of all countries, in particular developing countries, for
early warning, risk reduction and management of national and global health risks

9. Comprehensive assessment of Health in the SDGs:

10. The health-related SDG-Index:
http://www.thelancet.com/lancet/visualisations/gbd-SDGs

11. HIAP and the SDGs on national level: Example Germany
• The new German Strategy for Sustainability
(2016) is organised along the SDGs
• It includes an action plan, national targets and
indicators.
• It is translated into strategies at regional level.
• It includes a section on global partnership (SDG
17) and has initiated GH initiatives under the G7
and G20 presidency.
(see also http://www.thelancet.com/series/germany
• Similar processes are going on in other countries

12. Targets and indicators in the strategy for sustainability for SDG 3
Reduce premature female mortality
(< 70 years)
Reduce premature male mortality
(< 70 years)
Stop obesity epidemic in youth
Reduce fine particles in air to WHO
standard (20 micrograms/m3)
Reduce smoking >15 years
Reduce smoking among youth 12-17 years
Reduce air pollution emissions by 45%
(2005-2030)
Stop obesity among adults

13. But not all is fine with HIAP in Germany……
In case of competing interests with other ministries and business,
health often loses out, e.g.:
• Germany is the last EU country not to ban billboard advertising for
cigarettes
• Weak regulation of car emissions …witness the diesel scandal
• No speed limit on highways
• Little support for TRIPS flexibilities in the context of access to
medicines

14. The view of WHO

15. Health in the SDGs revisited
• Yes, Health is there, but it is not at the center and has lost
prominence compared to the MDGs
• Environment with a focus on climate change is on top of the agenda
• The health community is already reacting to this thematic shift

16. Health and Environment closing in ?

17. Links between
greenhouse gas
emissions, climate
change and health
(Watts et al. Lancet 2015)

18. Environmental Health Perspectives.
volume 125 number 2 February 2017

19. Conclusions
• The SDGs provide a powerful platform to promote HIAP and we should
make best use of it.
• Health has lost some exclusivity with respect of being the ultimate policy
objective, as climate change and environmental degradation are by many
perceived as the biggest threats to humanity
• Given that health and environment-friendly policies are in most cases
synergistic and not competitive, there is a strong case for expanding HIAP to
include environmental
• Both Health and Environment suffer from the political „handicap“, that most
interventions work only long-term
• Still, we have to acknowledge that there are areas, where health and
environmental policies may conflict