This document provides a glossary of terms related to implementing Health in All Policies (HiAP). It defines key concepts such as HiAP, intersectoral action, intersectoral engagement, implementation, and strategies to facilitate intersectoral engagement like agenda setting, raising awareness, and using a "win-win" approach. The glossary was developed based on case studies of HiAP initiatives in multiple jurisdictions to understand how and why certain structures and strategies are useful for implementing HiAP across government sectors.
Government of every nation of the world seeks to improve the health condition of their country aggregately. This over time induces them to adopt various health terminologies such as community health and public health for their health sector. Government of the emerging economies of the world (developing countries), often concentrate their interest on either public health or community health,but adoption of public health and community health by these governments seems to yield little in aggregate health performance in their country. Inspite of this bedeviling fact, governments of emerging economies have no shifted their attention from either public health or community health. It is due to this undesirable situation that the paper sought to enlighten governments of these emerging economies on the need for them to shifts their attention to population health as a means to enhanced aggregate health performance in their respective countries. The paper focused on the concept of population health; benefits of adopting population health; importance of population health as compared to community health and public health; difference in design/content of population health practices from community health practices and public health practices; how current measurements using community and public health practices deter aggregate health performance in emerging economies; reasons for adoption of population health in emerging economies; evaluating population health; global variables for measuring population health; measuring population health; measuring community health, public health and population in emerging countries; reasons for measuring population health; tracking population health; potential limitations to population health conceptual framework; and strategies for effective and efficient population health in the emerging economies. It was recommended among others that training and retraining should be encouraged among person for population health, which will assist them to be
equipped with the needed skills and competencies for them to effectively/efficiently perform their duties, so as to actualize the mandate of population health.
Government of every nation of the world seeks to improve the health condition of their country aggregately. This over time induces them to adopt various health terminologies such as community health and public health for their health sector. Government of the emerging economies of the world (developing countries), often concentrate their interest on either public health or community health,but adoption of public health and community health by these governments seems to yield little in aggregate health performance in their country. Inspite of this bedeviling fact, governments of emerging economies have no shifted their attention from either public health or community health. It is due to this undesirable situation that the paper sought to enlighten governments of these emerging economies on the need for them to shifts their attention to population health as a means to enhanced aggregate health performance in their respective countries. The paper focused on the concept of population health; benefits of adopting population health; importance of population health as compared to community health and public health; difference in design/content of population health practices from community health practices and public health practices; how current measurements using community and public health practices deter aggregate health performance in emerging economies; reasons for adoption of population health in emerging economies; evaluating population health; global variables for measuring population health; measuring population health; measuring community health, public health and population in emerging countries; reasons for measuring population health; tracking population health; potential limitations to population health conceptual framework; and strategies for effective and efficient population health in the emerging economies. It was recommended among others that training and retraining should be encouraged among person for population health, which will assist them to be
equipped with the needed skills and competencies for them to effectively/efficiently perform their duties, so as to actualize the mandate of population health.
Programs for public health practitioners in the field, due to the profession is so dispersed in its work—from employment in private managed care organizations and clinics. The main purpose of this study is to analysis the relationship between law and ethics with public healthcare performance. The present study used a quantitative research design, specifically the descriptive survey design. This is because such design accurately and objectively describes the characteristics of a situation or phenomenon being investigated in a given study. It provides a description of the variables in a particular situation and, sometimes, the relationship among these variables rather than focusing on the cause-and effect relationships. Thus, this study used a questionnaire which was developed from previous research in order to measure the relationships among the investigated variables. This study was carried out in different healthcare centers located in Erbil, the total of 81 participants participated in this study. The researcher developed research hypothesis as follow; there is a positive and significant relationship between law and healthcare performance in Erbil. The finding of this study showed that the value of beta for law and ethics factor is .749 with the P-value .000 this means that the law and ethics will have positive and significant influence on healthcare performance; accordingly the main research hypothesis is supported.
Desafíos para el Epidemiólogo en América Latina. Por Jaime Miranda.Viralizando
Presentación de Jaime Miranda en el marco del III Congreso Chileno de Salud Pública y el V Congreso Chileno de Epidemiología.
Santiago de Chile, Julio 2014.
El Médico que Chile necesita? Felipe DelpínViralizando
Presentación de Felipe Delpín, Presidente Comisión de Salud, Asociación Chilena de Municipalidades; en el marco del III Congreso Chileno de Salud Pública y el V Congreso Chileno de Epidemiología.
Santiago de Chile, Julio 2014.
Programs for public health practitioners in the field, due to the profession is so dispersed in its work—from employment in private managed care organizations and clinics. The main purpose of this study is to analysis the relationship between law and ethics with public healthcare performance. The present study used a quantitative research design, specifically the descriptive survey design. This is because such design accurately and objectively describes the characteristics of a situation or phenomenon being investigated in a given study. It provides a description of the variables in a particular situation and, sometimes, the relationship among these variables rather than focusing on the cause-and effect relationships. Thus, this study used a questionnaire which was developed from previous research in order to measure the relationships among the investigated variables. This study was carried out in different healthcare centers located in Erbil, the total of 81 participants participated in this study. The researcher developed research hypothesis as follow; there is a positive and significant relationship between law and healthcare performance in Erbil. The finding of this study showed that the value of beta for law and ethics factor is .749 with the P-value .000 this means that the law and ethics will have positive and significant influence on healthcare performance; accordingly the main research hypothesis is supported.
Desafíos para el Epidemiólogo en América Latina. Por Jaime Miranda.Viralizando
Presentación de Jaime Miranda en el marco del III Congreso Chileno de Salud Pública y el V Congreso Chileno de Epidemiología.
Santiago de Chile, Julio 2014.
El Médico que Chile necesita? Felipe DelpínViralizando
Presentación de Felipe Delpín, Presidente Comisión de Salud, Asociación Chilena de Municipalidades; en el marco del III Congreso Chileno de Salud Pública y el V Congreso Chileno de Epidemiología.
Santiago de Chile, Julio 2014.
El Profesional Médico que Chile necesita. Por Humberto Guajardo.Viralizando
Presentación de Humberto Guajardo, Decano Facultad de Ciencias Médicas, Universidad de Santiago; en el marco del III Congreso Chileno de Salud Pública y el V Congreso Chileno de Epidemiología.
Santiago de Chile, Julio 2014.
El Profesional Médico que Chile necesita. Por Pedro Lucero.Viralizando
Presentación de Pedro Lucero en el marco del III Congreso Chileno de Salud Pública y el V Congreso Chileno de Epidemiología.
Santiago de Chile, Julio 2014.
Discusión sobre la determinación social histórica de las condiciones de salud y de vida poblacional, y de sus relaciones con el ejercicio del poder, la convivencia y la solidaridad en un Estado social de derecho.
Salud en todas las políticas: El caso de Finlandia. Por Eeva Ollila.Viralizando
Presentación de Eeva Ollila en el marco del III Congreso Chileno de Salud Pública y el V Congreso Chileno de Epidemiología.
Santiago de Chile, Julio 2014.
Rol de los profesionales en la Salud Pública. Por Jose Concha.Viralizando
Presentación de José Concha en el marco del III Congreso Chileno de Salud Pública y el V Congreso Chileno de Epidemiología.
Santiago de Chile, Julio 2014.
El Profesional Médico que Chile necesita. Por Camilo Bass.Viralizando
Presentación de Camilo Bass en el marco del III Congreso Chileno de Salud Pública y el V Congreso Chileno de Epidemiología.
Santiago de Chile, Julio 2014.
Stakeholder engagement methodologies & practices. In the world of interaction. An understanding of the nuances of relationships, how to build them and what to do with them is key to personal & business success
Following on from the success of the second edition, 'Theory in a Nutshell 3e' explores the main theoretical concepts and models in health promotion and explains the significance, practical application and impact of different theories on the individual, community and organisation. This edition includes concise reviews of established theories, such as social cognitive theory and health belief model, as well as expanding on new developments in the field including evidence-based policy making and health impact assessment. Thoroughly revised and updated, the book maintains the accessible style suitable for public health practitioners, health promotion and health education specialists, epidemiologists and social policy makers, as well as students of public health and health promotion.
Sec. S-i. Med. Vol. 38, No. 2, pp. 205-215, 1994 Printed in .docxbagotjesusa
Sec. S-i. Med. Vol. 38, No. 2, pp. 205-215, 1994
Printed in Great Britain.
THE HOUSEHOLD PRODUCTION
0277.9536/94 $6.00 + 0.00
Pergamon Press Ltd
OF HEALTH:
INTEGRATING SOCIAL SCIENCE PERSPECTIVES ON
MICRO-LEVEL HEALTH DETERMINANTS
PETER BERMAN’, CARL KENDALL’ and KARABI BHATTACHARYYA’
‘Department of Population and International Health, Harvard School of Public Health , 665 Huntington
Avenue, Boston, MA 02115 and ‘Department of International Health, School of Hygiene and Public
Health. The Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, U.S.A.
Abstract-Efforts to control disease and improve health in developing countries require increasing
collaboration between social and medical scientists. This collaboration should extend from the early stages
of technology development to the evaluation and improvement of population-wide interventions. This
paper provides an integrating framework for social science research on health producing processes at the
household level, drawing on recent work in economics, anthropology, and public health. Further
development of theory and methods in this area would benefit from interdisciplinary research in categories
as defined by social and behavioral science in addition to those related to specific diseases and intervention
programs.
Key words-health, development, social science methods. household economics
The natural locus of disease is the natural locus of life - the
family: gentle, spontaneous care, expressive of love and a
common desire for a cure, assists nature in its struggle
against the illness, and allows the illness itself to attain its
own truth [I, p.171.
lNTRODUCTION
In medicine and public health in developing
countries, technology has captured center stage. Oral
rehydration therapy, vitamin supplements, recombi-
nant vaccines-these are the vanguard of the ‘revolu-
tion’ in child survival. Whereas once the eradication
of a single disease was a dream, today elimination of
a host of killers is deemed a likelihood.
While technology can certainly hasten public
health improvements, historical experience suggests
that other factors are also needed. As is well known,
major health improvements in the West preceded
rather than accompanied the advent of antibiotics
and most vaccines [2]. Some low income countries
and regions have achieved levels of infant mortality
below those of some American cities with low cost,
decentralized systems of primary health care [3].
There is reason to believe that such successes of
health development depend on a combination of
appropriate technology, sound health care delivery,
and social and economic changes affecting house-
holds and communities. Where health care provision
of adequate quality or related social advances are
absent or lagging, simple mass extension of clinically
efficacious medical techniques, such as promotion of
oral rehydration may exhibit high initial rates of
success and r.
National Institute of Health: Theory at a Glance, A Guide for Health Promotio...Zach Lukasiewicz
Introduction viii
Audience and Purpose 1
Contents 1
Part 1: Foundations of Theory in Health Promotion and Health Behavior 3
Why Is Theory Important to Health Promotion and Health Behavior Practice? 4
What Is Theory? 4
How Can Theory Help Plan Effective Programs? 4
Explanatory Theory and Change Theory 5
Fitting Theory to the Field of Practice 5
Using Theory to Address Health Issues in Diverse Populations 7
Part 2: Theories and Applications 9
The Ecological Perspective: A Multilevel, Interactive Approach 10
Theoretical Explanations of Three Levels of Influence 12
Individual or Intrapersonal Level 12
Health Belief Model 13
Stages of Change Model 15
Theory of Planned Behavior 16
Precaution Adoption Process Model 18
Interpersonal Level 19
Social Cognitive Theory 19
Community Level 22
Community Organization and Other Participatory Models 23
Diffusion of Innovations 27
Communication Theory 29
Media Effects 30
Agenda Setting 30
New Communication Technologies 31
Oral health promotion is a comprehensive approach to enhancing the oral health of
families, communities and populations which both
complements and challenges the approach on which formal
health care systems are based.
Key Element 4 Increase Upstream InvestmentsA population health .docxtawnyataylor528
Key Element 4: Increase Upstream Investments
A population health approach maximizes its potential by directing efforts and investments “upstream” to address root causes of health and illness.
What are upstream investments?
Upstream investments are interventions aimed at the root causes of a population health problem or benefit. Root causes are often identified by determining the most immediate and direct causes, and working backwards from there. In many cases, upstream action addresses social, economic and environmental conditions.
The population health approach is grounded in the notion that the earlier in the causal stream action is taken (i.e. the more upstream the action is), the greater the potential for population health gains and health-related cost savings. It is often true, however, that these root causes are more difficult to change, requiring more time, more resources and more will.
Because of this, upstream interventions may not be the most appropriate choice; the context, timing, resources, mandate and available evidence must be considered. The choice should be based on the best evidence, not just on an article of faith that “further upstream is always better.”
Resources to Increase Understanding:
What are upstream investments?
· The Case for Prevention: Moving Upstream to Improve Health of All Ontarians – Health Nexus (formerly the Ontario Prevention Clearinghouse)
Key questions
· a) What is the best balance of investments?
· b) Who will provide support and what will it be?
A) What is the best balance of investments?
A population health approach recognizes the tension between short and long term goals. Health problems have to be treated immediately, but at the same time, upstream investments are needed to keep people healthy. Furthermore, upstream investments need sustained support to have a real impact.
The population health approach strives to strike a balance between investments of three types:
· Short term, e.g. responding to citizen concerns about the quality and accessibility of health care, food and drug safety, and emergency response procedures
· Medium term, e.g. programs that favour equity, such as redistribution of resources, and programs that invest in children, such as responding to windows of developmental opportunity
· Long term, e.g. investment in alternative energy sources and other technologies that reduce stress on the physical environment.
B) Who will provide support and what will it be?
Taking upstream action on the social, economic and environmental health determinants requires influencing how multiple sectors of government assign their resources. In this Key Element, it is important to identify what investments by what partners outside health are required. To generate this list, consider all the sectors whose mandates impact upon health determinants and focus on those that are most relevant.
How are upstream investments increased?
4.1 Balance short, medium and long term investments
The decision-making fram ...
HIA in Decision Making: What We Know and What We Need to Know Francesca Viliani
HIA in Decision Making: What We Know and What We Need to Know presentation made at the 2015 Global Health Forum on “Public Health Governance” in Taiwan
Similar to JECH Glosario Salud en todas las políticas 2013 (20)
Revisión útil de las concepciones de la salud de las poblaciones y de los modelos útiles en salud pública para explicar y predecir las situaciones de salud y de enfermedad en las poblaciones.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
1. Glossary for the implementation of Health
in All Policies (HiAP)
Alix Freiler,1
Carles Muntaner,2,3
Ketan Shankardass,1,3,4
Catherine L Mah,3
Agnes Molnar,1
Emilie Renahy,1
Patricia O’Campo1,3
1
Centre for Research on Inner
City Health, Li Ka Shing
Knowledge Institute, Toronto,
Ontario, Canada
2
Bloomberg School of Nursing,
University of Toronto, Toronto,
Ontario, Canada
3
Dalla Lana School of Public
Health, University of Toronto,
Toronto, Ontario, Canada
4
Department of Psychology,
Wilfrid Laurier University,
Waterloo, Ontario, Canada
Correspondence to
Alix Freiler, Centre for Research
on Inner City Health, Li Ka
Shing Knowledge Institute, 209
Victoria Street, 3rd floor,
Toronto, ON, Canada
M5C 1N8;
freilera@smh.ca
Received 10 April 2013
Revised 15 July 2013
Accepted 17 July 2013
Published Online First
28 August 2013
To cite: Freiler A,
Muntaner C, Shankardass K,
et al. J Epidemiol
Community Health
2013;67:1068–1072.
ABSTRACT
Health in All Policies (HiAP) is becoming increasingly
popular as a governmental strategy to improve
population health by coordinating action across health
and non-health sectors. A variety of intersectoral
initiatives may be used in HiAP that frame health
determinants as the bridge between policies and health
outcomes. The purpose of this glossary is to present
concepts and terms useful in understanding the
implementation of HiAP as a cross-sectoral policy.
The concepts presented here were applied and
elaborated over the course of case studies of HiAP in
multiple jurisdictions, which used key informant
interviews and the systematic review of literature to
study the implementation of specific HiAP initiatives.
INTRODUCTION
Evidence suggests there is a growing gap in world-
wide health inequities.1–6
Structural determinants
are important in addressing these inequities and
particular attention must be paid to the ways in
which governments of all levels work to address
such issues (including governance).7
To narrow
widening health inequities worldwide, the 2008
report by the Commission on the Social
Determinants of Health recommended that ‘pol-
icies and programmes must embrace all the key
sectors of society not just the health sector’ (p. 1).5
Health in All Policies (HiAP) is becoming increas-
ingly popular as a governmental strategy to
improve population health by coordinating action
across health and non-health sectors.8–13
A variety
of intersectoral initiatives may be used in HiAP that
frame health determinants as the bridge between
policies and health outcomes.
Public health researchers and practitioners are
increasingly expected to study and inform the
policy initiatives of government; yet, the complex-
ity of policies and their intended and unintended
consequences present major challenges.14 15
For
example, health policies do not always improve
population health and not all non-health policies
have health effects.16
Other glossary contributions
have examined healthy public policies, welfare
regime concepts, health inequalities, core public
administration and policy change theories.17–20
Healthy public policies refer to policies that
‘improve the conditions under which people live’,
and include policies implemented by both health
and non-health sectors.17
Our glossary comple-
ments these contributions by proposing a conceptu-
alisation of specific techniques, structures and
strategies required to bring sectors together for
health equity. In doing so, it addresses three gaps in
the previous glossaries. First, it expands upon the
dimension of policy implementation introduced in
the previous glossary by Smith and Katikireddi;20
second, it highlights issues specific to intersectoral
action; and third, it reflects theoretical premises
that have been empirically refined.
The concepts presented here were applied and
elaborated over the course of case studies of HiAP
in multiple jurisdictions, which used key informant
interviews and the systematic review of literature to
study the implementation of specific HiAP initia-
tives. In particular, realist methods have informed
our understanding of how and why certain struc-
tures and strategies are useful in implementing
HiAP.21–25
In addition to enabling researchers and
other stakeholders to contribute to the implementa-
tion of HiAP initiatives, this glossary also reflects
the need for a better understanding of the intersec-
tion between a HiAP approach and the study of
policy implementation to encourage more rigorous
evaluation of these initiatives.
This glossary is described in two parts, as illu-
strated by figure 1 (underlined terms are defined in
the glossary). First, the implementation of HiAP is
described as a special case of intersectoral action
for healthy public policy where intersectoral
engagement is the process for bringing different
sectors together in action. Second, intersectoral
engagement is driven by strategies and other factors
that aim to place HiAP on sectoral agendas (ie,
agenda setting) and through the provision of spe-
cific resources (ie, capacity building). We discuss
two strategies to setting the sectoral agenda, raising
awareness of the importance of a HiAP approach,
including how each sector can contribute, and
using a ‘win–win’ approach, where sectors stand to
gain by using a HiAP approach. In building capacity
for sectors to best implement HiAP, there are two
considerations: institutional capacity (eg, infrastruc-
ture, ‘manpower’ and financial resources) and
expert capacity (eg, expertise and training). Also
potentially important in engagement is a sector’s
prior experience with intersectoral action as this
may inform their interest in working on imple-
menting HiAP.
POLICY IMPLEMENTATION
Health in All Policies
A single case of HiAP reflects a multisectoral initiative
toward healthy policymaking involving the national
or state/provincial level of government where sectors
collaborate (often through processes of cooperation,
coordination or integration) to develop policies and
programmes that include population health initiatives
for preventing the manifestation of inequities (ie,
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1068 Freiler A, et al. J Epidemiol Community Health 2013;67:1068–1072. doi:10.1136/jech-2013-202731
Glossary
2. these are initiatives that are not limited to increasing access to
primary healthcare; these actions involve impacts on social deter-
minants of health such as education, housing conditions or
poverty reduction). Such action could aim to impact equity by tar-
geting marginalised or otherwise dispossessed populations (eg,
using means testing) but should also include a universal approach
to preventing inequities (ie, across the population at-large). HiAP
requires a mechanism for moving beyond the detection of health
equity problems (eg, mere health equity impact assessment) to
foster remedial action involving an intersectoral response. It is
recognised that policies related to HiAP may foster multiple pro-
grammes or projects at multiple levels of context (ie, multiple
entry points for the implementation policies and strategies)—
either directly or indirectly related to the policy commitment.
HiAP approaches are distinguishable from other intersectoral
initiatives to advance health equity in two important ways. First,
HiAP approaches are coordinated primarily by formal structures
and mechanisms of governments, although they may include non-
governmental actors, including those from academic, private, and
community/civil sectors. Second, initiatives adopted under HiAP
approaches are explicitly linked to structural or long-term govern-
mental policies or agendas, rather than being ad hoc in nature.
Intersectoral action
The concept of intersectoral action developed in several waves,
preceding that of HiAP. In 1978, the Alma-Ata Declaration on
Primary Health Care called for action by health, social and eco-
nomic sectors for the ‘attainment of the highest possible level of
health’, leading to the Health for All movement in the 1980s
and 1990s.26
An early definition originated at the 1997 World
Health Organization’s Conference on Intersectoral Action for
Health:
A recognised relationship between part or parts of the health
sector with part or parts of another sector which has been
formed to take action on an issue to achieve health outcomes (or
intermediate health outcomes) in a way that is more effective,
efficient or sustainable than could be achieved by the health
sector acting alone.27
Intersectoral action may occur across various levels of govern-
ment and between governmental and non-governmental sector,
and does not necessarily rely on formal structures (ie, commit-
tees, legislation).28
As a result, they may be ad hoc in nature,
unlike the HiAP approach whose design is for long-term endur-
ance. Intersectoral action may be issue-specific (eg, tobacco
control) or centred around responding to systemic concerns (eg,
overall quality of life).29
During HiAP implementation, individ-
ual projects may be issue-specific but a HiAP mandate focuses
distinctly on addressing systemic considerations (see intersec-
toral model in Solar et al).30
Therefore, if intersectoral action is the coordination of
various sectors towards the improvement of health equity, HiAP
should be considered the most administratively integrated,
formal and systemically-focused form of intersectoral action.
Intersectoral action may also be referred to as intersectoral
initiatives, intersectoral approach or whole-of-government
approach. However, whole-of-government approach implies a
horizontal, government-only arrangement, whereas intersectoral
action can include both horizontal and vertical relationships as
well as non-governmental agencies.31
Intersectoral engagement
The process of recruiting health and non-health sectors to col-
laborate on policymaking for health outcomes. In many cases,
this responsibility may fall on members of the public health or
healthcare sectors but special bodies or committees (ie, intermi-
nisterial or cabinet committees) may also be involved in the
process.32 33
We draw on the analytic framework of Morestin
et al,34
in which they describe the important considerations for
government in the implementation of health policy: acceptabil-
ity and feasibility. Because HiAP necessarily involves multiple
sectors, this framework is useful in understanding how to
engage sectors given their own concerns. As a result, this
approach makes progress towards the implementation of a HiAP
approach and relies on strategies, such as agenda setting and
capacity building to generate acceptability and feasibility.
Implementation
The carrying out of a governmental decision as specified by offi-
cial legislation or formal strategy (ie, mandate).35 36
Mandates
signal the beginning of HiAP implementation and may: (1)
outline processes and, in some cases, (mandatory) rules for
Figure 1 Relationship among terms
related to Health in All Policies (HiAP)
implementation.
Freiler A, et al. J Epidemiol Community Health 2013;67:1068–1072. doi:10.1136/jech-2013-202731 1069
Glossary
3. healthy policymaking, for example, the use of health impact
assessment tools in policy development—mandates could reflect
a ‘paper strategy’ (ie, the initial policy plan) that requires trans-
lation in developing processes for healthy policymaking and
may be interpreted differently as various actors participate in
implementation; (2) allocate or provide guidance on the division
of responsibilities for implementation of health policy making
processes between specific sectors, other formal structures (eg,
committees, quasi-governmental institutes) or levels of govern-
ment; and (3) allocate resources (broadly) to support processes
for healthy policymaking.
DRIVERS OF INTERSECTORAL ENGAGEMENT
Agenda setting
A key process for implementing HiAP requiring the alignment
of multiple interests to facilitate ‘buy-in’ by potential collabora-
tors. This reflects the notion that implementation requires what
Morestin et al34
refer to as acceptability. In particular, stake-
holders consider the acceptability of both the need for and
appropriateness of the policy solution (eg, is the problem
important, is the solution logical and one that we can live with),
as well as of the legitimacy/accountability and capability of the
system within which the policy will be implemented (ie, deci-
sions makers, the decision-making process and the actors
involved in implementation).
Agenda setting refers to the process of narrowing issues on
which governments focus their attention.37 38
The term agenda
setting is typically used in the context of the early stages of the
policymaking ‘cycle’ (eg, to encourage the adoption of an initial
mandate). We use agenda setting to reflect the need for accept-
ability of the mandate to be agreed on by the diverse and poten-
tially numerous sectors required to actively participate
throughout the implementation of HiAP.
Kingdon argues that the policy process relies on the conver-
gence of three policy streams: problems, politics and policy.
Therefore, understanding how to shape the problem can be par-
ticularly effective in engaging political actors.39
Ultimately,
acceptability of HiAP by non-health sectors may be gained by
defining the problem in a particular way. As Stone notes:
[P]roblem definition is never simply a matter of defining goals
and measuring our distance from them. It is rather the strategic
representation of situations… Representations of a problem are
therefore constructed to win the most people to one’s side and
the most leverage over one’s opponents (original emphasis)
(p. 106–7).40
Therefore, understanding each sector’s needs and culture may
be crucial to frame the need for HiAP in a way that places it on
their agenda.32
For example, while some sectors may share the
value of equity (eg, in a sector devoted to providing social ser-
vices), others may be more concerned with compatible goals,
like social sustainability. As a result, agenda setting may require
problem definition to occur uniquely for different sectors and
levels of government, and it may be fostered as a result of
greater awareness or a range of contextual factors (eg, political
orientation of a government or in relation to a prior experience
with health or sustainability). The way in which the problem is
defined or framed may contribute to whether a HiAP approach
is prioritised by non-health sectors or whether it winds up on
their agendas at all. Therefore, setting the agenda may entail
agreement on values associated with the mandate (eg, in terms
of a health equity or social sustainability agenda), achieved by
raising awareness, or finding other ways to motivate buy-in to
the mandate, such as using a win–win approach.
Raising awareness
Raising awareness, specifically, refers to the need and reasons for an
intersectoral approach to address health equity articulated to poten-
tial participants in order to set a HiAP agenda.10 11
For example,
awareness may be raised on the contributions of non-health sectors
to public health outcomes or, alternatively, sectors’ influence on
health.11
In South Australia, several awareness-raising strategies
were used to engage non-health sectors, such as using their 2004
South Australia Strategic Plan targets to assess health impacts and
intersectoral workshops exploring the potential links between stra-
tegic plan targets and individual sectors.9
While an awareness-
raising strategy may, in some cases, boost HiAP higher on sectors’
agendas, it may not lead to the acceptability of a HiAP approach,
which may depend on a sector’s familiarity and/or comfort with
intersectoral action or health equity (see Prior experience section) as
well as the feasibility of implementation for individual sectors.
Win–win approach
Alternatively, employing a win–win approach (also referred to as
mutual gains and cobenefits) may be more effective in engaging
certain non-health sectors to implement HiAP, where ‘(t)he goal
is to achieve health gains but not to diminish the primary inten-
tion of various sectors or agencies. The aim is to look at expected
health gains, but also, for example, social and economic gains’
(p. 12).12
This strategy is useful where there is no simple agree-
ment on values associated with the mandate (eg, in terms of a
health equity or social sustainability agenda) and where agenda
setting is facilitated by appealing to non-health interests (eg, sec-
toral efficiencies), ultimately, leading to the acceptability of a
HiAP strategy. In essence, the win–win approach should demon-
strate that through addressing health considerations, non-health
sectors can still invest full attention in their own agendas, yet
achieve both health and non-health benefits for populations.
Krech describes this approach as a form of ‘health diplomacy’
‘to make the healthier choice the easier choice for policy
makers’.41
This is in contrast to the notion that more directive
approaches to agenda setting can lead others to view the health
sector as ‘imperialists’.42
Others note that this may involve trade-
offs in short-term goals and values to foster durable relations
with increasingly health-aware partners.10 32 43
Capacity building
A key process for implementing HiAP contingent on the pres-
ence of appropriate and/or adequate human, information, finan-
cial or infrastructural resources for implementation of a HiAP
strategy. This reflects the notion that implementation requires
what Morestin et al34
refer to as feasibility. In particular, actors
may consider institutional and expert realities of implementing
a HiAP strategy (eg, do actors know what to do and how to do
it, and do they have the financial, infrastructural or human
resources to do it).
While some of these resources may be present for implemen-
tation by design (ie, implementation as it was originally con-
ceived), other resources may be required to deal with challenges
that emerge in the course of implementing HiAP, which suggests
an ongoing process of capacity building. For example, the
context of frequent human resources transitions in public sector
bureaucracies may result in poor ‘institutional memory’ within a
particular staff team for intersectoral implementation processes.
Institutional capacity
A dimension of capacity building related to the need for appro-
priate/adequate resources to support the development and
1070 Freiler A, et al. J Epidemiol Community Health 2013;67:1068–1072. doi:10.1136/jech-2013-202731
Glossary
4. implementation of HiAP, including: (1) processes for healthy pol-
icymaking that may need to be developed in order to meet the
objectives of the mandate, such as the adoption of a health
impact assessment tool to facilitate cross-sectoral consultation
during policy development; (2) civil servants and experts to carry
out day-to-day activities related to processes for healthy policy-
making (human resources as ‘manpower’); (3) knowledge of or
training in how to use resources appropriately (see Expert cap-
acity section); (4) infrastructure for facilitating processes for
healthy policymaking, such as websites containing informational
resources and ‘bricks and mortar’; and (5) financial resources to
support various aspects of processes for healthy policymaking. In
particular, the availability of financial resources may also signal
the importance of a HiAP strategy and encourage cross-sectoral
commitment (read: acceptability), which may (in turn) lead to
the availability of other aspects of institutional or expert capacity.
Institutional capacity is strengthened by the way in which the
mandate is structured, specifically: (1) in using existing systems or
structures (or automaticity); (2) its consistency with applicable/
appropriate legislation (or conformity); and (3) when the govern-
mental body initiating, financing or authorising a policy is also
being involved in its implementation (or directness).34 35 44
Expert capacity
A dimension of institutional capacity related to the need for appro-
priate/adequate resources to develop and implement processes for
healthy policymaking, including: (1) politicians and civil servants
within sectors possessing the expertise or knowledge to collabor-
ate on healthy policymaking processes (human resources as ‘staff
expertise’), including to support the use of tools for healthy pol-
icymaking, like health impact assessment, (2) to train staff (ie, civil
servants within sectors) about the processes for healthy policy-
making (eg, the use of health impact assessment tools in policy
development) and (3) to support staff in decision-making through
the provision of evidence and analysis (eg, informational resources
about the potential health impacts of road development or the
possible applications of health impact assessment, respectively). As
a result, expert capacity strengthens the overall operation of imple-
mentation when specific resources are made available, such as per-
sonnel, material resources and technology.35 45
Prior experience
A dimension of intersectoral engagement where previous
involvement with activities related to healthy policymaking and/
or intersectoral action may facilitate agenda setting or capacity
building and, ultimately, increased acceptability of the values
associated with a HiAP strategy and/or increased knowledge of
technical aspects of implementation (ie, expert capacity). For
example, prior experience may be relevant where activities
involved adherence to similarly intersectoral values (eg, in
working toward social sustainability) or required similarly inter-
sectoral solutions (eg, in using environmental impact assessment).
Prior experience may also facilitate implementation because of a
sector’s familiarity with the structural aspects of HiAP (see con-
formity and automaticity under Institutional capacity section).
Acknowledgements The authors gratefully acknowledge Alex St. John for his
contributions to the analyses and write up of the case studies and the support of
Peterborough KM Hunter Charitable Foundation.
Contributors This glossary was jointly conceived by AF, CMun and KS. AF wrote
the first draft of the glossary and CMun, KS, CLMah, AM and POC contributed to
the editing. CMun and ER suggested using a visual framework. ER was involved in
the earlier stages of glossary conceptualisation. AF, CMun, KS, CLMah and POC
contributed to the revisions.
Funding This work was supported by Canadian Institute of Health Research grant
numbers 111608 and 96566 and the Ontario Ministry of Health and Long-Term Care.
Competing interests None.
Ethics approval Research Ethics Board, St. Michaels Hospital.
Provenance and peer review Not commissioned; externally peer reviewed.
Open Access This is an Open Access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which
permits others to distribute, remix, adapt, build upon this work non-commercially,
and license their derivative works on different terms, provided the original work is
properly cited and the use is non-commercial. See: http://creativecommons.org/
licenses/by-nc/3.0/
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