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Volume 81 • Number 4




As environmental health practice increas-

ingly shifts from a regulatory focus toward

community-based approaches to prevention,

more jurisdictions are adopting a Health in

All Policies (HiAP) approach. While the lit-

erature provides multiple definitions of HiAP,

we use the definition provided by the World

Health Organization (WHO), which encom-

passes outcomes, purpose, and an ultimate

goal: HiAP 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” (WHO, 2014). This

practice uses a systems approach to ensure

that policy making has neutral or beneficial

health impacts.

Environmental health professionals rou-

tinely work with other sectors, so HiAP is

particularly relevant as a process that can

promote prevention-focused policies across

sectors to improve health outcomes. As such,

environmental health professionals have

played a key role in developing HiAP initia-

tives. For example, the District of Colum-

bia’s HiAP taskforce is cochaired by the city’s

Department of Health and Department of

the Environment (National Association of

County and City Health Officials [NAC-

CHO], 2017). At the state level, California’s

HiAP Task Force works on a number of

environmental health initiatives, including

healthy housing, air quality, climate change,

and green spaces (California Strategic

Growth Council, 2018).

Identifying the Need for a Unifying


In 2015, the National Association of County

and City Health Officials (NACCHO) under-

took a review of current HiAP efforts across

the country, focusing specifically on local

governmental efforts. The authors of this

evaluation updated an earlier literature

review on HiAP (Gase, Pennotti, & Smith,

2013); interviewed state and local practi-

tioners who were implementing HiAP; and

explored the themes, commonalities, and dif-

ferences that distinguished their approaches

(NACCHO, 2017). Two trends emerged from

this work.

First, interest in HiAP has exploded in

recent years. Though the concept of “inter-

sectoral collaboration for health” dates back

to the 1978 WHO Declaration of Alma-Ata,

HiAP has truly proliferated both nation-

ally and internationally in the past 15 years

(Rudolph, Caplan, Ben-Moshe, & Dil-

lon, 2013). As an illustration of this recent

growth, PubMed search results over time for

“health in all policies” (quotations included)

reveal only one article on the topic published

in 2007, compared with 29 results in 2016.

Nevertheless, research efforts remain rela-

tively nascent.

Abs t r ac t

As environmental health practice increasingly shifts

from a regulatory focus toward community-based approaches to prevention,

more communities are adopting a Health in All Policies (HiAP) approach.

This approach uses a systems approach to policy making to ensure that

policies have neutral or beneficial health impacts. As communities engage

in cross-sector collaborations, however, the lack of a consistent vision and

defined role for environmental healthprofessionals can limit implementation.

We address this challenge by proposing a framework for understanding the

various terms and methods used to describe HiAP efforts; we also identify

roles for environmental health. Our framework begins with collaboration

as the core of intersectoral work, then overlays other government-based

and health-based approaches. HiAP sits at the final intersection of these

elements. The resulting framework provides practitioners with a common

language for working with partners, assessing current HiAP work, and

planning and evaluating HiAP implementation.

Tiffany J. Huang, MPH, MA

Department of Sociology

Columbia University

Bridget Kerner, MS

National Association of County

and City Health Officials

Sandra Whitehead, PhD

National Environmental

Health Association

Navigating Degrees of

Collaboration: A Proposed

Framework for Identifying

and Implementing Health in

All Policies