‘Wellbeing in every decision’: reframing ‘health in all policies’
We know that most of the things that influence population health — poverty, education, the environment, transport, work, relationships, safe and comfortable homes — are not really touched by what the money marked as ‘health’ gets spent on. If we’re going to make a big impact on health, what we really need therefore is an approach in which local and national decision makers explicitly consider health in all policies….
Luckily we do — and it’s called, nattily, Health in All Policies (HiAP).
The WHO defines HiAP 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. 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”.
Bit wordy, perhaps… but great! Problem solved! We can all bask in the warm salutogenic glow of health being created and improved all over the place. Except, of course, we can’t. The underlying aspiration of HiAP is great but it hasn’t been well or widely implemented. Partly, I’m sure, this is because budget cuts have reduced the capacity to do, well, anything. But I think there might be another reason for the failure of HiAP to really take off: language.
Language can affect both what we understand and how we feel about something. Some health-related examples might include:
• The different connotations of the phrases ‘committed suicide’ and ‘died by suicide’; the former implies some aspect of criminality, immorality or other wrongness (we would say commit a sin, an error, a crime); the latter is neutral and non-judgemental.
• Similar for ‘substance abuser’ and ‘having a substance misuse disorder’; immorality vs illness.
• Disagreements on whether the term ‘social prescribing’ is appropriate and/or useful.
• Whether a focus on ‘resilience’ is admirable or yet another way to shift the onus onto individuals and communities to accept their lot and sort themselves out, instead of fixing bigger…