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Is health care too important to be left to health departments?

Toronto, February 19, 2015

By Geoff Koehler

Dr. Andrew Pinto
Dr. Andrew Pinto. (Photo by Amna Iqbal)

Some governments have decided that health care is too important to leave to their health departments and have made health care a priority for all departments. The concept, called Health in All Policies, or HiAP, has gained traction in some governments but little research has gone into measuring its effectiveness.

In a study published today in the journal BMC Public Health, St. Michael’s Hospital researchers interviewed 12 to 14 policy makers from each of Sweden, South Australia and Quebec – three governments that have adopted HiAP.

Before decisions are made and policies implemented, most governments practicing HiAP use health impact assessments to inform policy makers about the potential effects of a project or policy on a population’s health and well-being.

“Politicians in these high-income regions are concerned about the growing costs of health care and see HiAP as part of the solution,” said Dr. Andrew Pinto, lead author of the study and a family physician with St. Michael's Hospital. “But the policy makers we spoke to made it clear that even when health impact assessments are available, political agendas are still a key factor in determining whether to implement policy.”

Quebec’s Public Health Act requires all government departments ensure that their legislative bills and regulations will not have significant negative health impacts on the population. Recognizing the influence of municipal policies on the determinants of health, Quebec has also attempted to incorporate HiAP at the local level. For example, the small Quebec town of Acton Vale requested a health impact assessment for a residential development near a snowmobile trail and school. The assessment called for safe street design to prevent accidents, asked for measures to reduce noise pollution and encouraged the preservation of green space for physical activities.

Experienced policy makers told the researchers that health impact assessments are important to guiding policy development, however, the policy makers conceded that when final decisions were made HiAP assessments were often absent, informal or incomplete.

Funding for HiAP initiatives is often split between government departments, which is another challenge to its success.

“Funding can come jointly from groups and several levels of government, which can be a good thing if it increases participation across levels of government,” said Dr. Pinto. “But shared investment between ministries can create challenges if there are underlying tensions or power struggles playing out between the government groups.”

Dr. Pinto said more research needs to be done but that he hopes this study and research to come will help governments lay the groundwork for effectively establishing HiAP and measuring its impact.

“HiAP is potentially a powerful tool for reducing health inequities by bringing the potential health impact of certain decisions to the surface, especially those concerning the most vulnerable populations,” said Dr. Pinto. “Combined with economic evaluation, this gives you a chance to pause, consider the costs and benefits and perhaps alter the policy to better address the needs of the population, especially the needs of the most marginalized.”

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.