LGA/ADPH Annual Public Health Conference and Exhibition: 11 February 2015 Health & Health Equity in All Policies Mark Dooris, Professor in Health & Sustainability, University of Central Lancashire Adviser, Health Equity and Place Division

2Health & Health Equity in All Policies O VERVIEW : T HE C ONCEPT  Health in All Policies (HiAP) strongly advocated by WHO and EU – and adopted worldwide.  “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, 2013]  Building on the Marmot Review and appreciating the importance of making equity an explicit focus, Health Equity and Place Division is exploring how PHE can support a ‘Health and Health Equity in All Policies’ (H&HEiAP) approach.

3Health & Health Equity in All Policies O VERVIEW : T HE C ONCEPT  H&HEiAP recognises that:  health and health equity are values and goals in their own right, and prerequisites for achieving other societal goals  governments at all levels have range of often divergent priorities, informed by concerns that are difficult to reconcile.  H&HEiAP offers a framework to co-ordinate ‘horizontally’ and ‘vertically’ – and to manage competing and conflicting interests transparently, supporting all sectors to find ‘win-win’ solutions and contribute positively to health, wellbeing and equity outcomes.

4Health & Health Equity in All Policies C ONTEXT : D ETERMINANTS OF H EALTH King’s Fund/LGA (2014) Making the Case for Public Health Interventions

 Health and health inequalities (and associated risk factors) largely determined by living conditions and wider factors – which in turn are controlled by policies and actions outside of the ‘health’ sector.  Effective action on the wider determinants of health therefore requires action across multiple policy areas and sectors. 5Health & Health Equity in All Policies R ATIONALE : W HY H&HEiAP? Ackn: EuroHealth  H&HEiAP offers a means of working with and ‘joining up’ across government departments (nationally and locally) – to consider systematically and comprehensively how relevant policy areas can incorporate health and health equity considerations.

 Locally, the transition of public health into local authorities offers the opportunity to improve health and reduce inequalities by:  leading and influencing across the whole of local government to address the wider determinants of health that are affected by a range of local authority policies and functions  commissioning in ways that apply a ‘H&HEiAP’ perspective.  Nationally, Government policy provides a context for local action – and PHE’s seven priorities represent complex ‘wicked’ challenges underpinned by wider determinants: to address them effectively demands policy and action across the whole of government and the whole of society; and solutions require cross-government and cross-sector working, able to reveal potential conflicts and highlight synergies and co-benefits. 6Health & Health Equity in All Policies N ATIONAL AND L OCAL P ERSPECTIVES

7Health & Health Equity in All Policies A M ULTI -L ENS A PPROACH  Health is just one of many priorities: in implementing H&HEiAP, we can choose to take a ‘single-lens’ or ‘multi-lens’ approach.  The former can be seen as ‘health imperialist’ and may fail to maximise synergies and identify conflicts between policy agendas.  The latter risks health being marginalised as one of many ‘boxes to tick’, but offers potential to pursue ‘win-win’ approaches by identifying co-benefits across sectors. It also points to the need for appropriate/inclusive language that spans boundaries and secures buy-in/ ownership.  It is important to consider how health/health equity relate to agendas such as wellbeing and sustainability – and to develop a joined-up ‘narrative’. Ackn: International Futures Forum

8Health & Health Equity in All Policies I MPLEMENTING THE H&HEiAP A PPROACH  Effective implementation requires use of ‘hard’ tools such as health impact assessment, alongside active engagement with the ‘softer’ dimensions of the policy process – such as leadership; implementation; stakeholder engagement; relationship-building across sectors and policy arenas [+ links to agendas such as social value and return on investment].  H&HEiAP can:  focus on specific public health issues (e.g. obesity) and identify policies with major impact  focus on a key policy area with significant health impacts (e.g. transport, housing) and work with relevant department/sector  focus on windows of opportunity that can potentially provide success for all partners.

9Health & Health Equity in All Policies N EXT S TEPS PHE will pursue its work on H&HEiAP – with a focus on national and local levels:  Nationally, it will work with DH and Cross-Government Officials’ Group on Public Health to explore how it can influence across Whitehall.  Locally, it will work with PHE centres, LGA and ADPH to support local authorities and wider public health system to develop and implement the approach. Photo Credit, David Niblack, imagebase.nettt

10Health & Health Equity in All Policies D ISCUSSION  To what extent are you already embracing and implementing the Health and Health Equity in All Policies approach?  What are the opportunities and challenges for further embedding this work in a systematic and comprehensive way?  What are the particular opportunities and challenges offered by housing for public health and wellbeing?  How can PHE best offer support?