Health in All Policies--All Talk and Little Action?(Commentary) (Report‪)‬

Canada has long been a leader in establishing direction on population and public health through the release of inspiring documents such as the Ottawa Charter for Health Promotion and the Epp Report, both published in 1986, (1,2) and legislation such as the Canada Health Act in 1984. (3) Numerous reports have been released over the past three decades establishing the importance of improving the determinants of health and reducing inequities, generating upstream interventions, or designing policies with health uppermost in mind. (4-7) These have parallels in other countries, notably England, in initiatives such as the Whitehall studies (beginning in 1967) and the Marmot Review. (8) Recently, the World Health Organization held a Commission on the Social Determinants of Health, led by Sir Michael Marmot and engaging Canadian leaders such as Monique Begin in key roles. (9) Health in All Policies (HiAP) is a type of large-scale intersectoral action to improve health through attention to the full range of determinants. Because it does not take a single form and tends to develop seamlessly out of other initiatives, it is difficult to pinpoint exactly when or how it started. According to some researchers, it was first instantiated in Sri Lanka in 1980, but the term has become much more common in the last decade. (10) Finland, which has been recognized as one of the pioneers in implementing HiAP, promoted HiAP as a theme of its 2006 presidency of the European Union, releasing a comprehensive report on prospects for improving the social determinants of health through cross-government policy; (11) these principles have been reiterated at international conferences in Rome (in 2007) (12) and Adelaide (in 2010). (13)