Policy and Position Statements


Health in All Policies Position Statement

I. ASTHO Supports a Health in All Policies Approach

In recent years, it has become more apparent that the health of communities is determined by a multitude of factors beyond healthcare, and, in many cases, beyond the traditional scope of public health activities. Public health practitioners, researchers, and policymakers have started to look more closely at the root causes of chronic diseases that face modern societies and are beginning to identify social and environmental circumstances as major contributors. Health in all policies (HiAP) is an encompassing approach that goes beyond the boundaries of the health sector.  The Surgeon General's National Prevention Strategy, released in June 2011, uses a HiAP approach. Lack of access to quality, affordable housing, limited access to public transportation, neighborhoods where the built environment prevents safe physical activity, and agricultural practices that contaminate food and water are all examples of modern day environmental conditions that significantly affect health but do not fall under the scope of any one single agency or organization. Thus, to fully address the health consequences and benefits of all public projects, policies, and programs and to improve population health in the future, it is imperative that diverse sectors work together to address complex issues through a Health in All Policies approach.

Although engagement in HiAP can be challenging due to lack of precedents, limited funding, and competing priorities, it is imperative that state and territorial health agencies (S/THAs) embrace the challenge and take a leading role to improve the long-term health of communities.

II. Within This Context, ASTHO Recommends:

  • ASTHO recommends working across sectors to improve public health, acknowledging that decisions and policies made in non-health sectors have significant impact on the health of populations.
  • ASTHO recommends HiAP as a strategy for moving S/THAs and their partners closer to the goal of achieving health equity and addressing the social and environmental determinants of health and recognizes that population health cannot be improved without addressing disparities and their root causes.

Strategies for Achieving HiAP

  • ASTHO supports the role of S/THA leadership in promoting HiAP, as well as encouraging leadership in other sectors to incorporate health considerations into their work.
  • ASTHO recommends the use of HiAP principles and strategies in all sectors, including those with emerging links to public health (e.g., education) as well as less traditional linkages (e.g., criminal justice).
  • ASTHO supports the use of HiAP principles and strategies for more closely aligning the public health and healthcare systems.
  • ASTHO believes that HiAP is most effective in achieving sustained integration of health concepts into the work of non-health sectors when common goals are defined and specific activities are proposed that benefit both parties.
  • ASTHO recognizes the crucial role of local partners, including local health agencies, nongovernmental agencies, and community members, in defining the health values and needs of their own communities and encourages S/THAs to provide support for their work.
  • ASTHO encourages S/THAs to provide active leadership in health consultation to non-health sectors where current laws already mandate the inclusion of health in state projects and policies.
  • ASTHO supports the use of health impact assessments as promising tools for achieving HiAP.
  • ASTHO supports the integration of HiAP into ongoing S/THA work across all departments and levels, including policy, programs, and initiatives, as a means of employing a preventive approach to broadly address public health issues.
  • ASTHO supports the use of state-level, multiagency task forces to begin discussions around HiAP or specific topics.
  • ASTHO recognizes that although HiAP is a relatively new concept, cross-sector work that integrates health considerations in non-health sectors is ongoing in many S/THAs, and S/THAs have significant capacity and expertise that is valuable to internal and external stakeholders in a HiAP initiative.
  • ASTHO supports the engagement of the private sector as a valuable partner in HiAP initiatives.
  • ASTHO encourages all HiAP partners to recognize and enumerate the economic costs and benefits of HiAP strategies and activities.

III. Background

HiAP is a collaborative approach that articulates and integrates health considerations into policymaking and programming across sectors and at all levels to improve the health of all communities and people. ASTHO supports a leadership role for S/THAs in a coordinated, national, multidisciplinary, and multilevel HiAP initiative. S/THAs are the primary protectors and promoters of basic public health services to communities, including the protection of food and water and the encouragement of a built environment that facilitates healthy lifestyles and injury prevention. As such, S/THAs are well-suited to integrate health protection and health equity activities across the multiple divisions and programs in their agency and to collaborate with other sectors to define and achieve mutually beneficial goals.

Environmental Health and HiAP

Environmental health is concerned with interactions between humans and their environments that affect human health. The field emerged from a need to protect people from chemical or biological threats in their environment, with a focus on issues such as sanitation and air pollution. More recently, the scope of environmental health work has expanded to include creating health-promoting environments, such as homes, workplaces, schools, neighborhoods, and communities. As such, the term "environment" has become a broad, all-encompassing term for the situations humans face every day.

Recognizing the complexity and extensiveness of human-environment interactions, creating healthier populations is an evolving challenge for the field. One distinct feature of environmental health is that the environmental factors that influence health are often under the jurisdiction of multiple agencies or organizations. For example, environmental agencies may be responsible for air and water quality, while natural resource agencies may be responsible for energy creation. Therefore, it would be nearly impossible to improve population health without addressing the policies, programs, and projects created by these other agencies and organizations. HiAP provides a framework for working with other sectors to address these multifaceted issues.

Chronic Disease and HiAP

The prevention of chronic disease involves adopting effective primary, secondary, and tertiary intervention strategies. In the past, chronic disease prevention was largely seen as the responsibility of the healthcare sector and was centered around health screening using key indicators such as blood pressure, cholesterol levels, and tobacco use. Individuals depended on their healthcare practitioner to recommend pharmacotherapy to manage their illnesses. However, as obesity, diabetes, and other chronic diseases become more prevalent, attention to individuals' environments, including places they live, work, and play, has played an increasingly larger role in chronic disease prevention. Access to healthier food, injury prevention efforts, safe and accessible places for physical activity, smokefree environments, and the integration of community services with primary care are important components of a comprehensive approach to chronic disease prevention. There are many key partners and sectors that must work together to create safer and healthier communities that allow individuals to better prevent or manage chronic disease.  

IV. Summary

The HiAP approach aims to improve health outcomes and mitigate health disparities by establishing a multidisciplinary framework that allows partners from various sectors to come together and advance overall health.

Approval History:

ASTHO position statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate Policy Committees and the ASTHO Executive Committee. Position statements are not voted on by the full ASTHO membership.

Environmental Health Committee Review and Approval: March 2013
Prevention Committee Review and Approval: January 2013 
Board of Directors Review and Approval: June 2013

Position Expires: June 2016

For further information about this position statement, please contact ASTHO Environmental Health Policy staff at environmentalhealth@astho.org.