Taking health into account in all policies
Authors: Lauri Kokkinen
Journal: The Lancet Global Health (2015)

Francisco Becerra-Posada (July, 2015)1Becerra-Posada F Health in all policies: a strategy to support the Sustainable Development Goals.Lancet Glob Health. 2015; 3: e360Summary Full Text Full Text PDF Scopus (14) Google Scholar writes about the efforts of the Pan American Health Organization to take up the challenge of addressing the social determinants of health through action across sectors and on becoming the first in the world to adopt a Regional Plan of Action on Health in All Policies. I fully agree with his comment that “the public health community now has a unique opportunity to use a Health in All Policies approach in informing policies and practices”.1Becerra-Posada F Health in all policies: a strategy to support the Sustainable Development Goals.Lancet Glob Health. 2015; 3: e360Summary Full Text Full Text PDF Scopus (14) Google Scholar However, I would like to stress that adopting a Health in All Policies plan does not automatically lead to taking health into account in all policies. For an example, Finland's role in promoting Health in All Policies in the European Union has been substantial,2Ståhl T Wismar M Ollila E Lahtinen E Leppo K Health in all policies: prospects and potentials. Ministry of Social Affairs and Health, Helsinki2006Google Scholar whereas the realpolitik in Finland has not always been very health-supportive. The first Finnish national programme “Health for all by the year 2000” was implemented in 1986, and at the very same year the abrupt liberalisation of Finnish financial markets led to massive unemployment and widening health inequalities.3Kokkinen L Muntaner C Kouvonen A Koskinen A Varje P Väänänen A Welfare state retrenchment and increasing mental health inequality by educational credentials in Finland: a multicohort study.BMJ Open. 2015; 5: e007297Crossref Scopus (11) Google Scholar A revised programme was implemented in 1993, which was soon followed by severe austerity policies that were not allocated evenly across all public spending but were more heavily concentrated on the services for social classes with least power to resist them.4Lehto J Blomster P Recession in the 1990s and its policy influence on social and health care services.Yhteiskuntapolitiikka. 1999; 64 (in Finnish).: 207-221Google Scholar The latest programme “Health 2015” was implemented in 2001, and, 3 years later, the Finnish alcohol policy was changed dramatically despite warnings given by health impact assessments, resulting in a 20% rise in alcohol-related mortality within a year.5Herttua K The effects of the 2004 reduction in the price of alcohol on alcohol-related harm in Finland: a natural experiment based on register data. University of Helsinki, Helsinki2010Google Scholar As Becerra-Posada writes,1Becerra-Posada F Health in all policies: a strategy to support the Sustainable Development Goals.Lancet Glob Health. 2015; 3: e360Summary Full Text Full Text PDF Scopus (14) Google Scholar attention must be given to the development of capacities and structures for taking health into account in all policies. But should the public health community also give attention to raising the standing of health on the political agenda and to helping induce political solutions through often contentious and divisive political policy processes? I declare no competing interests. Health in all policies: a strategy to support the Sustainable Development GoalsRegarding the Comment by Jeff Waage and colleagues (May, 2015)1 about governing the UN Sustainable Development Goals (SDGs), we appreciate the authors' perspectives on the process of finalising the SDGs and agree with their recommendations to develop new and more accountable governance structures that work across sectors. As a result, the Pan American Health Organization (PAHO) has begun to incorporate the Health in All Policies framework,2 putting it into practice across the region of the Americas. Full-Text PDF Open AccessTaking health into account in all policies – Author's replyThe singularity of the opportunity presented by the UN Sustainable Development Goals (SDGs) lies in their explicit aim to support economic, social, and environmental development that promotes human rights, sustainability, and equity. And there is no better way to achieve this goal than promoting health. Within the complexity of the proposed goals and targets lies a key strength: the stakeholders responsible for promoting the broader sustainable development agenda agree to define development not in the reductive terms of gross domestic product, but framed by central considerations of equity, health, and sustainability. Full-Text PDF Open Access