With improvements in life expectancy stalling and inequalities in healthy life expectancy widening, there is growing recognition across the UK of the importance of improving and maintaining people’s health and reducing health inequalities. It is clear this cannot be achieved from action by the ‘health’ system alone.

People’s health is, to a large extent, shaped by the social, economic, commercial and environmental conditions they live in – the wider determinants of health. People who experience health-promoting conditions, such as a good education, high-quality employment, a decent and secure home, and strong, supportive relationships, are more likely to lead long, healthy lives than those without such opportunities. Whether through transport, housing, or fiscal or employment policies, decisions taken by national and local governments have the potential to create the conditions for healthy lives, or indeed erode them. Thus, there is a need for whole government strategies to create conditions that enable people to lead healthy lives.

‘Health in all policies’ is an established approach to improving health and health equity through concerted cross-sector action on the wider determinants of health. This collection of case studies illustrates practical attempts to do this around the world, from Australia to Canada. Some show national initiatives, while others focus on action taken in regional or local authorities. Each project achieved different successes and demonstrated various challenges, and all offer valuable insights into implementing health in all policies for the UK and beyond.

The collection is not designed to be prescriptive, but aims to stimulate ideas, generate discussion, and share knowledge and experience from around the world.

Background to health in all policies

Governments across the globe have responsibilities for the health and wellbeing of their citizens. In 2013, at the Eighth Global Conference on Health Promotion – organised by the World Health Organization (WHO) and Finland’s Ministry of Social Affairs and Health – governments endorsed a definition of health in all policies (see the box below). This important step built on decades of international work to improve health and equity through the wider determinants of health.

Box 1: Defining health in all policies: the Helsinki Statement

'Health in all policies is 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.'

The aim of the statement was to encourage a pragmatic, systematic approach to embedding health and health equity considerations across sectors, policies and service areas. In practice, the approach may entail collaboration between two or more parts of government, or it may involve stakeholders outside government, such as businesses and voluntary, community and social enterprise (VCSE) organisations.

A health in all policies approach should consider the perspective and priorities of the non-health policy area, such as transport or housing policy, when developing strategies to improve health. For example, by aiming to reduce traffic congestion, it is possible to work through the strategies that will both achieve this goal for transport departments and deliver wider health benefits, such as through reduced air pollution and more active travel. By considering other sectors’ priorities and constraints from the outset, participants are best able to capture the full range of health improvement opportunities their sector offers, and to show how such a sector’s core activities are relevant to health, rather than appearing to add health activities to the department’s existing work.

A health in all policies approach is built on the principle of co-benefits: all parties that contribute should benefit from being involved. As well as improving health and health equity, partnerships should support other sectors to achieve their own goals, such as creating good-quality jobs or local economic stability. At the same time, a healthier population is likely to bring social and economic benefits to other sectors in the long term. This offers further rationale for cross-sectoral investment.,

Making this happen in practice is not simple. Working across sectors to improve health presents several challenges for traditional models of public policy. The policymaking process is rarely a linear path from ideas to implementation, and the process can become even messier when policy problems are complex, affected by multiple factors, and require a coordinated response across departments and over time. Policy partnerships often struggle to navigate the cultural, organisational and accountability issues they face. There is therefore value in taking a systematic approach to learning from past experiences of implementing health in all policies.

The UK context

In the UK, various pieces of legislation give public bodies duties around improving health and reducing inequalities. For example, in England the Health and Social Care Act 2012 confers on local authorities a duty to improve health in their localities, and the Social Value Act 2012 requires the public sector to consider economic, environmental and social wellbeing when commissioning services.

Wales and Scotland have gone further and created their own separate national frameworks for assessing the impact and value of policy decisions on health and wellbeing. In Wales, the Well-being of Future Generations (Wales) Act 2015 aims to improve the country’s social, economic, environmental and cultural wellbeing. It places a duty on a wide range of public bodies, including government ministries, local authorities and local health boards, to work towards seven wellbeing goals: prosperity, resilience, health, equity, community cohesion, a vibrant culture and thriving Welsh language, and global responsibility. The act also sets out five principles for ways of working that public bodies should adopt to achieve the goals: long term, prevention, integration, collaboration and involvement. By enshrining these goals in legislation, the Welsh government aimed to embed health and equity considerations across all sectors. The act also established a Future Generations Commissioner to promote the sustainable development principle, acting as a guardian for future generations, and to hold public bodies to account for implementing their wellbeing objectives.

Scotland’s National Performance Framework was launched in 2007 and put into law in 2015. It is a wellbeing framework that reflects the Scottish people’s values and aspirations, that aligns with the United Nations Sustainable Development Goals, and that tracks progress in reducing inequality. It articulates 11 national outcomes – such as Scottish people growing up loved, safe and respected so they realise their full potential, and living in inclusive, empowered, resilient and safe communities – and tracks progress towards these outcomes through 81 economic, social and environmental indicators. The Scottish government uses the data to develop policy and services across Scotland.

In practice, there are increasing numbers of cross-sectoral collaborations for health at local and regional levels too. For example, since devolution of its health and social care budget in 2015, Greater Manchester has brought together NHS organisations, local authorities and other stakeholders to improve the population’s health, reduce inequalities and address growing demand for health services. The reforms have involved joining up public services in neighbourhoods, developing shared city-wide governance and decision-making processes, and pooling budgets to achieve mutually agreed goals by 2021, such as 16,000 fewer children living in poverty and 1,300 fewer people dying from cancer.

The Health Foundation, with NHS Research and Development, has funded an evaluation to explore the changes that followed Greater Manchester’s devolution and its impact on health, inequalities, and health and social care services. A qualitative analysis of the first 18 months of devolution was published in 2018. It described stakeholders’ strong support for adopting a place-based approach and integrating public services to improve health, but noted a variety of challenges to implementing reforms. The evaluation’s quantitative findings will be reported in 2019.

There remains both scope and need for more cross-sectoral action. A health in all policies approach has not been implemented at the pace and scale many hoped for. National and local policymaking often fails to seize opportunities to improve health through non-health policy levers and does not account for the harmful health effects of non-health policies.

Why this publication?

Implementing a health in all policies approach is not without challenges, but much more can be done to unlock the potential of government and local authorities to improve health through cross-sectoral action.

Despite extensive literature on the barriers to, and facilitators of, health in all policies, there is a lack of pragmatic, context-specific evidence showing how actors have successfully built partnerships and why different approaches have worked or failed in different settings.

In recognition of this need, the Health Foundation commissioned the UK Health Forum to analyse international examples where national, regional or local governments have introduced social policies or programmes to improve health and reduce health inequalities through actions outside the health sector.

For each case study, the researchers explored the context in which the policy and action evolved, how the actors developed ideas and solutions, the motivation for and attitudes towards interventions, and what helped or hindered implementation. Finally, they reflected on what their findings might mean for the UK.


To identify the case studies, the research team initially consulted international public health research and policy experts, looking for examples of national, regional or local government-led policies or programmes, implemented from the year 2000 onwards, which aimed to improve health through non-health sector action. From a long list of 35 options, the team carried out detailed literature searches. They shortlisted those policies and programmes with clear evidence of: the intervention’s goals and the lead institutions; the outcomes or intended outcomes; the context in which the intervention was developed; and how the ideas and solutions came about. The final nine case studies were selected to provide a diverse range of non-health sector policies, countries and policy implementation levels.

For each case study, the researchers interviewed key stakeholders – either participants in the policy process or academics who had reviewed or evaluated the policy – who provided first-hand insights into what influenced the policy process, what did and did not work, and why.

The team analysed the findings in relation to several theoretical policy frameworks. They identified themes in each case study that helped explain how or why the intervention succeeded or failed and what this might mean for UK policy and practice. The researchers also looked for consistent themes between the case studies to generate more overarching learning points.

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