What is healthy public policy about?
Public policies refer to strategic actions led by a public authority with the aim of increasing the presence of a phenomena, such as health and well-being, within the population.i
Healthy public policy is one of the five building blocks of the Healthy Communities Approach. These policies can take many forms across a community to improve population health and quality of life, but are not necessarily developed by the health sector,ii as they focus on broader structural and social determinants of health rather than downstream healthcare services.iii Healthy public policy improves housing, living conditions (education, food security, childcare, transportation), livelihoods, and social and health services.iv
Examples of healthy public policy-focused projects include:
- Developing an equity-informed policy framework, or integrating an equity lens into an existing policy framework
- Engagement, implementation or evaluation processes for strengthening the equitability of a policy under development
- Conducting a policy analysis from an equity perspective; looking through an equity lens in order to revise an existing policy or plan, such as a transportation plan, housing strategy, poverty reduction strategy or election bylaw
- Initiating an exploratory study or report on a potential healthy public policy in your community, such as a feasibility study for an agricultural land trust or a report on the potential impact of a participatory budgeting process
How can we make healthy public policy work for everyone?
Healthy public policy brings health and equity considerations to all areas of policy, with the end goal of improving health outcomes for all. To do so, existing public policies must be analyzed and evaluated for their impact on health equity and population health. Both applied research and academic research are used to help to inform where improvements can be made. Then, new policy approaches can be introduced that address these health impacts.v
Approaches such as Health Impact Assessment can be used to ensure equitable outcomes. Health Impact Assessment is an evidence-based methodology that informs the decision-making process by assessing the ways in which policies both positively and negatively affect health outcomes.vi
Policy-making is a complex, nonlinear process. To ensure that healthy public policy is effectively implemented, it is useful to assess potential health trade-offs at each stage of the policy development process. The National Collaborating Centre for Healthy Public Policy uses a five-stage model for policy development:vii
- Agenda setting
- Policy formulation
- Adoption/decision making
- Implementation
- Evaluation
Source: https://www.ncchpp.ca/docs/ModeleEtapesPolPubliques_EN.pdf
Questions can be asked at each of these stages to assess unforeseen or hidden health outcomes of a policy. For example, at the agenda setting stage, questions such as “Are the impacts of the problem on population sub-groups known, particularly on vulnerable or marginalized groups?” or “What social norms are relevant to this problem?”viii can be brought forward to evaluate how equitable a policy is. Further examples of potential questions to ask can be found here.
Why does healthy public policy matter for local and Indigenous governments?
Although the intent of a policy is to increase well-being, oftentimes, adverse effects on health are indirect and difficult to predict. Public policies can improve population health on an overall average, but unintended consequences can surface further down the line that increase inequity among certain communities.
Excerpt from The Missing Middle Mystery, by planner Uytae Lee. In this video, Lee explains how historical zoning policies in Vancouver that were originally meant to improve the well-being of certain groups in society have resulted in a lack of diverse housing stock in the city, contributing to housing unaffordability.
“As many of the determinants of health lie outside the domain of the health sector, such as housing, income, and physical environments, healthy public policy approaches cross multiple policy domains. As such, partnerships and collaboration with other sectors such as education, transportation, urban planning, among others, continue to be a priority for public health practice.ix”
–Excerpt from Winnipeg Regional Health Authority’s Healthy Public Policy Toolkit
Governments need to stay vigilant in ensuring that policies are constantly evaluated and incremental changes are made so that inequitable consequences are remedied. In creating, adopting and evaluating a public policy though a health equity lens, local and Indigenous governments can create long-term positive impacts for community members.
