1963-2013 - 50 years of Research for Social Change

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Back | Programme Area: Social Policy and Development

Health Systems as Social Institutions: Progress towards Health in All Policies

  • Project from: 2012 to 2013


Health is intrinsic to social and economic development – as a determinant, a measure of progress and an outcome. One of the greatest challenges facing health systems worldwide relates to the fact that population health and health equity are produced largely outside the health sector. Ensuring that population health is a shared goal across all areas of public policy – in sectors such as education, agriculture, transport and environment, as well as in economic and social policies – is essential for improving population health and thus social well-being.

The Research Issue in Context

In the struggle for developmental and inclusive social policy, health is a battleground on which competing visions of the ethical and political basis of society are fought out. Health systems act as powerful drivers of inclusion or exclusion. But it is also outside the health sector, in areas such as employment, transport, education and the environment, that many health problems are created, or where solutions to ill-health may be built.

The World Health Organization’s (WHO) Commission on the Social Determinants of Health, established in 2005, attracted fresh attention to such issues, which had arisen in global debates in the 1970s. The government of Finland used the opportunity of its presidency of the European Union in 2006 to focus on Health in All Policies, emphasizing the crucial role that public policies outside the health sector play in determining population health. As part of its ongoing commitment in this area, Finland, in collaboration with the WHO, convened the 8th Global Conference on Health Promotion from 10–14 June 2013 in Helsinki.

UNRISD collaborated with the Ministry of Social Affairs and Health of Finland on a key input to this conference: as editor and contributor to a volume Health in All Policies: Seizing Opportunities, Implementing Policies. Targeted at national policy makers worldwide, this volume brings together leading experts from around the world to explore pathways to promoting health equity through health in all policies. It reviews and evaluates the evidence on intersectoral approaches to health in different contexts, drawing out good practices and lessons for policy and implementation.

Research Objectives and Questions
Examples of intersectoral action for health, or Health in All Policies approaches, are found mainly in developed economies with strong state institutions. But what are the appropriate policy approaches for improving population health and promoting health equity in countries with limited financial and human resources, a poorly developed health sector or weak governance structures? What is the relationship between health and other key development indicators (economic, social or demographic, for example), and what does this mean for the choice of effective health policies and approaches in different development contexts?

Methodology/Approach
The chapter "Health and development: Challenges and pathways to HiAP in low-income countries" (Sarah Cook, Shufang Zhang and Ilcheong Yi) addresses these questions, drawing on earlier UNRISD research which positions health policy as part of broader social and public policies. Health systems are the institutional expression of these policies, rooted in legal rights, values and political commitments. They are also an important means of redistribution and solidarity. From this perspective, health systems (which encompass health care, public health, health promotion and assessment of the health implications of other policies) are the institutional expression of ethically framed policy commitments of a society – which should equally be expressed across all sectors.

Outputs and Activities
In addition to serving on the editorial and advisory committees, UNRISD Director Sarah Cook together with Shufang Zhang, Project Coordinator, and Ilcheong Yi, Research Coordinator, contributed the chapter, "Health and development: Challenges and pathways to HiAP in low-income countries".

The volume was launched at a side event of the World Health Assembly on 23 May 2013 from 12.30-13.45 in Room XV of the Palais des Nations in Geneva.

This project was a collaboration between UNRISD, the Finnish Ministry of Social Affairs and Health, the Finnish National Institute for Health and Welfare and the European Observatory on Health Systems and Policies. It is funded by the Finnish Ministry of Social Affairs and Health, the Finnish National Institute for Health and Welfare, and the Ministry of Foreign Affairs of Finland.