Implications of the Adelaide Statement on Health in All Policies

Data presented at the United Nations Summit in September in New York has revealed that many countries are unlikely to achieve all the health targets of the Millennium Development Goals by 2015.¹ The simultaneous and interrelated challenges of poverty, health, food security, energy, the global economic crisis and climate change should be viewed by the global community as a unique opportunity to develop innovative approaches to achieve sustainable growth without compromising health equity.

One such innovative approach is the concept of working across many sectors to improve governance for health and well-being. In April 2010, experts and practitioners from multiple sectors gathered in Adelaide, South Australia, for the International Meeting on Health in All Policies. Their discussions on how the health sector can support broader policy goals related to societal well-being evolved into the Adelaide Statement on Health in All Policies.²

The Adelaide Statement draws on the increasing body of knowledge on “joined-up” government³ to propose a new way for governments to engage multiple sectors in the joint goal of improving health and well-being. It starts by stressing the need to examine the management of policies and goals across government. Further, it calls upon the health sector to be involved in the development of policies in other sectors to ensure health equity. This does not necessarily mean a departure from the health sector’s main functions, but rather a broadening of its scope and role within public policy-making.

The Adelaide Statement describes key features of this type of intersectoral work – referred to as a Health in All Policies “approach” – as well as the professional capacities needed within the health sector. It acknowledges that most governments are organized in “silos” – each sector having its own leadership, organizational structure and culture. The Statement advocates moving towards a hybrid system of policy-making to enable governments to cope more effectively with the increased interdependency of today's societal challenges. It calls on the health sector to play a supportive role in other sectors and to improve its “understanding [of] the political agendas and administrative imperatives of other sectors” in order to participate in broader policy debates.

For the health sector to play a broader role, new accountability arrangements must also be created across government that recognize that health and well-being issues are in everyone's interest. The Adelaide Statement describes promising models emerging from different corners of the globe. Crucial to their success has been the creation of decision-making structures and processes relevant to different constituencies (politicians, the administration and broader society), and the application of tools for assessing social and health impacts.

Most importantly, the health sector needs to undergo a cultural change in its approach to public health. This will have implications for its relationships with other sectors. Change will take time: it will involve continued learning from both successes and failures and will require new evidence-gathering standards. Of critical importance to understanding other sectors' policies and interventions, and the effectiveness of the Health in All Policies approach, will be an alignment of evidence criteria to include observational studies⁴ of policy and implementation contexts and processes. This approach to evidence is exemplified in the growing body of work in nutrition and food policy.⁵

Changes will also be needed in human resource development. Schools of public health, medicine, nursing, allied health sciences and public administration will be critical partners in ensuring that the health workforce is up to the challenge of working across sectors. Dual-degree programmes have been established between public health and fields such as law, journalism, public policy and administration, and urban planning.⁶ This is an excellent start, however, more work needs to be done to incorporate the principle of intersectoral action into the core curriculum requirements for all students of public health.

The time has come for an accountability mechanism between governments and their citizens, to ensure that global commitments on health are honoured. The shortfalls in progress towards the Millennium Development Goals have occurred not because they are unreachable, but rather due to unmet commitments, inadequate resources, lack of focus and insufficient interest in sustainable development. The Adelaide Statement is a stepping stone that shows the way forward for improving accountability and the effectiveness of government.