Abstract
For three decades, Canadian and international researchers have been suggesting that improving population and public health requires attention to a range of determinants and factors and that concerted and coordinated action on the part of non-health ministries and organizations might be necessary to achieve this goal. Suggestions have been made for collaboration and integration by explicitly designing intersectoral actions and interventions and assessing the impact of all policies and programs for their effects on health. While some progress has been made on these goals, it is minor compared to the size of the problem. This article addresses one type of intersectoral action, Health in All Policies (HiAP), and asks questions about why it has not gained a place in governments across Canada. Possible barriers are suggested, such as current structural and political factors that prevent long-range, shared strategies to improve health. Suggestions are made for generating economic and evaluative data on HiAP, developing more sensitive tools for measuring HiAP and adopting explicit “trans-sectoral” approaches to policy-making.
Key words: Health in All Policies, social determinants, equity, intersectoral action
Résumé
Depuis 30 ans, les chercheurs canadiens et internationaux font valoir que l’amélioration de la santé publique nécessite de porter une attention particulière à un ensemble de déterminants et de facteurs, et qu’une action concertée et coordonnée de la part des ministères et organismes non liés au secteur de la santé est nécessaire. Pour réaliser cette collaboration et cette intégration, il a été suggéré de concevoir des plans d’action et d’intervention explicitement intersectoriels et d’évaluer l’impact sur la santé de toutes les politiques et de tous les programmes. Bien que de nombreux progrès aient été réalisés, ceux-ci restent mineurs face à un problème de cette taille. Notre article se penche sur une catégorie d’actions intersectorielles, « La santé dans toutes les politiques (SdTP) », et s’intéresse aux raisons pour lesquelles ce programme ne s’est pas imposé dans les différentes administrations du Canada. Certains facteurs sont abordés, tels que les structures et politiques actuelles qui font obstacles à l’amélioration de la santé publique par des stratégies communes de longue portée. Nous suggérons des moyens de produire des données économiques et évaluatives sur les actions SdTP afin d’élaborer des outils plus sensibles pour mesurer ces actions et d’adopter des approches « transsectorielles » plus claires dans les processus décisionnels.
Mots clés: La santé dans toutes les politiques, déterminants sociaux, équité, action intersectorielle
Footnotes
Disclaimer: The opinions expressed in this article are those of the authors alone.
Conflict of Interest: None to declare.
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