Improving health across sectors: a health in all policies approach for the state of Delaware
Cain, Rachael Marion
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CONTEXT: Health is influenced by a broad range of social, economic, and environmental factors beyond the typical remit of professional public health. It is therefore increasingly recognized that multiple sectors need to be engaged in efforts to improve population health. Health in All Policies (HiAP) is an approach to systematically consider health across policies and programs. HiAP has not been implemented in Delaware, despite interest from stakeholders. Using Delaware as a model state where HiAP could be implemented comprehensively, this research sought to answer two questions: 1) “What HiAP adoption and implementation models are appropriate for the state of Delaware?” and 2) “Using the Intervention Mapping framework, how can such models be adapted to the state?” The study provides a method to operationalize HiAP – which can be used by researchers and practitioners globally – and gives Delaware a concrete plan to move HiAP forward. METHODS: The study used a cross-sectional design to achieve its aims. Methods included document review, key informant interviews, focus groups, and a questionnaire. Thematic analysis was used to analyze qualitative data and descriptive statistics were generated to examine questionnaire data. Intervention Mapping, a framework for program design, implementation and evaluation, provided the study’s guiding structure. FINDINGS: Three key findings emerged regarding HiAP broadly: 1) HiAP practitioners do not adequately use strategic communications to increase buy-in across sectors; 2) the scope and reach of HiAP is influenced by the degree of institutional power held by the lead organization and cross-sector partners; and 3) practitioners do not fully recognize the importance of being adaptable throughout HiAP implementation, which hinders sustainability. The study also synthesized best practices and identified Delaware’s relevant contextual factors. The research demonstrated the value Intervention Mapping can bring to operationalizing HiAP. CONCLUSIONS: Scholars need to refine the essential elements of HiAP to add: 1) strategic communications across sectors and 2) flexibility throughout HiAP implementation. Practitioners and researchers seeking to advance HiAP in a jurisdiction should use contextual factors and Intervention Mapping to systematically create a theory-based, practical approach with measurable objectives. Future research should further examine the roles of strategic communications and institutional power in HiAP.