人人共享，人人健康

ContentsExecutive SummaryIntroductionWhat Is HiAP?Why Should CountriesImplement HiAP?What Are The CriticalSuccess Factors?Where To Begin With IntersectoralPolicies?Future DirectionsConcluding Thoughts 45811283031333 The COVID-19 pandemic helped bring to lightthe inadequacies of public health infrastructureworldwide. It also highlighted acute weaknessesin the health system as well as challenges relatedto resilience. Policy changes focused on thehealth security agenda to improve the system’sability to respond to short-term, high-impactthreats through better crisis coordination, surgediagnostics, care, disease control capacity, andglobal collaboration, among other priorities.Before and since the pandemic, a differenttype of problem has been brewing: the chronicinsufficiencies of policymaking writ large. Wedescribe these insufficiencies as ‘chronic’ becausethey relate to the activities and features of thesystem that are slow-growing and persistentand, in contrast to acute inadequacies, have beenside-stepped by the pandemic-driven momentumfor reform. These inadequacies take the form ofsiloed policy mandates, inactive collaborationnetworks, and fragmented public service delivery.The neglect of these chronic inadequaciesleaves societies worse off in terms of health andwellbeing. Indeed, policymaking systems aroundthe world are at a critical juncture, which, if leftunaddressed, could propel a divergence betweenthe structure of the policymaking system and itsability to achieve new ambitions for populationhealth beyond strictly responding to emergencyevents.Introduction The COVID-19 pandemic brought much-neededattention to the systemic weaknesses in local andglobal health systems. The resulting conversationson health system change have focused onresilience and capacity building to withstandshort-term, acute health threats. This focus,however, has come at the expense of discussionson systemic weaknesses addressing long-termhealth threats (e.g., non-communicable diseases,antimicrobial resistance, and climate change,among others). The emergence of these long-term threats will require us to address the widerdeterminants of health (i.e., the influences onhealth from outside the health sector), which itselfrelies on a deep commitment to collaboratingacross different sectors and levels of government– even without short-term, acute health threats. Itis also an appropriate time to identify governancemodels that can drive intersectoral collaboration,given policymaking trends that have createdgreater distance between entities involved inpublic service delivery – notably, governmentdecentralization and privatization. Health in AllPolicies (HiAP) provides a blueprint to foster amore efficient and representative future of healthvia its whole-of-government approach, crucialto ‘healthy’ policymaking both within the healthsector and outside it.1Government of South Australia and Global Network for Health in All Policies. The Global Status Report on Health in All Policies [Internet]. Adelaide (AU): Government of South Australia; 2019[cited 2023 Jan 5]. Available from:https://actionsdg.ctb.ku.edu/wp-content/uploads/2019/10/HiAP-Global-Status-Report-final-single-pages.pdfHiAP has been implemented in over 40jurisdictions around the world1. Its tractioncontinues to grow as governments realize HiAP’spotential to unlock the intersectoral collaborationrequired for the promotion of population health,health equity, and sustainability. Within eachjurisdiction, the concept of HiAP has been adaptedto the local context.In doing so, new and existing HiAP programsneeded to consider shared challenges relative toachieving effective collaboration with multiplestakeholders, each with their own focus areasand priorities. For this, HiAP programs needto employ several tools to help achieve thedesired impact, including robust governance andeffective coordination and communication withstakeholders.The cases of Finland, South Australia, and theKingdom of Saudi Arabia demonstrate howcountries can introduce HiAP in practice. Lookingto the future, HiAP programs will need toconsider how to engage stakeholders beyond thepublic sector to achieve their full potential. Thefuture of HiAP lies in evolving from a ‘whole-of-government’ to a ‘whole-system’ approach thateffectively brings a wide range of stakeholdersinto the fold – be they public sector, private sector,or third sector – to continue advancing populationhealth, health equity, and sustainability in theirrespective jurisdictions.Executive Summary“The cases of•Finland,•South Australia, and•the Kingdom of Saudi Arabiademonstrate how countriescan introduce HiAP in practice.”4 As policymaking systems navigate this criticaljuncture, they will need to look at governancemodels that can marry their new ambitions withtheir new configurations, which otherwise run therisk of pulling in opposite directions.Indeed,new governmental ambitions are trendingtoward holistic definitions of progress, includingconcepts such as ‘