Are you confident your council’s decisions consider the opportunities to improve your communities’ health and wellbeing? Our health, and the gap between good and poor health in our communities, is shaped far more by where we live, learn, work and play than by hospitals.
These wider determinants or ‘building blocks’ of health include warm homes, safe streets, good jobs, clean air, education, transport, green spaces and social support. Councils have significant influence over many of these wider determinants of health.
By embedding considerations of health and health equity in decisions about the wider determinants, there is potential to:
- Reduce pressure on your local social care, NHS and other public services by tackling problems before they start.
- Deliver shared wins: from better-connected transport and inclusive growth to warmer homes and safer streets.
- Tackle inequality: target resources where needs are greatest, to level the playing field and narrow the health gap.
Health in All Policies (HiAP) is “an approach to public policies that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts.” (World Health Organisation Helsinki Statement, 2013.
Leicestershire: embedding health in every decision
Leicestershire County Council introduced health impact questions into its decision-making process and supported staff with training and tools. The result? More than 250 people have already applied this thinking to areas like libraries, school buildings, and transport planning. The approach helps deliver better decisions, saves money through prevention, and ensures that health is considered early, when it can make the biggest difference
HiAP asks us to ‘think health’ before we decide. It’s a smarter way of working:
- It can be applied at any scale, from frontline service decisions to corporate plans, Local Plans and homelessness strategies, to cross-authority economic deals.
- People, communities and partners come together, to understand how decisions may impact on health, to identify and shape solutions to improve health, to share resources.
- It’s about prevention: a small change ‘upstream’ eg, in a planning decision or licensing policy, can delay or avoid costly downstream health and social care needs.
Southampton: tackling substance harm with a whole-council strategy
Southampton City Council used a ‘health in all policies’ approach to create a single strategy for tobacco, alcohol and drugs that spans all council departments. Each directorate leads on its own part, making it easier for staff to take ownership and act. This whole-council approach has built relationships, improved services, and laid the foundation for long-term progress on complex health issues.
What you can do next
- Find out if your council is already considering health and wellbeing in decision-making and taking a health in all policies approach across the council: speak to your local public health team, have a look at Council, Scrutiny and other committee reports for a ‘health implications or consideration’ section, and ask officers if and how they’re doing this.
- Review upcoming decisions in the Forward Plan: think about how these have the potential to impact on your communities’ health and wellbeing, and inequalities, and where there might be opportunities to achieve ‘win wins’ such as an improved health and more people in good employment
- Ask for consideration to health, wellbeing and equity in some or all of the decisions you feel have the potential to impact, for example request health impact assessments where decisions have potential to impact on specific neighbourhoods or populations who already experience inequalities
- With officers, and partners, share the stories you hear from your communities about how their lives, health and wellbeing, are affected by the wider determinants of health; facilitate and advocate for your communities to be involved in decisions that have the potential to affect their health and wellbeing
- Refer to the LGA’s guide to local authority public health responsibilities and to the online HiAP resource [add LINK] for more information, and ideas and stories of how other councils are taking this approach [add link to case studies page].
East Sussex: working together on health and housing
East Sussex created a cross-sector partnership with a shared vision: safe, healthy homes for all. The strategy brings together councils, health services and communities to tackle homelessness, poor housing, and fuel poverty. It shows how long-term partnerships can improve services and reduce pressure on health and care by addressing problems at their root.
Questions you could ask about Health in All Policies (HiAP)
Questions to ask officers about current practice
- Where in our decision making processes do we currently consider health, wellbeing and health equity?
- Do committee reports include a clear “health implications” section? If not, why not?
- How are officers supported to think about health impacts — do they receive training, tools or templates (e.g., health impact questions or assessments)?
- Which teams already use a HiAP approach, and where are the gaps?
- Are we routinely identifying opportunities for ‘shared wins’ (e.g., warmer homes, safer streets, inclusive growth) when developing proposals?
Questions to inform scrutiny of individual decisions
- What are the potential positive and negative health impacts of this decision?
- Which communities or population groups are most affected? Does this risk widening health inequalities?
- Have we applied a Health Impact Assessment (HIA), especially for decisions affecting specific neighbourhoods or vulnerable groups?
- Are wider determinants of health, such as housing, transport, employment, green space or air quality — clearly considered in the paper?
- Could small upstream changes reduce future pressure on social care, the NHS or other services?
Questions about partnership working
- How are we working with NHS, VCS, housing, economic development and other partners to maximise health benefits?
- Are partners aware that we are taking a HiAP approach? How are they involved in shaping decisions?
- Do we have a shared vision across partners for tackling the wider determinants of health?
- How are community voices — including those with lived experience — being built into the decision making process?
Questions about strategy, planning and corporate frameworks
- Does our Local Plan, Transport Plan or other strategic frameworks explicitly address health and health equity?
- Are health considerations built into our corporate plan, performance framework and impact assessment processes?
- How does the Forward Plan reflect decisions that could influence long term health and wellbeing?
- Do we have a council wide HiAP strategy or governance mechanism, (see Southampton’s whole council approach)?
Questions about implementation, impact and improvement
- How do we monitor and evaluate the health impact of major decisions over time?
- What evidence or data do we routinely use to understand health inequalities in our area?
- How are findings from HIAs or other assessments used to improve the final decision or design of the programme?
- What barriers prevent us from embedding health consistently, and what support would help?
- Where have we seen good examples of HiAP already in our council (similar to Leicestershire, Southampton or East Sussex), and what can we learn from them?