The 2020/21 Director of Public Health (DPH) Annual Report and the COVID-19 Health Impact Assessment highlighted the need to tackle the root causes of health inequalities to improve residents’ health and wellbeing.
The Annual report recommended adopting a Health in All Policies (HiAP) approach to reduce health inequalities and ensure health considerations were embedded into all council decisions. This recommendation was endorsed by Warwickshire Health and Wellbeing Board in March 2021, setting in motion a coordinated effort to embed HiAP principles across the council and its partners.
A HiAP project team, initially largely comprising of public health colleagues, was established to drive forward the implementation of the HiAP approach. The first two phases of the implementation plan, approved by Warwickshire Corporate Board, focused on raising awareness and building organisational commitment to a HiAP approach.
Visible support from the council’s senior leadership team demonstrated strong senior level support in the County Council (‘the council’). However, HiAP was not well understood across directorates (Social Care and Health, Communities, Resources, and Children and Young People) and risked remaining a high-level aspiration without practical tools or ownership from colleagues outside of the public health team.
The public health team identified the need to build capacity across the council workforce to ensure HiAP became a practical, understood, recognised and owned approach, embedded in the council’s ways of working. This required developing resources, strengthening governance and fostering ownership among services beyond Public Health.
One-to-one discussions with council service areas explored how HiAP principles could be applied to their work, ensuring the approach felt relevant and practical across the organisation.
Results
In 2021, the project team supported a group of early adopters who were keen to bring HiAP principles into their work. One of the strongest examples was the incorporation of HiAP into Warwickshire’s Local Transport Plan, helping to shape a transport strategy that actively considers the health and wellbeing of residents.
Alongside this, the project team helped build capability across the workforce through the development of a new Children and Young People (CYP) Making Every Contact Count training course which had 330 participants completing the course in its first year of launch.
By engaging senior leaders, managers, and practitioners, the course has helped staff bring meaningful, health focused conversations into their everyday interactions with children, young people, and families.
As the wider work progressed, the HiAP project team grew to include colleagues from a much broader range of council services. This expanded involvement helped build genuine ownership and enthusiasm across the organisation, leading to the creation of a refreshed and more active WCC HiAP Network.
HiAP is now embedded within council processes, through integration within the council’s Strategy Development Framework ensuring that health implications are considered at the earliest “strategy proposal” stage and are reflected in the way strategic priorities and deliverables are shaped across service areas.
Early discussions have also begun around the development of a framework for healthy places, which would provide a shared approach for embedding health and wellbeing into spatial planning decisions across Warwickshire.
Senior leaders have reinforced this work by delivering a series of HiAP briefings and have created a series of “talking head” videos featuring the council’s four executive directors. These videos help to clearly articulate the importance of HiAP from a leadership perspective, strengthening its credibility and raising its profile across the organisation.
The HiAP Network is now developing an internal HiAP Toolkit in partnership with communication colleagues. This includes:
- Guidance, codesigned with staff volunteers from each directorate, to apply HiAP principles in ways that align with their service priorities
- Directorate briefings to share examples and build understanding
- A tiered training programme to include:
- A “Health in All Our Work” e-Learning course for the council’s workforce, to educate learners on the wider determinants of health, and how cross sector collaboration can improve health outcomes.
- Training for managers
- Training for senior leaders
In addition, a new HiAP intranet page - the Heathy Warwickshire Hub - will act as a single repository for all HiAP related resources, and an updated external webpage will provide easy access to information and resources for partners and the public.
Developing system capacity
Alongside work to develop internal council capacity and awareness of HiAP there has been clear strategic steer that a systemwide approach to HiAP should be explored.
Following endorsement at the Warwickshire Health and Wellbeing Board in 2021, this has included:
- Working in partnership with the Local Government Association, a series of workshops were held with external partners through the three Place Partnerships to strengthen understanding of the HiAP concept and its relevance to local priorities.
- Organisational adoption of HiAP at Nuneaton and Bedworth Borough Council including incorporation of health and wellbeing considerations within the governance processes and delivery of HEAT (Health Equity Assessment Tool) service specific workshops.
- Working closely with Warwickshire’s District and Borough planning teams and the WCC Developer Negotiations and Contributions Team, to embed health at every stage of the planning process.
- This partnership has allowed health considerations to be built into Local Plans and supported the development of robust health impact assessment (HIA) guidance.
- The public health team is also routinely engaged in reviewing planning applications, providing standardised response for larger schemes, tailored input for smaller developments, and helping shape a more localised approach to HIAs.
- At the development stage, joint work is underway to set out clear public health requirements for developer contributions and to create a “planning for healthier places” webpage. This collaborative way of working has ensured that health is no longer an add on, but a shared priority embedded throughout the planning process.
- A green and blue spaces workshop jointly facilitated by WCC’s Country Parks team and public health where different organisations shared examples of how they are actively working with communities to better connect people with nature. This workshop has resulted in a proposal for a countywide green and blue spaces partnership.
By the end of 2024 an end of year Report was jointly produced with system partners to showcase progress and illustrate integration at different levels:
- Service level – Planning
- Organisational level - Nuneaton and Bedworth Borough Council
- Place level - South Warwickshire Place Partnership
- System level – Whole Systems Approach to Healthy Weight
This was presented to the Warwickshire Health and Wellbeing Board in January 2025, reflecting the growing maturity of the approach. As a direct outcome, HiAP has now been formally embedded as a core component of the refreshed Health and Wellbeing Strategy 2026 - 2031.
In addition, the 2024 Director of Public Health Annual Report (also presented to Warwickshire Health and Wellbeing Board in Jan 2025) recommended accelerating the HiAP approach through Warwickshire’s three place-based Health and Wellbeing Partnerships, to capture and coordinate activity across the wider system.
Warwickshire’s HiAP journey continues to evolve with growing ownership across the County Council and partners, ensuring that improving health and wellbeing and reducing inequalities is at the heart of everything the council does.
Contact Chioma Chimezie [email protected] for further information.