For decades, the prevailing logic of public health focused on the clinical encounter—the interaction between a patient and a provider within the four walls of a clinic. However, as any practicing physician can attest, the most significant drivers of a patient’s health often happen long before they enter the exam room. From the quality of local housing and the availability of fresh produce to the safety of urban transit and the stability of employment, the “social determinants of health” dictate outcomes far more than medical interventions alone.
This realization has given rise to the “Health in All Policies” (HiAP) approach—known in French as politiques publiques favorables à la santé (PPFS). The philosophy is simple but ambitious: since health is influenced by policies in non-health sectors, those sectors must be integrated into health planning. Yet, the transition from a conceptual goal to an operational reality is where many public health organizations stumble. The gap is rarely a lack of will, but rather a lack of organizational capacity.
To bridge this gap, the Institut national de santé publique du Québec (INSPQ) has developed a structured internal reflection tool designed specifically for public health professionals and managers. Rather than offering a rigid set of rules, the tool provides a framework for organizations to analyze their own strengths and weaknesses, allowing them to build the internal infrastructure necessary to influence policy across government silos.
Moving Beyond the Silo: The Logic of Organizational Capacity
The primary challenge of the HiAP approach is that it requires public health officials to operate outside their traditional jurisdiction. To improve respiratory health, for example, a health official must be able to effectively collaborate with urban planners on emissions standards or with housing authorities on mold remediation. This requires a specific set of organizational “muscles” that many health departments haven’t been trained to flex.
The INSPQ tool treats organizational capacity not as a single trait, but as a composite of several dimensions. By guiding managers through a structured self-assessment, the tool prevents the common mistake of launching a high-profile partnership without first ensuring the organization has the staff, the legal mandate, or the leadership support to sustain it.
For the professionals using the tool, the process is designed to be iterative. It encourages respondents to describe existing initiatives—essentially auditing what is already working—and then comparing those efforts against strategic benchmarks to identify where the organization is lagging. This prevents the “reinvention of the wheel” and allows managers to prioritize resources where they will have the most systemic impact.
The Five Dimensions of Health-Supportive Policy
The framework breaks down organizational capacity into five critical pillars. Each pillar represents a different lever that a manager can pull to strengthen their organization’s ability to implement health-supportive policies.
1. Partnerships and Intersectoral Collaboration
Health does not happen in a vacuum. This dimension focuses on the ability to build and maintain relationships with partners outside the health sector. It asks whether the organization has formal agreements in place, how trust is built with non-health stakeholders, and whether these partnerships are transactional or truly integrated.
2. Organizational Structures and Resources
Good intentions cannot overcome a lack of infrastructure. This pillar examines whether the organization’s internal hierarchy supports cross-sectoral work. If a public health officer must navigate five levels of approval to speak with a city planner, the structure is a barrier. This dimension looks at budget allocations, reporting lines, and the physical or digital tools available for collaboration.
3. Workforce Competencies
Implementing HiAP requires a different skill set than traditional epidemiology or clinical care. It requires negotiation, political acuity, and an understanding of how other sectors (like transport or agriculture) operate. The tool helps organizations identify gaps in their workforce’s expertise and suggests pathways for professional development.
4. Knowledge Development and Translation
Data is the currency of policy change, but raw data is rarely enough to move a politician or a city manager. This dimension focuses on the ability to translate complex health research into actionable policy briefs. It assesses how the organization gathers evidence and, more importantly, how it communicates that evidence to non-experts.
5. Leadership and Governance
Without top-down legitimacy, intersectoral work is often viewed as a “side project.” This pillar evaluates whether leadership actively champions the HiAP approach and whether there are governance mechanisms—such as steering committees or shared mandates—that hold different sectors accountable for health outcomes.
| Dimension | Primary Focus | Operational Goal |
|---|---|---|
| Partnerships | External Relations | Move from silos to integrated collaboration. |
| Structures | Internal Logistics | Align resources and mandates with HiAP goals. |
| Workforce | Human Capital | Develop political acuity and negotiation skills. |
| Knowledge | Evidence Translation | Turn health data into actionable policy advice. |
| Leadership | Governance | Secure institutional mandate and accountability. |
Practical Implementation and Impact
For a public health manager, the utility of this tool lies in its ability to turn an abstract ambition—”we want to be more intersectoral”—into a concrete work plan. By prioritizing one or two dimensions, an organization can avoid the burnout associated with trying to overhaul everything at once. For instance, a department might realize that while they have great partnerships (Dimension 1), they lack the workforce skills (Dimension 3) to turn those relationships into policy changes.
The tool also serves as a resource hub, connecting users to strategies and documentation that have worked in other jurisdictions. This peer-to-peer knowledge transfer is essential in public health, where the challenges of bureaucracy and political resistance are universal.
The ultimate goal is a shift in the “organizational DNA.” When health-supportive policy becomes a core competency rather than an occasional project, the result is a more resilient public health system. Instead of simply treating the symptoms of a poor environment, the organization becomes an architect of an environment that promotes health by default.
Disclaimer: This article is provided for informational purposes and discusses public health administrative frameworks. It does not constitute medical advice or official government policy.
As public health agencies continue to integrate these frameworks, the next phase of implementation will likely focus on the measurement of long-term outcomes—moving from assessing “capacity” to measuring the actual health gains resulting from these intersectoral policies. Official updates on the application of these tools can be found through the INSPQ and associated public health governance bodies.
We want to hear from you. Does your organization use a structured framework for intersectoral health policies? Share your experiences in the comments below.
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