n 2013, Margaret Chan, who served as Director-General of the World Health Organization (WHO) from 2006 until 2017, invited civil society to reflect on why all ministers around the world could be, to some extent, ministers of health: “Prevention must be the cornerstone of the global response to … diseases. Their root causes reside in non-health sectors. Collaboration among multiple sectors is imperative.” This disruptive approach is grounded on the “health in all policies” (HiAP) principle outlined in the 1993 Helsinki Declaration.

This appeal was and remains noble and relevant, but it has competition: climate change. There is no doubt that the environment has managed to establish itself as a priority on the global political agenda with greater firmness and determination. Global health must strive to achieve similar priority status, not least because it is inextricably linked to the health of the environment.

Origins of Health in All Policies (HiAP)

The ambition of HiAP is addressing all subjects that affect population health to promote and safeguard the health of all, whilst ensuring equity. Such areas include transportation, housing, urban planning, environment, education, food, finance, taxes, and economic development policies. This principle is supported by the Final Report of the Commission on Social Determinants of Health and the Rio Political Declaration of 2011.

As the WHO’s definition of health in 1946 already suggested, it is crucial to emphasize social well-being as part of health and health equity, because health is determined by variables (such as behavior and environment) that go beyond biology and the functioning of the healthcare system. We are still in the realm of ethereal concepts, but it is time to make HiAP operational. For such impact, one major public health tool emerges: Health Impact Assessment (HIA), an evaluation tool that will enable placing health at the center as a common good pursued by all public policies and authorities.

Barriers to HIA’s Way Forward

The potential benefit of HIA is clear: Placing social well-being and equity at the center of public action. Possible “bureaucratization,” leading to HIA becoming a compulsory “box to check” procedure without practical value, stands out among its challenges.

HIA also runs the risk of competing with the Environmental Impact Assessment (EIA). One way to eliminate this risk will be to clearly limit HIA to health impact and equity (beyond climate issues) as the essential and distinctive content that characterizes and differentiates HIA from EIA. In this regard, the 28th Conference of the Parties to the United Nations Framework Convention on Climate Change (COP28) held December 2023 in Dubai promoted the connection between health and the environment through the celebration of a “Health Day” culminating in the signing of a Climate and Health Declaration supported by 124 countries. Likewise, US climate envoy John Kerry echoed in his COP28 speech the important impact of the environment on health: “We should not measure progress in the climate crisis only by degrees avoided but by lives saved.”

It is essential for National Public Health organizations to develop a clear methodology that combines sources of information and required professional competencies to ensure the operability and effectiveness of HIA, ensuring it is also aligned with major global organizations, especially WHO, which has already developed several toolkits. Such methodology should at least include the minimum criteria to be analyzed, recommended data sources for analysis, and valid statistical and mathematical methods to study HIA. This will implicitly strengthen the impact evaluation capabilities within the health workforce (mainly epidemiologists, statisticians, and mathematicians). The role of public health surveillance and the training of public health professionals remain two pending initiatives and will inevitably be linked to the rise of well-equipped, well-funded, well-staffed public health agencies that can “spearhead” HIA efforts.

Globally, the need remains for a “social conscience” about health as an inalienable social good. Allowing HIA to help ensure, per Margaret Chan, that all ministers are in effect “ministers of health” would be a step in the right direction.