The Long Road to the “All” of HiAP

The objective of health in all policies (HiAP) is straightforward: integrating health and equity considerations into policies across all sectors of government will transform systems and environments in ways that support healthier, more equitable outcomes. However, pursuing that objective is complex and achieving those outcomes takes time. This article examines three communities (Minneapolis, MN, Seattle, WA, and Richmond, CA) which have been pursuing HiAP long enough to achieve meaningful policy, systems, and environmental change. We identify when and how each community employed five key strategies for effectively adopting and implementing HiAP. And we present policies each community has adopted with examples of outcomes these initiatives have achieved. The purpose of this assessment is to set realistic expectations for how long it may take to achieve HiAP and to identify themes that could help other communities realize this level of progress more quickly and efficiently. Based on our assessment of these communities, we conclude that it is not uncommon for it to take ten years or more to integrate health and equity into a substantial and coordinated set of policies across government agencies and departments. However, we also see that each step taken toward HiAP makes subsequent steps easier. And as more policies include health and equity concerns, the entire system does become more effective at improving health and equity outcomes. Finally, we show that that integrating health and equity across a range of plans and policies does shape decisions, lead to actual community transformation, and improve community health outcomes.