Table 1 The contextual factors of HiAP implementation in Sweden, Quebec and South Australia

Welfare state regime

High-income

High-income

High-income

High in labour market egalitarianism

Low in labour market egalitarianism (Canada)

Low in labour market egalitarianism (Australia)

Mandate type & year

Legislated bill, 2003

Legislated in Public Health Act, 2002

Strategy, 2008

Mandate description

Minister of Health with directors-general of “concerned agencies” guides national, regional and municipal level intersectoral health coordination in regards to the health policy. There was a change in 2008 initiated by the Moderate Party (centre-right) where the focus shifted to elderly, children and young people with emphasis on lifestyle changes.

All prospective policies that may impact population health must pass through a health impact assessment administered by the Ministry of Health and Social Services.

Health lens analyses are used to help government sectors meet targets laid out in the South Australia Strategic Plan (2004). There was a change in 2011 initiated by the Australian Labor Party (left-leaning) with an amendment to the Public Health Act to include a provision that the Minister of Health may provide advice or develop procedures to ensure enhancement of health.

Level of implementation

Country, county, municipal

Province

State, municipal

Financing HiAP

At the national level, there are no financing mechanisms to directly fund sectors to participate in HiAP and to conduct Health Impact Assessments (HIA) but some examples of coordinated budgeting/policy-oriented funding to encourage action on specific objectives. The Swedish National Institute of Public Health provides in-kind support to sectors at all levels of government to integrate health considerations in policymaking, including the use of HIA tools and hosting cross-sectoral meetings. Sectors may pool budgets when they collaborate. At the municipal level HiAP work is financed by the various sectors and from various state/public donors with supported by public health coordinator.

At the provincial level, there are no financing mechanisms to directly fund sectors to participate in HiAP or to carry out HIA. Ministries are expected to provide in-kind support to allow employees to participate in the inter-ministerial committee. The Direction Générale de Santé Publique funds research to support the development of knowledge and expertise in using HIA tools and the Institut National de Santé Publique du Québec provides in-kind support to sectors at all levels government to use HIA tools.

At the state level, there are no financing mechanisms to directly fund sectors to participate in HiAP. Individual projects rely on joint funding from partner agencies. Foundation of HiAP in South Australia acknowledges that many of the most pressing health problems of the population require long-term policy and budgetary commitment, including innovative budgetary approaches. Dedicated funding for global aspects of HiAP initiative provided by South Australia Health, and for dedicated staff in a Health in All Policies Unit provided by Health Promotion and Public Health.