Intended for healthcare professionals


Working towards “health in all policies” at a national level

BMJ 2013; 346 doi: (Published 18 February 2013) Cite this as: BMJ 2013;346:f1096
  1. Adam Fletcher, senior lecturer in social science and health
  1. 1Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff CF10 3BD, UK
  1. FletcherA{at}

Wales as a world leader?

The World Health Organization has challenged governments to adopt the principle of “health in all policies” to tackle the social determinants of health and health inequalities.1 However, policy making is complex, especially across multiple government departments, which makes implementing such an approach challenging. The Welsh government is consulting on whether and how to introduce this principle, asking whether there is a “need for a public health bill to place statutory duties on bodies to consider public health issues.”2

The strategy proposed in the Welsh green paper echoes Geoffrey Rose’s famous conclusion that to improve the health of a nation the “only acceptable answer, is the mass strategy, whose aim is to shift the whole population’s distribution of the risk variable.”3 The mass strategy proposed is healthier public policy in multiple areas, including education, social care, housing, transport, and urban planning. With life expectancy in Wales lower than in England and health inequalities within Wales increasing, this offers the possibility that Wales’s first public health bill will rise to WHO’s radical challenge for a health in all policies approach to tackling social determinants of health.

If Wales establishes a statutory duty on non-health policy makers to improve health at a national level it will lead the way in the United Kingdom and …

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