BC needs to prioritize health beyond health care

By late summer, 2017 had seen the death of 1013 British Columbians due to the opioid crisis.[1] Though considerable progress has been made through distribution of naloxone kits, increased treatment programs, and the opening of supervised consumption and overdose prevention sites, BC seems on track this year to nearly double the number of deaths in 2016. High-risk substance use is often fueled by homelessness, child poverty, lack of meaningful employment, and colonial systems that disrupt Indigenous peoples’ connections to land and community. These issues cannot be fixed solely through the health system; they require other ministries like Labour, Housing, and Education. In order to address the upstream determinants of health, government decision-makers need to consider how policies in other sectors can affect the public’s health.

Health in all policies (HiAP) is an approach supported by organizations like the World Health Organization and Canadian Medical Association.[2,3] Under HiAP, government policies that might affect population health undergo health impact assessments, no matter what ministry develops them. For example, if the Ministry of Education closed a school, it could be required to address health impacts like families’ use of active transportation (walking and biking to school), social services for at-risk families, and delivery of food security programs. Within Canada, Quebec has already adopted HiAP.[4] Farther from home, Scandinavian countries have seen success using this approach to coordinate agencies to combat health issues such as heart disease.[5]

The Ministry of Health cannot stand alone in tackling the acute and chronic health issues. While the designation of a Minister of Mental Health and Addictions signals interest in broadening health leadership beyond traditional siloes, there are still additional opportunities for collaboration. By embracing a HiAP approach, the province could reduce the burden on the health care system and improve the health of British Columbians.
—Alex Choi, MD, MHSc, CCFP
—Alexis Crabtree, MD, PhD, MPH
—Geoff McKee, MD, MPH


1.    BC Coroners Service. Illicit drug overdose deaths in BC January 1, 2007–August 31, 2017. Ministry of Public Safety & Solicitor General 2017. Accessed 16 October 2017. www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/death-investigation/statistical/illicit-drug.pdf.
2.    World Health Organization. Health in All Policies: Framework for country action. World Health Organization 2014. Accessed 18 October 2017. www.who.int/healthpromotion/frameworkforcountryaction/en. 
3.    Canadian Medical Association. CMA policy—health in all policies. Canadian Medical Association; 2015. Accessed 18 October 2017. www.cma.ca/Assets/assets-library/document/en/policies/cma_policy_health_....
4.    Greaves LJ, Bialystok LR. Health in All Policies—all talk and little action? Can J Public Health 2011;102:407-409.
5.    Melkas T. Health in all policies as a priority in Finnish health policy: A case study on national health policy development. Scand J Public Health. 2013 Mar;41(11 Suppl):3-28.

Alexandra Choi, MD, MHSc, CCFP, Alexis Crabtree, MD, MPH, PhD, Geoffrey McKee, MD, MPH. BC needs to prioritize health beyond health care. BCMJ, Vol. 60, No. 1, January, February, 2018, Page(s) 8 - Letters.

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John G Abbott says: reply

I just wanted the author to know that government of Newfoundland Labrador has also embarked on a HiAP approach and has both announced it in its major policy document "The Way Forward", Fall 2016, and imbedded it in its recent new public health legislation. As well, Premier Ball recently announced a special adviser on HiAP, namely me. The author is definitely on the right track and has used some current concrete examples where a HiAP approach can and will be more effective in addressing some 'wicked' public policy challenges. Thank you.

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