Why the ‘Health in All Policies’ Framework Keeps Getting Ignored
“Health in All Policies” (HiAP) is an evidence-backed governance framework requiring every government sector—housing, education, transportation, criminal justice—to evaluate its impact on population health. Writing in Health Affairs Forefront, four former public health leaders document why HiAP adoption has stalled: most agencies outside health lack awareness of the framework, don’t understand how their decisions affect health outcomes, and face no incentive to engage. The authors argue that the dominant “sick care” narrative—health equals hospitals and medicine—keeps policymakers blind to prevention and upstream determinants. With 24 million Americans at risk of losing coverage or subsidies, the piece contends the current disruption in government health programs creates a rare opening to rewrite the health narrative and embed whole-of-government accountability for health outcomes.
As coverage instability and social determinants increasingly drive patient volume and payer mix, PE-backed operators and community health leaders face downstream consequences of upstream policy failures. Understanding HiAP helps operators anticipate regulatory shifts, engage community partners effectively, and position their organizations ahead of access-driven market changes.
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