Policy in all sectors affects health, through multiple pathways and determinants. Health in all policies (HiAP) is an approach that seeks to identify and influence the health and equity impacts of policy decisions, to enhance health benefits and avoid harm. This usually involves the use of health impact assessment or health lens analysis. There is growing international experience in these approaches, and some countries have cross-sectoral governance structures that prioritize the assessment of the policies that are most likely to affect health. The fundamental elements of HiAP are inter-sectoral collaboration, policy influence, and holistic consideration of the range of health determinants affected by a policy area or proposal. HiAP requires public health professionals to invest time to build partnerships and engage meaningfully with the sectors affecting the social determinants of health and health equity. With commitment, political will and tools such as the health impact assessment, it provides a powerful approach to integrated policymaking that promotes health, well-being, and equity. The COVID-19 pandemic has raised the profile of public health and highlighted the links between health and other policy areas. This paper describes the rationale for, and principles underpinning, HiAP mechanisms, including HIA, experiences, challenges and opportunities for the future.

Background: Health Impact Assessment (HIA) is promoted as a decision-informing tool by public health and governmental agencies. HIA is beneficial when carried out as part of policy development but is also valuable as a methodology when a policy is being implemented to identify and understand the wider health and well-being impacts of policy decisions, particularly when a decision needs to be taken rapidly to protect the population. This paper focusses on a HIA of the ‘Staying at Home and Social Distancing Policy’ or ‘lockdown’ in response to the COVID-19 pandemic in Wales conducted by the Welsh national public health institute. It describes the process and findings, captures the learning and discusses how the process has been used to better understand the wider health and well-being impacts of policy decisions beyond direct health harm. It also examines the role of public health institutes in promoting and using HIA. Methods: A HIA was conducted following a standard HIA five step process. A literature review was undertaken alongside 15 qualitative semi-structured interviews with key stakeholders, and relevant health and demographic data were collated. The results were triangulated and analysed to form a holistic assessment of the policy decision and its impacts. Results: A wide range of major health and well-being impacts of the lockdown in Wales were identified across the determinants of health, which included positive and negative social, economic, environmental and mental well-being impacts beyond the impact on direct health. Populations affected included children and young people, those on low incomes and women as well as those whose health has been directly impacted by COVID-19 such as older people. The work highlighted the benefit that HIA can bring in emphasizing impacts which can inform policy and shared learning with others. Conclusion: HIA is a largely underused tool to understand the impact of policy and political decisions, particularly when a decision has been taken at speed. This case study highlights how HIA provide evidence and information for advocacy and further work by public health institutes, health agencies and policy makers.

Welsh Government’s (WG) Wellbeing of Future Generations (Wales) Act 2015 (Welsh Government 2015) is a unique legislation which demonstrates its commitment to sustainable development. It is the only global legislation that enshrines the UNs Sustainable Development Goals (SDGs) within it. It emphasises WGs commitment to a ‘Health in All Policies’ approach to policymaking by emphasising the sustainable development principle is integrated to address seven Wellbeing Goals. Two of these goals are focussed on health and (in)equality which ties them distinctly to the practice of Health Impact Assessment (HIA). The World Health Organisation recommends the use of HIA to achieve the SDGs but not how to practically do this. This paper describes a HIA undertaken on a proposed major electricity cable connection development in Wales. It discusses how this HIA was the catalyst for considered thinking about the HIA process and how it can be used to consider and implement the Well-being Goals in practice, and initiates further thinking about how this can be extended to implement and address the SDGs at a local, regional and national level.

The use of health impact assessments (HIAs) has rapidly increased over the last two decades and has been undertaken to evaluate the health implications of many new projects across the globe. In July 2017, Wales became the first country to legislate for broad approach HIAs, i.e. it considers not only environmental health effects but the social determinants of health, well-being and inequalities. Although the introduction of statutory HIA will ensure the use of HIAs, experts have expressed concerns that legislative measures could lead to poor-quality HIAs and associated reports. This paper outlines the development process and analytical reflections of a quality assurance (QA) review framework for HIAs. The framework has been developed over a 2-year period which allowed the collective intellectual capital behind it to evolve in response to practice-based learning. A standardised form of QA for all types and levels of HIA will provide greater clarity regarding the required criteria for conducting and completing an HIA and ensuring this takes place in a robust, interdisciplinary and inter-sectoral manner. Therefore, this QA review framework should fit into existing HIA practice and complement other tools such as best practice guidance to sustain the global reputation of HIA.

Health impact assessment (HIA) is a systematic and flexible tool, which is advocated by the World Health Organisation as a method through which to consider the impact of policies on the health and well-being of a population, and the inequalities that may arise because of it. In 2018, the HIA support unit in Wales carried out a comprehensive and unique HIA on the impact of Brexit in Wales. The aims were to understand the differential impacts that Brexit would have on the health and well-being of the population and to provide evidence to inform decision makers across a range of public bodies. It followed a five-step process for HIA and utilised a wide range of evidence sources and health intelligence including both quantitative and qualitative evidence. This paper reflects on the process of carrying out the HIA and the methods used. It discusses the stages of the HIA, and shares the findings and reflections of implementation which will be beneficial to other HIA practitioners and policy makers. It does not concentrate on the findings of the HIA in detail, but focusses on what worked and any challenges encountered. It has been used to progress the practice of HIA in Wales and demonstrates the value of HIA as a method to inform and influence complex decisions.