HARMONICS: Health in All Policies Analysis using Realist Methods ON International Case Studies.

What we’re doing: We’re looking at how governments around the world can improve population health outcomes by adopting a ‘Health in All Policies’ (HiAP) approach. HiAP is characterized by:

1) A broad view of population health which includes not only access to quality health care, but, also:

  • The broader determinants of health, such as quality housing, healthy food and education.
  • The policies and processes that promote equitable distribution of the above, such as taxation and urban planning.

2) Increased collaboration across sectors and departments to achieve this broad view of population health.

Why we’re doing it: With widening health inequities worldwide there have been repeated calls to move beyond health care system interventions to address determinants of population health. Jurisdictions around the world have already experimented with implementing HiAP at various levels of government. These case studies offer an opportunity to explore the potential of this approach, and the conditions that lead to its implementation and effectiveness.

How we’re doing it: We’re using policy documents, key informant interviews and theory to explore why and how different jurisdictions around the world have adopted HiAP. We are placing a particular focus on exploring the political and economic factors that contribute to the adoption of HiAP. To date, we case studies have included California, Ecuador, Finland, Norway, Quebec, Scotland, South Australia, Sweden and Thailand.

We will:

  • Contribute to the evidence base related to the implementation of HiAP at all levels of government and in diverse global settings
  • Contribute theory and methodologies to the study of policy implementation
  • Translate findings globally and locally to public health actors and policymakers to encourage and support the implementation of HiAP

Our partners: Policymakers and public health actors currently involved or interested in implementing HiAP in their respective communities.

For more information: Please contact Principal Investigator Dr. Ketan Shankardass at shankardassk@smh.ca


Kokkinen, L, Muntaner, C, O’Campo P, Freiler, A, Oneka, G, Shankardass, K. Implementation of Health 2015 public health program in Finland: a welfare state in transition. Health Promotion International. 2017. Available here.

Oneka, G, Shahidi, FV, Muntaner, C, Bayoumi, A, Finn-Mahabir, D, Freiler, A, O’Campo, P, Shankardass, K. A glossary of terms for understanding political aspects in the implementation of Health in all Policies (HiAP). J Epidemiol Com Health. 2017. 71(8):835-838. Available here.

Kokkinen, L, Shankardass, K, O’Campo, P, Muntaner, C. Taking health into account in all policies: raising and keeping health equity high on the political agenda. J Epidemiol Com Health. 2017 (Online First) DOI: 10.1136/jech-2016-207736. Available here.

Molnar, Agnes, Renahy E, O’Campo P, Muntaner C, Freiler A, Shankardass K. “Using Win-Win Strategies to Implement Health in All Policies: A Cross-Case Analysis.” PloS one 11.2 (2016): e0147003. doi:10.1371/journal.pone.0147003. Full text available here.

Pinto, Andrew D., Molnar A, Shankardass K, O’Campo P, Bayoumi A. “Economic considerations and health in all policies initiatives: evidence from interviews with key informants in Sweden, Quebec and South Australia.” BMC public health 15.1 (2015): 1. doi: 10.1186/s12889-015-1350-0. Full text available here.

Shankardass K, Renahy E, Muntaner C, O’Campo P. Strengthening the implementation of Health in All Policies: a methodology for realist explanatory case studies. Health policy and planning. (2014):May. doi: 10.1093/heapol/czu021. Full text available here.

Freiler A, Muntaner C, Shankardass K, Mah CL, Molnar A, Renahy E, O’Campo P. “Glossary for the Implementation of Health in All Policies (HiAP).” Journal of Epidemiology and Community Health, 67 (2013):1068–1072.

Shankardass K, O’Campo P, Muntaner C, Renahy E, Freiler A. Realist Multiple Explanatory Case Studies: Strengthening the implementation of Health in All Policies, workshop booklet. Toronto: Centre for Research on Inner City Health, 2014. Available here.

Shankardass K, Solar O, Murphy K, Freiler A, Bobbili S, Bayoumi A, O’Campo P. Health in All Policies: Results of a Realist-Informed Scoping Review of the Literature, in A Report to the Ontario Ministry of Health and Long Term Care. December, 2010. Available here.

World Health Organization. 2012. WHO Database on Intersectoral Action for Health Equity (ISACS): Bridging research and policy to strengthen the social determinants of health. World Health Organization, Geneva, Switzerland. Available here.