Moving Beyond Health in All Policies: Exploring How Policy Could Front and Centre the Reduction of Social Inequities in Health

In recent years there has been a proliferation of concepts to describe intersectoral health policies. Much of this work orients around the promise of Health in All Policies (HiAP), an intersectoral approach that promotes addressing the social determinants of health (SDH) and social inequities in health. However, in practice, questions of health equity are often marginal or unattainable. Based on a conceptual critique of HiAP, we explore some of the problems involved when trying to effectively design and implement policies with the explicit goal of reducing social inequities in health. We find that the intersectoral approaches to policymaking and implementation of health equity policies should be seen as distinct from Health in All Policies. Using the example of intersectoral health policies seeking to reduce smoking, we argue that they have been relatively ineffective at reducing social inequities in smoking. We suggest that the capability approach (CA) could provide the basis of a policy framework for guiding more effective intersectoral policy action to reduce social inequities in health.