Opportunities to reduce health inequalities by 'Health in All Policies' in the Netherlands: an explorative study on the national level

OBJECTIVES: In the last few years the Dutch ministry of Health has been searching for a renewed Health in All Policies (HiAP) strategy. This study analyses the Dutch practices and explores opportunities to reduce health inequalities by HiAP.

METHODS: A qualitative screening on the Dutch national budget was performed to explore ongoing policy resolutions of ministries inside and outside the public health domain. Additionally, semi-structured (group) interviews were conducted with 19 policy officers of seven ministries to identify critical factors for intersectoral collaboration.

RESULTS: Using the Dutch model on health inequalities 38 policy resolutions were selected: 15 on improving the socioeconomic position of people; four on improving participation of people with health problems; 19 on improving living and working conditions and lifestyle; and four on accessibility and quality of care. To improve intersectoral collaboration, policy officers suggested to strengthen existing links between the ministries, create common interest of objectives as well as visible results, approach this theme in a coordinated way, and to achieve broad political agreement.

CONCLUSIONS: The main challenges for a formal HiAP strategy are to (a) cover the determinants of health inequalities in a balanced way linked to concrete objectives and visible results, (b) enhance high level agreement and coordinated mechanisms from the government in general and the ministry of Health in particular.