An understanding of structural change interventions to facilitate the achievement of health in all policies

A recent supplement to the journal Health Education & Behaviorhighlighted 12 articles focused on the state of the evidence for interventions aimed at structural changes to promote health. Seeking to understand what type and amount of evidence is needed to demonstrate effectiveness, as well as whether poorly resourced communities benefited equally from such approaches, the articles provided meaningful perspectives on the state of the art with respect to such interventions.  Key themes included  the importance of partnerships and coalitions outside of traditional public health; the substantial amount of time and resources (financial and otherwise) needed to implement and study structural changes; the challenges of evaluating multi-level approaches and building evidence for effectiveness; multi-level approaches that link income, institutions (such as housing), and health outcomes; the importance of historical context for interpreting cultural changes; the role of theories that place individuals as stakeholders or nodes in social networks that drive organizational change; and the power of market forces to make health-directed policies less effective than they might otherwise be.  Key themes in understanding broad structural approaches to promoting health, and identifying remaining questions, will be presented.  These include: how do we assure that structural changes actually reach communities most in need, and to what extent are the problems we prioritize, and the language used to advocate for them, a consequence of unequal access to power and, ultimately, resources? The presentation will address how understanding the circumstances under which structural approaches actually improve health will better serve our efforts to support Health in All Policies.