{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T12:27:21Z","timestamp":1784291241825,"version":"3.55.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes for Health Research","doi-asserted-by":"crossref","award":["159469"],"award-info":[{"award-number":["159469"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Can J Public Health"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Setting. Health system leaders in Canada recognise that quality improvement alone cannot address health inequities. Intersectoral action, which involves coordination and collaboration across public, private, and third-sector organisations, can improve the distribution of social determinants of health (SDOH) and thereby, health equity. While Health in All Policies (HiAP) promotes this approach, critiques and empirical data highlight implementation gaps over whether health equity is actually being improved. The potential for HiAP initiatives to reduce health inequities can be strengthened by paying greater attention to how these interventions are designed, implemented, and evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>We developed and pilot tested a self-study tool that helps organisations learn and reflect on how health equity can be targeted in intersectoral initiatives, including HiAP. This is not the only tool that can be used to consider ways to integrate health equity into intersectoral action; however, it is the first one designed for HiAP initiatives specifically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>The self-study tool asks the user to reflect on a series of health equity concepts to raise awareness about opportunities to better integrate health equity into the design, implementation, and evaluation of intersectoral\u00a0initiatives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>The survey and appendix can fill in the gaps of other tools meant to support intersectoral action for health by focusing on ways to strengthen the health equity potential of initiatives. Users can apply the tool prospectively and retrospectively to explicitly target specific criteria to improve how their interventions focus on and potentially address health equity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.17269\/s41997-025-01098-2","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T12:56:02Z","timestamp":1757681762000},"page":"384-390","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Self-study tool for integrating health equity into Health in All Policies (HiAP) initiatives"],"prefix":"10.17269","volume":"117","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4571-7019","authenticated-orcid":false,"given":"Carol","family":"Ragheb","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8410-2201","authenticated-orcid":false,"given":"Ketan","family":"Shankardass","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura Lee","family":"Noonan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"key":"1098_CR1","unstructured":"Action: SDG \u2013 All for Equity \u2013 Convening SDH Actors to Reach the SDGs. (2019). Retrieved from August 13, 2025 from Ku.edu. https:\/\/actionsdg.ctb.ku.edu\/"},{"key":"1098_CR2","unstructured":"Baciu, A., Negussie, Y., Geller, A., & Weinstein, J. N. (2017, January 11). The root causes of health inequity. Nih.gov; National Academies Press (US). https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK425845\/"},{"key":"1098_CR3","unstructured":"Bharmal, N., Derose, K., Felician, M., Weden, M., & Health, R. (2015). Understanding the upstream social determinants of health. https:\/\/www.rand.org\/content\/dam\/rand\/pubs\/working_papers\/WR1000\/WR1096\/RAND_WR1096.pdf?utm_source=miragenews&utm_medium=miragenews&utm_campaign=news"},{"issue":"5","key":"1098_CR4","doi-asserted-by":"publisher","first-page":"E105","DOI":"10.1503\/cmaj.200085","volume":"192","author":"A Boozary","year":"2020","unstructured":"Boozary, A., & Laupacis, A. (2020). The mirage of universality: Canada\u2019s failure to act on social policy and health care. Canadian Medical Association Journal,\n192(5), E105\u2013E106. https:\/\/doi.org\/10.1503\/cmaj.200085","journal-title":"Canadian Medical Association Journal"},{"issue":"1","key":"1098_CR5","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1146\/annurev.publhealth.27.021405.102103","volume":"27","author":"P Braveman","year":"2006","unstructured":"Braveman, P. (2006). Health disparities and health equity: Concepts and measurement. Annual Review of Public Health, 27(1), 167\u2013194. https:\/\/doi.org\/10.1146\/annurev.publhealth.27.021405.102103","journal-title":"Annual Review of Public Health"},{"issue":"Suppl 2","key":"1098_CR6","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1177\/00333549141291S206","volume":"129","author":"P Braveman","year":"2014","unstructured":"Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It\u2019s time to consider the causes of the causes. Public Health Reports, 129(Suppl 2), 19\u201331.","journal-title":"Public Health Reports"},{"key":"1098_CR7","doi-asserted-by":"publisher","first-page":"76","DOI":"10.12688\/openreseurope.14841.2","volume":"2","author":"Paul Cairney","year":"2022","unstructured":"Cairney, Paul, et al. (2022). Why is health improvement policy so difficult to secure? Open Research Europe,\n2, 76. https:\/\/doi.org\/10.12688\/openreseurope.14841.2","journal-title":"Open Research Europe"},{"key":"#cr-split#-1098_CR8.1","unstructured":"Canada. (2024). A healthy, productive Canada : A determinant of health approach \/ The Honourable Wilbert Joseph Keon, Chair"},{"key":"#cr-split#-1098_CR8.2","unstructured":"The Honourable Lucie P\u00e9pin, Deputy Chair. : YC17-402\/3-01E-PDF - Government of Canada Publications - Canada.ca. Publications.gc.ca. Retrieved August 12, 2025, from https:\/\/publications.gc.ca\/site\/eng\/359901\/publication.html"},{"key":"1098_CR9","unstructured":"Canadian Network for Health in All Policies (2025, August 13). (n.d.)National Collaborating Centre for Healthy Public Policy. Retrieved , from https:\/\/ccnpps-ncchpp.ca\/canadian-network-for-health-in-all-policies-cnhiap\/"},{"issue":"3","key":"1098_CR10","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1377\/hlthaff.2017.1292","volume":"37","author":"RL Hall","year":"2018","unstructured":"Hall, R. L., & Jacobson, P. D. (2018). Examining whether the health-in-all-policies approach promotes health equity. Health Affairs, 37(3), 364\u2013370. https:\/\/doi.org\/10.1377\/hlthaff.2017.1292","journal-title":"Health Affairs"},{"key":"1098_CR11","unstructured":"Health Equity Assessment Toolkit. (n.d.). Www.who.int https:\/\/www.who.int\/data\/inequalitymonitor\/assessment_toolkit"},{"key":"1098_CR12","unstructured":"Health Equity Impact Assessment (HEIA). (n.d.). CAMH. Retrieved August 12, 2025, from https:\/\/www.camh.ca\/en\/professionals\/professionals--projects\/heia"},{"key":"1098_CR13","unstructured":"Health in All Policies. (2022, December 13). National Collaborating Centre for Healthy Public Policy. Retrieved August 13, 2025, from https:\/\/ccnpps-ncchpp.ca\/health-in-all-policies\/"},{"key":"1098_CR14","doi-asserted-by":"publisher","unstructured":"Holt, D. H., & Frohlich, K. L. (2022). Moving beyond health in all policies: Exploring how policy could front and centre the reduction of social inequities in health. Integrating Science and Politics for Public Health, 267\u2013291. https:\/\/doi.org\/10.1007\/978-3-030-98985-9_12","DOI":"10.1007\/978-3-030-98985-9_12"},{"key":"1098_CR15","doi-asserted-by":"publisher","unstructured":"Hoyer, D., et al. (2022) How do we define and measure health equity? The state of current practice and tools to advance health equity.\u00a0Journal of Public Health Management and Practice, 28(5), 570\u2013577. journals.lww.com\/jphmp\/Fulltext\/2022\/09000\/How_Do_We_Define_and_Measure_Health_EquityThe.20.aspx, https:\/\/doi.org\/10.1097\/PHH.0000000000001603","DOI":"10.1097\/PHH.0000000000001603"},{"issue":"2","key":"1098_CR16","doi-asserted-by":"publisher","first-page":"17","DOI":"10.24095\/hpcdp.36.2.01","volume":"36","author":"B Jackson","year":"2016","unstructured":"Jackson, B., & Huston, P. (2016). Advancing health equity to improve health: The time is now. Health Promotion and Chronic Disease Prevention in Canada\u202f: Research, Policy and Practice, 36(2), 17\u201320.","journal-title":"Health Promotion and Chronic Disease Prevention in Canada : Research, Policy and Practice"},{"issue":"3","key":"1098_CR17","doi-asserted-by":"publisher","first-page":"E64","DOI":"10.1503\/cmaj.171530","volume":"190","author":"P Kershaw","year":"2018","unstructured":"Kershaw, P. (2018). The need for health in all policies in Canada. Canadian Medical Association Journal, 190(3), E64\u2013E65. https:\/\/doi.org\/10.1503\/cmaj.171530","journal-title":"Canadian Medical Association Journal"},{"issue":"2","key":"1098_CR18","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1093\/heapro\/dax081","volume":"34","author":"L Kokkinen","year":"2017","unstructured":"Kokkinen, L., Muntaner, C., O\u2019Campo, P., Freiler, A., Oneka, G., & Shankardass, K. (2017a). Implementation of Health 2015 public health program in Finland: A welfare state in transition. Health Promotion International, 34(2), 258\u2013268. https:\/\/doi.org\/10.1093\/heapro\/dax081","journal-title":"Health Promotion International"},{"issue":"8","key":"1098_CR19","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1136\/jech-2016-207736","volume":"71","author":"L Kokkinen","year":"2017","unstructured":"Kokkinen, L., Shankardass, K., O\u2019Campo, P., & Muntaner, C. (2017b). Taking health into account in all policies: Raising and keeping health equity high on the political agenda. Journal of Epidemiology and Community Health, 71(8), 745\u2013746. https:\/\/doi.org\/10.1136\/jech-2016-207736","journal-title":"Journal of Epidemiology and Community Health"},{"key":"1098_CR20","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-040119-094119","author":"LC Liburd","year":"2020","unstructured":"Liburd, L. C., Hall, J. E., Mpofu, J. J., Marshall Williams, S., Bouye, K., & Penman-Aguilar, A. (2020). Addressing health equity in public health practice: Frameworks, promising strategies, and measurement considerations. Annual Review of Public Health. https:\/\/doi.org\/10.1146\/annurev-publhealth-040119-094119","journal-title":"Annual Review of Public Health"},{"issue":"10131","key":"1098_CR21","doi-asserted-by":"publisher","first-page":"1718","DOI":"10.1016\/S0140-6736(18)30181-8","volume":"391","author":"D Martin","year":"2018","unstructured":"Martin, D., Miller, A. P., Quesnel-Vall\u00e9e, A., Caron, N. R., Vissandj\u00e9e, B., & Marchildon, G. P. (2018). Canada\u2019s universal health-care system: Achieving its potential. The Lancet,\n391(10131), 1718\u20131735.","journal-title":"The Lancet"},{"key":"1098_CR22","unstructured":"National Collaborating Centre for Healthy Public Policy (2024). Stronger together! Five policy briefs about strengthening implementation of Health in All Policies (HiAP) at the local level in Ontario and Qu?bec. Retrieved August 13, 2025, from https:\/\/ccnpps-ncchpp.ca\/stronger-together-five-policy-briefs-about-strengthening-implementation-of-health-in-all-policies-hiap-at-the-local-level-in-ontario-and-quebec\/"},{"key":"1098_CR23","unstructured":"National Collaborating Centre for Methods and Tools. (2013). Nccmt.ca. Retrieved August 13, 2025, from https:\/\/www.nccmt.ca\/"},{"key":"1098_CR24","unstructured":"Pan American Health Organization. (n.d.).\u00a0 Health in all policies - PAHO\/WHO. Retrieved August 13, 2025, from https:\/\/www.paho.org\/en\/topics\/intersectoral-action-health-all-policies"},{"key":"1098_CR25","unstructured":"Province of Quebec (2023, August 2) - Global Network for Health in All Policies. Global Network for Health in All Policies. Retrieved August 13, 2025, from https:\/\/actionsdg.ctb.ku.edu\/network-members\/province-of-quebec\/"},{"key":"1098_CR26","unstructured":"Public Health Agency of Canada. (2017). The Chief Public Health Officer\u2019s Report on the State of Public Health in Canada 2017 \u2013Designing healthy living - Canada.ca. Retrieved August 13, 2025, https:\/\/www.canada.ca\/en\/public-health\/services\/publications\/chief-public-health-officer-reports-state-public-health-canada\/2017-designing-healthy-living.html"},{"key":"1098_CR27","doi-asserted-by":"publisher","unstructured":"Rudolph, L. I., & Rudolph, S. H. (2013). Health in all policies: Improving health through intersectoral collaboration. Studies in Indian Politics, vol. 1, no. 1, June 2013, https:\/\/doi.org\/10.1177\/2321023013482782.","DOI":"10.1177\/2321023013482782"},{"issue":"2\u20133","key":"1098_CR28","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.healthpol.2013.05.006","volume":"114","author":"I Storm","year":"2014","unstructured":"Storm, I., Harting, J., Stronks, K., & Schuit, A. J. (2014). Measuring stages of health in all policies on a local level: The applicability of a maturity model. Health Policy, 114(2\u20133), 183\u2013191. https:\/\/doi.org\/10.1016\/j.healthpol.2013.05.006","journal-title":"Health Policy"},{"issue":"3","key":"1098_CR29","doi-asserted-by":"publisher","first-page":"E61","DOI":"10.1503\/cmaj.190517","volume":"192","author":"M Tonelli","year":"2020","unstructured":"Tonelli, M., et al. (2020). Canada needs a \u201cHealth in All Policies\u201d action plan now. Canadian Medical Association Journal, 192(3), E61\u2013E67. https:\/\/doi.org\/10.1503\/cmaj.190517","journal-title":"Canadian Medical Association Journal"},{"issue":"11","key":"1098_CR30","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph14111288","volume":"14","author":"H van Eyk","year":"2017","unstructured":"van Eyk, H., Harris, E., Baum, F., Delany-Crowe, T., Lawless, A., & MacDougall, C. (2017). Health in all policies in South Australia\u2014did it promote and enact an equity perspective? International Journal of Environmental Research and Public Health,\n14(11), Article 1288. https:\/\/doi.org\/10.3390\/ijerph14111288","journal-title":"International Journal of Environmental Research and Public Health"},{"issue":"4","key":"1098_CR31","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1093\/heapro\/dax008","volume":"33","author":"CE Van Vliet-Brown","year":"2017","unstructured":"Van Vliet-Brown, C. E., Shahram, S., & Oelke, N. D. (2017). Health in all policies utilization by municipal governments: Scoping review. Health Promotion International, 33(4), 713\u2013722. https:\/\/doi.org\/10.1093\/heapro\/dax008","journal-title":"Health Promotion International"},{"key":"1098_CR32","unstructured":"World Health Organization (WHO). (2023). Working together for equity and healthier populations Sustainable multisectoral collaboration based on health in all policies approaches. Retrieved August 13, 2025, from https:\/\/iris.who.int\/bitstream\/handle\/10665\/372714\/9789240067530-eng.pdf?sequence=1"},{"key":"1098_CR33","unstructured":"World Health Organisation. (2022). Health Equity -- Global. Retrieved August 12, 2025, from\u00a0www.who.int.\u00a0https:\/\/www.who.int\/health-topics\/health-equity#tab=tab_1"},{"issue":"3","key":"1098_CR34","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1007\/s10900-019-00778-8","volume":"45","author":"A Zygmunt","year":"2019","unstructured":"Zygmunt, A., Kendall, C. E., James, P., Lima, I., Tuna, M., & Tanuseputro, P. (2019). Avoidable mortality rates decrease but inequity gaps widen for marginalized neighborhoods: A population-based analysis in Ontario, Canada from 1993 to 2014. Journal of Community Health, 45(3), 579\u2013597. https:\/\/doi.org\/10.1007\/s10900-019-00778-8","journal-title":"Journal of Community Health"}],"container-title":["Canadian Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.17269\/s41997-025-01098-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.17269\/s41997-025-01098-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.17269\/s41997-025-01098-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T13:52:00Z","timestamp":1776088320000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.17269\/s41997-025-01098-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,12]]},"references-count":35,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["1098"],"URL":"https:\/\/doi.org\/10.17269\/s41997-025-01098-2","relation":{},"ISSN":["0008-4263","1920-7476"],"issn-type":[{"value":"0008-4263","type":"print"},{"value":"1920-7476","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,12]]},"assertion":[{"value":"15 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee (# 8578, Wilfrid Laurier University) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"\u201c\n                      If you have any questions about the information provided here, please contact Dr. Shankardass using the email or phone number above. If you have no further questions, do you agree to participate in the study? Yes\/No\u201d","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}