In the United States, the recent change in federal administration has us thinking about policy. Any administration change at any level brings new priorities, policy actions, and legislation. Indeed, all levels of government in all countries are faced with the constant evolution of laws, regulations, and implementation plans that have a direct or indirect impact on the health of their citizens. Some changes can be obviously related to "health," but others are not. It is particularly critical that we review those that are less clearly health related to evaluate the potential impact on health and well-being. As such, we urge all forensic nurses to adopt a "health in all policies" (HiAP) lens to all proposed legislation that explicitly includes forensic health and specifically the health of individuals, families, and communities affected by violence.

The World Health Organization (WHO, 2014) designed the HiAP approach to incorporate health considerations into decision making across sectors and policy areas. This means ensuring that all decision makers are well informed about the health consequences of any proposed plans throughout the policymaking process. This is especially important when poor health outcomes might be a byproduct of non-health-related legislation. Recognized and implemented internationally, the HiAP defines and contextualizes health in the broadest way-and in consideration of the many different factors that influence health and healthcare (Stahl, Wismar, Ollila, Lahtinen, & Leppo, 2006). As stated by WHO (2014),

Many of the determinants of health and health inequities in populations have social, environmental, and economic origins that extend beyond the direct influence of the health sector and health policies. Thus, public policies in all sectors and at different levels of governance can have a significant impact on population health and health equity. (p. 7)

Immigration policy is not health policy, but it may have broad health impacts. For example, Section 287(g) of the Immigration and Nationality Act allows the Department of Homeland Security to deputize local law enforcement officers to act as federal immigration agents (U.S. Immigration and Customs Enforcement, n.d.). Although it has been on the books since 1996, only 37 local law enforcement agencies have participated (U.S. Immigration and Customs Enforcement, n.d.). In a recent Executive Order (No. 13767, 2017), the President ordered his Secretary of Homeland Security to "immediately" reach out to state and local officials to sign 287(g) agreements. Through an HiAP lens, nurses are encouraged to engage with local law enforcement agencies to answer the following questions (or questions such as these) before entering into a 287(g) memorandum of agreement: How will this agreement affect violence in our community? How will this agreement affect the willingness of undocumented victims to work with our agencies, even when they are being victimized by U.S. citizens? How will this affect the willingness of undocumented community members to cooperate with our agencies on other investigations?

The HiAP approach is challenging because it requires us to move outside our clinical comfort zones. To facilitate the process, specific, actionable steps have been identified (Gase, Pennotti, & Smith, 2013). Those most applicable to forensic nurses include developing cross-sector relationships, empowering staff to work across sectors, and establishing systems that allow them to share information and knowledge across sectors. The Health Impact Assessment (HIA) also provides a systematic process to evaluate the impact of a policy or program on health-related outcomes (Collins & Koplan, 2009). A variety of HIA samples are available, all of which can provide guidance to teams seeking to review new or revised proposals. The WHO has assembled a collection of HIAs on their Web site (see http://www.who.int/hia/examples/en/forfurtherinformation).

Forensic nurses are especially skilled at coordinating efforts among health and non-health-related sectors. This will serve us well as we seek to impact change at the population level. The complicated issues facing forensic nursing also require that we focus on more upstream efforts-those that attempt to prevent problems. We know that the complex problems faced by the communities we seek to serve will only be adequately addressed with solutions that acknowledge this complexity, are attentive to the various facets involved, and are flexible enough to be able to respond to evolving conditions.

Some practicing nurses will not heed the call to action in the policy realm-not because they do not care or understand the importance but because competing professional demands require the setting of priorities. When we collectively believe that we are doing our part to address violence in our communities, isn't policy development someone else's job? It is precisely because forensic nurses are on the ground in communities affected by violence that we encourage you to engage in policy using an HiAP approach. Your experience is valuable and needed at the policy table.

So how should forensic nurses help to ensure that all policies are evaluated for their potential health impact?

* We can get informed about the policies that are up for debate at the local, regional, and national levels. Connecting with local advocacy organizations is a great way to do this, as they often track legislation.

* We can use our expertise to educate lawmakers and their staff about the potential health impact-expected or unintentional-of policies.

* We can use the available research or design new intersectoral research that shows or seeks to explain connections between communities, violence, safety, and health to help our lawmakers understand how policies in so many areas affect health outcomes.

* We can champion criminal justice reform efforts to improve social justice and health equity.

* We can lead work with other stakeholders to determine the health impact of policy changes and make recommendations to maximize positive health impacts.

* We can develop, empirically test, and implement new evidence-based interventions in forensic nursing, such as violence prevention, recovery from trauma, or improving outcomes in the criminal justice system that can be used for future policy development.

* We can conduct our HIAs for new policies, programs, or projects to closely examine their impact on safety and violence.

It goes without saying that forensic nurses, as a group, do not shy away from something because it is too messy or complicated. On the contrary, we often find ourselves at the forefront in those situations: providing care, advocating for action, or demanding change. The HiAP approach allows us to lengthen our reach and ensure that the programs, policies, and plans being considered for implementation are evaluated for their potential impact on the safety and health of our communities.

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