A Realist Explanatory Case Study Investigating How Common Goals, Leadership, and Committed Staff Facilitate Health in All Policies Implementation in the Municipality of Kuopio, Finland

Document Type : Original Article


1 Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada

2 MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada

3 Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

4 Faculty of Social Sciences, Tampere University, Tampere, Finland

5 Bloomberg School of Nursing University of Toronto, Toronto, ON, Canada


Health in All Policies (HiAP) encompasses collaboration across government and the consideration of health in various governmental sector’s policies and decisions. Despite increasing advocacy, interest, and uptake in HiAP globally, empirical and evaluative studies are underrepresented in this growing literature, particularly literature on HiAP implementation at the local level. Finland has been a pioneer in and champion for HiAP.

A realist explanatory case study design was used to test hypotheses about how HiAP is implemented in Kuopio, Finland. Semi-structured interviews with ten government employees from various sectors were conducted. Data from interviews and literature were analyzed with the aims of uncovering explanatory mechanisms in the form of context- strategy-mechanism-outcome (CSMO) configurations related to implementation strategies. Evidence was evaluated for quality based on triangulation of sources and strength of evidence. We hypothesized that having or creating a common goal between sectors and having committed staff and local leadership would facilitate implementation.

Strong evidence supports our hypothesis that having or creating a common goal can aid in positive implementation outcomes at the local level. Common goals can be created by the strategies of having a city mandate, engaging in cross-sectoral discussions, and/or by working together. Policy and political elite leadership led to HiAP implementation success because leaders supported HiAP work, thus providing justification for using time to work intersectorally. How and why the wellbeing committee facilitated implementation included by providing opportunities for discussion and learning, which led to understanding of how non-health decisions impact community wellbeing, and by acting as a conduit for the communication of wellbeing goals to government employees.

At the municipal level, having or creating a common goal, leadership from policy and political elites, and the presence of committed staff can facilitate HiAP implementation. Inclusion of not only strategies for HiAP, but also the explanatory mechanisms, aids in elucidating how and why HiAP is successfully implemented in a local setting.



Commentaries Published on this Paper


  • In Centralized Health Systems, Much Is Left Out When Analyses of Local HiAP Strategies Are Limited to Public Administration; Comment on “A Realist Explanatory Case Study Investigating How Common Goals, Leadership, and Committed Staff Facilitate Health in All Policies Implementation in the Municipality of Kuopio, Finland”

        Abstract | PDF


  • Where Is Equity in HiAP?; Comment on “A Realist Explanatory Case Study Investigating How Common Goals, Leadership, and Committed Staff Facilitate Health in All Policies Implementation in the Municipality of Kuopio, Finland”

        Abstract | PDF


  • Health in All Policies at the Local Level: What Facilitates Success?; Comment on “A Realist Explanatory Case Study Investigating How Common Goals, Leadership, and Committed Staff Facilitate Health in All Policies Implementation in the Municipality of Kuopio, Finland”

        Abstract | PDF


Authors' Response to the Commentaries


  • Developing a Research Agenda for HiAP Implementation: A Response to the Recent Commentaries

        Abstract | PDF



  • epublished Author Accepted Version: February 6, 2022
  • epublished Final Version: February 27, 2022
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Volume 11, Issue 11
November 2022
Pages 2651-2659
  • Receive Date: 13 May 2021
  • Revise Date: 05 February 2022
  • Accept Date: 05 February 2022
  • First Publish Date: 06 February 2022