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”

Document Type : Commentary

Authors

Department SHS and Arènes Research Unit (UMR CNRS 6051: team INSERM U1309), EHESP French National School of Public Health, Rennes, France

Abstract

We argue that the lessons drawn by Guglielmin and colleagues, from the Health in All Policies (HiAP) approach in the municipality of Kuopio, are of limited use to centralised health systems. There is a need for research more attuned to the circumstances of local governments that have little power over the provision of health programmes; yet can address a range of determinants of population health. In these cases, adopting a state-centric perspective may fail to capture the role of other actors such as non-governmental organizations (NGOs) and local branches of state agencies. Evidence from France shows that centralised health systems can foster HiAP locally through political commitment and dedicated coordination staff whose role is to mobilise and support NGOs, inhabitants, and other local branches of regional and central governments. We highlight, as three important challenges, the issue of legitimacy, funding and positioning of the HiAP instrument in the local government structure.

Keywords


  1. Guglielmin M, Shankardass K, Bayoumi A, O'Campo P, Kokkinen L, Muntaner C. 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. Int J Health Policy Manag. 2022. doi:34172/ijhpm.2022.6355
  2. WHO Commission on Social Determinants of Health (CSDH). Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health. Geneva: World Health Organization; 2008.
  3. Durie R, Wyatt K. Connecting communities and complexity: a case study in creating the conditions for transformational change. Crit Public Health. 2013;23(2):174-187. doi:1080/09581596.2013.781266
  4. Hawe P. Lessons from complex interventions to improve health. Annu Rev Public Health. 2015;36:307-323. doi:1146/annurev-publhealth-031912-114421
  5. Pawson R, Tilley N. Realistic Evaluation. London: SAGE Publications Ltd; 1997.
  6. Popay J, Whitehead M, Ponsford R, Egan M, Mead R. Power, control, communities and health inequalities I: theories, concepts and analytical frameworks. Health Promot Int. 2021;36(5):1253-1263. doi:1093/heapro/daaa133
  7. Porcherie M, Thomas MF, Quidu F, et al. How to evaluate Health in All Policies at the local level: methodological insights within municipalities from the WHO French Healthy Cities Network. Int J Health Policy Manag. 2022. doi:34172/ijhpm.2022.6584
  8. Breton E, Le Bodo Y, Diallo D, Sherlaw W, Harpet C, Hudebine H. The contribution of health promotion research to advancing local policies: new knowledge, lexicon and practice–research network. In: Potvin L, Jourdan D, eds. Global Handbook of Health Promotion Research. Vol 1. Cham: Springer International Publishing; 2022. p. 399-414. doi: 1007/978-3-030-97212-7_27.
  9. Le Bodo Y, Fonteneau R, Diallo D, et al. Measuring local strategies to address the determinants of population health: development and application of the CLoterreS instrument. Rev Epidemiol Sante Publique. 2022;70(6):286-298. doi:1016/j.respe.2022.09.073
  10. République Française. LOI N° 2009-879 Du 21 Juillet 2009 Portant Réforme de l’hôpital et Relative Aux Patients, à La Santé et Aux Territoires. République Française; 2009.
  11. Jeannot G, Goodchild B. Fuzzy jobs in local partnerships: case studies of urban and rural regeneration in France and England. Public Adm. 2011;89(3):1110-1127. doi:1111/j.1467-9299.2011.01920.x
  12. Jeannot G. Les Métiers Flous. Travail et Action Publique. 2nd ed. Toulouse: Octarès Éditions; 2011.
  • Receive Date: 24 August 2022
  • Revise Date: 12 November 2022
  • Accept Date: 21 November 2022
  • First Publish Date: 23 November 2022