International Journal of Health Policy and Management

International Journal of Health Policy and Management

How Intersectoral Priority Setting Can Support Action on Social Determinants of Health: A Qualitative Case Study From Pakistan’s Federal Health Ministry

Articles in Press

Document Type : Original Article

Authors
Wafa Aftab 1, 2, 3
Ole F. Norheim 1, 4
Inger Lise Teig 1
Sameen Siddiqi 2
Jesse B. Bump 1, 3, 4
1 Bergen Center for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
2 Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
3 Takemi Program for International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
4 Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Abstract
Background
Intersectoral actions can improve population health and reduce health inequities by addressing social determinants of health. Priority setting methods are used by health ministries to rationalize resource allocation within the sector, but not for intersectoral actions.

Methods
We conducted a qualitative case study of an intersectoral priority setting exercise—a novel use of priority setting methods—undertaken by Pakistan’s Federal Ministry of Health between 2019–2022. Drawing on theories of agenda setting and priority setting, we examined the priority setting process through key informant interviews. We explored the perceived appropriateness of the priority setting approach and the challenges encountered during its implementation across sectors.

Results
Our findings reveal that the process of intersectoral priority setting is deeply influenced by its political and institutional context. According to respondents, existing institutional structures and norms in Pakistan are not optimally suited to support intersectoral actions for health, although there is growing recognition of their importance. Regardless of sector, all respondents view engaging in intersectoral actions as part of the health ministry’s responsibility for population health. Priority setting, thereby, is viewed as a way of clarifying the health ministry’s intersectoral agenda. However, intersectoral priority setting methods are seen as underdeveloped in terms of available evidence, standardized economic and policy evaluation, and deliberative mechanisms. Respondents suggest that to implement the prioritized intersectoral agenda, the health ministry must effectively navigate the political space outside the health sector, such as by highlighting shared benefits, grounding the intersectoral agenda in local needs, and leveraging the political dynamics of other sectors. Moreover, this political engagement must be complemented by competence in evidence generation and communication to influence cross-sectoral policy dialogues.

Conclusion
Using a priority setting approach, health ministries can systematically advance intersectoral health agendas by building political coalitions around shared priorities supported by rigorous evidence and analysis.
Keywords
Agenda Setting
Priority Setting
Social Determinants
Intersectoral Actions
Pakistan
Health Systems
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International Journal of Health Policy and Management

Articles in Press, Accepted Manuscript
Available Online from 01 July 2026

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  • Received Date 11 May 2025
  • Revised Date 09 March 2026
  • Accepted Date 30 June 2026
  • First Published Date 01 July 2026
  • Published Date 01 July 2026