The implementation of Health in All Policies initiatives: A systems framework for government action

Ketan Shankardass, Carles Muntaner, Lauri Kokkinen, Faraz Vahid Shahidi, Alix Freiler, Goldameir Oneka, Ahmed Bayoumi, Patricia O'Campo

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: There has been a renewed interest in broadening the research agenda in health promotion to include action on the structural determinants of health, including a focus on the implementation of Health in All Policies (HiAP). Governments that use HiAP face the challenge of instituting governance structures and processes to facilitate policy coordination in an evidence-informed manner. Due to the complexity of government institutions and the policy process, systems theory has been proposed as a tool for evaluating the implementation of HiAP. Methods: Our multiple case study research programme (HiAP Analysis using Realist Methods On International Case Studies - HARMONICS) has relied on systems theory and realist methods to make sense of how and why the practices of policy-makers (including politicians and civil servants) from specific institutional environments (policy sectors) has either facilitated or hindered the implementation of HiAP. Herein, we present a systems framework for the implementation of HiAP based on our experience and empirical findings in studying this process. Results: We describe a system of 14 components within three subsystems of government. Subsystems include the executive (heads of state and their appointed political elites), intersectoral (the milieu of policy-makers and experts working with governance structures related to HiAP) and intrasectoral (policy-makers within policy sectors). Here, HiAP implementation is a process involving interactions between subsystems and their components that leads to the emergence of implementation outcomes, as well as effects on the system components themselves. We also describe the influence of extra-governmental systems, including (but not limited to) the academic sector, third sector, private sector and intergovernmental sector. Finally, we present a case study that applies this framework to understand the implementation of HiAP - the Health 2015 Strategy - in Finland, from 2001 onward. Conclusions: This framework is useful for helping to explain how, why and under what circumstances HiAP has been successfully and unsuccessfully implemented in a sustainable manner. It serves as a tool for researchers to study this process, and for policy-makers and other public health actors to manage this process.

Original languageEnglish
Article number26
JournalHealth Research Policy and Systems
Volume16
Issue number1
DOIs
Publication statusPublished - 2018 Mar 15
Externally publishedYes

Fingerprint

Health
Administrative Personnel
Systems Theory
Organizational Policy
Private Sector
Policy Making
Finland
Health Policy
Health Promotion
Research
Public Health
Head
Research Personnel

Keywords

  • Health equity
  • Health in all Policies
  • Intersectoral action
  • System framework

ASJC Scopus subject areas

  • Health Policy

Cite this

Shankardass, K., Muntaner, C., Kokkinen, L., Shahidi, F. V., Freiler, A., Oneka, G., ... O'Campo, P. (2018). The implementation of Health in All Policies initiatives: A systems framework for government action. Health Research Policy and Systems, 16(1), [26]. https://doi.org/10.1186/s12961-018-0295-z

The implementation of Health in All Policies initiatives : A systems framework for government action. / Shankardass, Ketan; Muntaner, Carles; Kokkinen, Lauri; Shahidi, Faraz Vahid; Freiler, Alix; Oneka, Goldameir; Bayoumi, Ahmed; O'Campo, Patricia.

In: Health Research Policy and Systems, Vol. 16, No. 1, 26, 15.03.2018.

Research output: Contribution to journalArticle

Shankardass, K, Muntaner, C, Kokkinen, L, Shahidi, FV, Freiler, A, Oneka, G, Bayoumi, A & O'Campo, P 2018, 'The implementation of Health in All Policies initiatives: A systems framework for government action', Health Research Policy and Systems, vol. 16, no. 1, 26. https://doi.org/10.1186/s12961-018-0295-z
Shankardass, Ketan ; Muntaner, Carles ; Kokkinen, Lauri ; Shahidi, Faraz Vahid ; Freiler, Alix ; Oneka, Goldameir ; Bayoumi, Ahmed ; O'Campo, Patricia. / The implementation of Health in All Policies initiatives : A systems framework for government action. In: Health Research Policy and Systems. 2018 ; Vol. 16, No. 1.
@article{a71b723d26fa4693b7342a0b26ecec4b,
title = "The implementation of Health in All Policies initiatives: A systems framework for government action",
abstract = "Background: There has been a renewed interest in broadening the research agenda in health promotion to include action on the structural determinants of health, including a focus on the implementation of Health in All Policies (HiAP). Governments that use HiAP face the challenge of instituting governance structures and processes to facilitate policy coordination in an evidence-informed manner. Due to the complexity of government institutions and the policy process, systems theory has been proposed as a tool for evaluating the implementation of HiAP. Methods: Our multiple case study research programme (HiAP Analysis using Realist Methods On International Case Studies - HARMONICS) has relied on systems theory and realist methods to make sense of how and why the practices of policy-makers (including politicians and civil servants) from specific institutional environments (policy sectors) has either facilitated or hindered the implementation of HiAP. Herein, we present a systems framework for the implementation of HiAP based on our experience and empirical findings in studying this process. Results: We describe a system of 14 components within three subsystems of government. Subsystems include the executive (heads of state and their appointed political elites), intersectoral (the milieu of policy-makers and experts working with governance structures related to HiAP) and intrasectoral (policy-makers within policy sectors). Here, HiAP implementation is a process involving interactions between subsystems and their components that leads to the emergence of implementation outcomes, as well as effects on the system components themselves. We also describe the influence of extra-governmental systems, including (but not limited to) the academic sector, third sector, private sector and intergovernmental sector. Finally, we present a case study that applies this framework to understand the implementation of HiAP - the Health 2015 Strategy - in Finland, from 2001 onward. Conclusions: This framework is useful for helping to explain how, why and under what circumstances HiAP has been successfully and unsuccessfully implemented in a sustainable manner. It serves as a tool for researchers to study this process, and for policy-makers and other public health actors to manage this process.",
keywords = "Health equity, Health in all Policies, Intersectoral action, System framework",
author = "Ketan Shankardass and Carles Muntaner and Lauri Kokkinen and Shahidi, {Faraz Vahid} and Alix Freiler and Goldameir Oneka and Ahmed Bayoumi and Patricia O'Campo",
year = "2018",
month = "3",
day = "15",
doi = "10.1186/s12961-018-0295-z",
language = "English",
volume = "16",
journal = "Health Research Policy and Systems",
issn = "1478-4505",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - The implementation of Health in All Policies initiatives

T2 - A systems framework for government action

AU - Shankardass, Ketan

AU - Muntaner, Carles

AU - Kokkinen, Lauri

AU - Shahidi, Faraz Vahid

AU - Freiler, Alix

AU - Oneka, Goldameir

AU - Bayoumi, Ahmed

AU - O'Campo, Patricia

PY - 2018/3/15

Y1 - 2018/3/15

N2 - Background: There has been a renewed interest in broadening the research agenda in health promotion to include action on the structural determinants of health, including a focus on the implementation of Health in All Policies (HiAP). Governments that use HiAP face the challenge of instituting governance structures and processes to facilitate policy coordination in an evidence-informed manner. Due to the complexity of government institutions and the policy process, systems theory has been proposed as a tool for evaluating the implementation of HiAP. Methods: Our multiple case study research programme (HiAP Analysis using Realist Methods On International Case Studies - HARMONICS) has relied on systems theory and realist methods to make sense of how and why the practices of policy-makers (including politicians and civil servants) from specific institutional environments (policy sectors) has either facilitated or hindered the implementation of HiAP. Herein, we present a systems framework for the implementation of HiAP based on our experience and empirical findings in studying this process. Results: We describe a system of 14 components within three subsystems of government. Subsystems include the executive (heads of state and their appointed political elites), intersectoral (the milieu of policy-makers and experts working with governance structures related to HiAP) and intrasectoral (policy-makers within policy sectors). Here, HiAP implementation is a process involving interactions between subsystems and their components that leads to the emergence of implementation outcomes, as well as effects on the system components themselves. We also describe the influence of extra-governmental systems, including (but not limited to) the academic sector, third sector, private sector and intergovernmental sector. Finally, we present a case study that applies this framework to understand the implementation of HiAP - the Health 2015 Strategy - in Finland, from 2001 onward. Conclusions: This framework is useful for helping to explain how, why and under what circumstances HiAP has been successfully and unsuccessfully implemented in a sustainable manner. It serves as a tool for researchers to study this process, and for policy-makers and other public health actors to manage this process.

AB - Background: There has been a renewed interest in broadening the research agenda in health promotion to include action on the structural determinants of health, including a focus on the implementation of Health in All Policies (HiAP). Governments that use HiAP face the challenge of instituting governance structures and processes to facilitate policy coordination in an evidence-informed manner. Due to the complexity of government institutions and the policy process, systems theory has been proposed as a tool for evaluating the implementation of HiAP. Methods: Our multiple case study research programme (HiAP Analysis using Realist Methods On International Case Studies - HARMONICS) has relied on systems theory and realist methods to make sense of how and why the practices of policy-makers (including politicians and civil servants) from specific institutional environments (policy sectors) has either facilitated or hindered the implementation of HiAP. Herein, we present a systems framework for the implementation of HiAP based on our experience and empirical findings in studying this process. Results: We describe a system of 14 components within three subsystems of government. Subsystems include the executive (heads of state and their appointed political elites), intersectoral (the milieu of policy-makers and experts working with governance structures related to HiAP) and intrasectoral (policy-makers within policy sectors). Here, HiAP implementation is a process involving interactions between subsystems and their components that leads to the emergence of implementation outcomes, as well as effects on the system components themselves. We also describe the influence of extra-governmental systems, including (but not limited to) the academic sector, third sector, private sector and intergovernmental sector. Finally, we present a case study that applies this framework to understand the implementation of HiAP - the Health 2015 Strategy - in Finland, from 2001 onward. Conclusions: This framework is useful for helping to explain how, why and under what circumstances HiAP has been successfully and unsuccessfully implemented in a sustainable manner. It serves as a tool for researchers to study this process, and for policy-makers and other public health actors to manage this process.

KW - Health equity

KW - Health in all Policies

KW - Intersectoral action

KW - System framework

UR - http://www.scopus.com/inward/record.url?scp=85043774913&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85043774913&partnerID=8YFLogxK

U2 - 10.1186/s12961-018-0295-z

DO - 10.1186/s12961-018-0295-z

M3 - Article

C2 - 29544496

AN - SCOPUS:85043774913

VL - 16

JO - Health Research Policy and Systems

JF - Health Research Policy and Systems

SN - 1478-4505

IS - 1

M1 - 26

ER -