How to Evaluate Health in All Policies at the Local Level: Methodological Insights Within Municipalities From the WHO French Healthy Cities Network

Abstract

Background: This article proposes a method for analysing the degree of maturity of health-in-all-policies (HiAP) among WHO French Healthy Cities Network (WHO-FHCN) as part of the GREENH-City project. We focused on the creation or enhancement of health-promoting environments, and more specifically, public green spaces. Methods: We conducted a cross-sectional quantitative study guided by the evaluative framework of the HiAP maturity level developed by Storm et al. mixed with a qualitative interpretation. A self-administered questionnaire was sent to elected officials and health department officers in the 85 member cities of the WHO-FHCN in 2017. Subsequently 58 cities were included in the analysis, which was based on a Multiple Correspondence Analysis (MCA) and a Hierarchical Ascending Correspondence (HAC). Results: 32 criteria among a total of 100 were identified and were used to organize the cities into 8 groups which was then reduced to three profiles among the cities: a less advanced HiAP profile, an established HiAP profile and an advanced HiAP profile. This process allows us to identify 4 dimensions that make it possible to evaluate the level of maturity of cities in the HiAP process, namely: (1) the consideration of social inequalities in health and/or health issues in the policies / actions of the sector studied, (2) occasional intersectoral collaboration, i.e. one-off initiatives between the health department and others sectors, (3) the existence of joint projects, i.e. common projects between two or more sectors, (4) the existence of intersectoral bodies, in this case on the theme of urban green spaces including an intersectoral committee and/or working groups. Conclusion: Four dimensionswhich allow to the measurement of the degree of progress in implementing health-all-policies are proposed. With a view to integrating knowledge into public action, this study carried out under real conditions offers a realistic method to evaluate HiAP.

In Centralized Health Systems, Much Is Left Out When Analyses of Local HiAP Strategies Are Limited to Public Administration; A Commentary 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"

“…Yet, as we will see below, this does not mean that the implementation of a HiAP instrument is not feasible. 7 This public service perspective on HiAP also leads the authors to turn a blind eye to the influence that non-state actors (nongovernmental organizations [NGOs], local businesses…) play in policy development and implementation. Yet, when vested interests hinder efforts towards a cross-sectoral municipal approach and favour the status quo, these actors can prove valuable in driving change.…”

“…Yet, as we will see below, this does not mean that the implementation of a HiAP instrument is not feasible. 7 …”

A Qualitative Assessment of Multi-sectoral Action for Non-communicable Diseases (NCDs) in Uttar Pradesh, India

“…The community was engaged directly, and health impacts was appreciated and evaluated 24 . Drawing from the collaborative response experienced during the COVID-19 pandemic, there's hope for enhanced multisectoral cooperation in UP and India.…”