Strengthening the implementation of Health in All Policies

A methodology for realist explanatory case studies

Bibliographic Data

ID11491119
AuthorsKetan Shankarda (0000-0002-8410-2201, St. Michael's Hospital, corresponding author), K Shankardass, Emilie Renahy (St. Michael's Hospital), Carles Muntaner (0000-0003-3535-467X, St. Michael's Hospital), Patricia O’campo (0000-0003-4549-7324, St. Michael's Hospital)
Year2015
Volume30
Issue4
Pages462-473
Publication date2015-05-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czu021
PMID24816571
OpenAlexW2138310303
LanguageEN
Citations received44
References cited50

To address macro-social and economic determinants of health and equity, there has been growing use of intersectoral action by governments around the world. Health in All Policies (HiAP) initiatives are a special case where governments use cross-sectoral structures and relationships to systematically address health in policymaking by targeting broad health determinants rather than health services alone. Although many examples of HiAP have emerged in recent decades, the reasons for their successful implementation--and for implementation failures--have not been systematically studied. Consequently, rigorous evidence based on systematic research of the social mechanisms that have regularly enabled or hindered implementation in different jurisdictions is sparse. We describe a novel methodology for explanatory case studies that use a scientific realist perspective to study the implementation of HiAP. Our methodology begins with the formulation of a conceptual framework to describe contexts, social mechanisms and outcomes of relevance to the sustainable implementation of HiAP. We then describe the process of systematically explaining phenomena of interest using evidence from literature and key informant interviews, and looking for patterns and themes. Finally, we present a comparative example of how Health Impact Assessment tools have been utilized in Sweden and Quebec to illustrate how this methodology uses evidence to first describe successful practices for implementation of HiAP and then refine the initial framework. The methodology that we describe helps researchers to identify and triangulate rich evidence describing social mechanisms and salient contextual factors that characterize successful practices in implementing HiAP in specific jurisdictions. This methodology can be applied to study the implementation of HiAP and other forms of intersectoral action to reduce health inequities involving multiple geographic levels of government in diverse settings.

Economics · Epistemology · Explanatory model · Management science · Political science · Public economics · Regional science · Sociology · Global Public Health Policies and Epidemiology · Philosophy · Public Health and Social Inequalities · Public Health Policies and Education