Molnar Agnes, Renahy Emilie, O'Campo Patricia, Muntaner Carles, Freiler Alix, Shankardass Ketan
Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
PLoS One. 2016 Feb 4;11(2):e0147003. doi: 10.1371/journal.pone.0147003. eCollection 2016.
In spite of increasing research into intersections of public policy and health, little evidence shows how policy processes impact the implementation of Health in All Policies (HiAP) initiatives. Our research sought to understand how and why strategies for engaging partners from diverse policy sectors in the implementation of HiAP succeed or fail in order to uncover the underlying social mechanisms contributing to sustainable implementation of HiAP.
In this explanatory multiple case study, we analyzed grey and peer-review literature and key informant interviews to identify mechanisms leading to implementation successes and failures in relation to different strategies for engagement across three case studies (Sweden, Quebec and South Australia), after accounting for the role of different contextual conditions.
Our results yielded no support for the use of awareness-raising or directive strategies as standalone approaches for engaging partners to implement HiAP. However, we found strong evidence that mechanisms related to "win-win" strategies facilitated implementation by increasing perceived acceptability (or buy-in) and feasibility of HiAP implementation across sectors. Win-win strategies were facilitated by mechanisms related to several activities, including: the development of a shared language to facilitate communication between actors from different sectors; integrating health into other policy agendas (eg., sustainability) and use of dual outcomes to appeal to the interests of diverse policy sectors; use of scientific evidence to demonstrate the effectiveness of HiAP; and using health impact assessment to make policy coordination for public health outcomes more feasible and to give credibility to policies being developed by diverse policy sectors.
Our findings enrich theoretical understanding in an under-unexplored area of intersectoral action. They also provide policy makers with examples of HiAP across wealthy welfare regimes, and improve understanding of successful HiAP implementation practices, including the win-win approach.
尽管对公共政策与健康交叉领域的研究不断增加，但鲜有证据表明政策过程如何影响“健康融入所有政策”（HiAP）倡议的实施。我们的研究旨在了解在HiAP实施过程中，让来自不同政策部门的合作伙伴参与的策略是如何以及为何成功或失败的，以便揭示有助于HiAP可持续实施的潜在社会机制。
在这项解释性多案例研究中，我们分析了灰色文献、同行评审文献以及关键 informant 访谈，在考虑不同背景条件的作用后，确定与三个案例研究（瑞典、魁北克和南澳大利亚）中不同参与策略相关的导致实施成功和失败的机制。
我们的结果不支持将提高意识或指令性策略作为让合作伙伴实施HiAP的独立方法。然而，我们发现有力证据表明，与“双赢”策略相关的机制通过提高各部门对HiAP实施的可接受性（或认同）和可行性来促进实施。与若干活动相关的机制促进了双赢策略，包括：开发一种共享语言以促进不同部门行为者之间的沟通；将健康纳入其他政策议程（如可持续性）并利用双重成果来吸引不同政策部门的利益；利用科学证据证明HiAP的有效性；以及利用健康影响评估使公共卫生成果的政策协调更可行，并为不同政策部门制定的政策提供可信度。
我们的研究结果丰富了跨部门行动这一未充分探索领域的理论理解。它们还为政策制定者提供了富裕福利制度下HiAP的实例，并增进了对HiAP成功实施实践（包括双赢方法）的理解。
