Beyond fragmented interventions: a setting-based collaboration and Health in All Policies approach

Health promotion in Flanders (Belgium) is often fragmented with multiple thematic interventions (e.g. on physical activity, tobacco…) competing for attention in the same settings. This limits uptake, coherence and long-term impact. There is a need for enhanced collaboration and approaches that streamline implementation and align actors in settings and policy domains. This abstract presents a setting-based collaboration approach to do so. Between 2021–2026, Flanders developed a setting-based collaboration model linking health promotion organisations, setting actors and policymakers in a Health in All Policies approach. For each setting (education, local authorities, care and well-being, family, work and leisure), a network group is established that connects 12–24 organisations. The model combines shared action plans, co-creation of tools (e.g. integrated “roadmaps” bundling available health initiatives) and capacity-building. The model led to increased alignment of initiatives and joint actions across organisations. E.g. the awareness tool designed to encourage a preventive mindset among various target groups was developed. Joint implementation led to a 175% increase in the number of users of the “roadmaps”. Capacity-building initiatives reached 6,000 people, increasing knowledge of and stronger connection with settings. Collaboration also strengthened links between health promotion organisations, policy and practice and resulting in policy papers. Moving from fragmented interventions to coordinated implementation comes with challenges such as complex coordination at the level of settings and governance. Co-creation with setting actors increases ownership, relevance and feasibility, but requires time and mutual understanding. Dedicated facilitators, shared goals, clear mandates and established HiAP are critical enablers. This approach offers a transferable model for strengthening health promotion systems and operationalising HiAP through enhanced collaboration.

Key messages

• Fragmentation in health promotion limits impact. Setting-based collaboration can align actors and streamline implementation across sectors.

• Enhanced collaboration between and co-creation and joint implementation initiatives with setting actors and policymakers improve uptake, relevance and sustainability of health promotion.