Implementing Health in All Policies at subnational level: lessons from six case studies

Health in All Policies (HiAP) implementation depends on the social, economic, administrative, and legislative context of each country. National frameworks and policies support local implementation, and municipalities, given their close connection to communities, have detailed knowledge of local needs and can deliver targeted responses. While HiAP is well studied at the national level, subnational research remains limited despite the growing role of local authorities. As part of the JA PreventNCD project, this study examines municipal HiAP implementation in six countries (Finland, France, Iceland, Norway, Slovenia, Spain). Using a case-study approach, six local HiAP initiatives were identified, and semi-structured interviews with key stakeholders were analysed using a common framework covering political context, governance, stakeholder involvement, health equity, monitoring and evaluation.

Across the six countries, despite differing governance structures, cross-cutting results emerged. Municipal HiAP relies on intersectoral coordination and governance mechanisms but faces siloed administrations. Therefore, developing informal collaborations, coordination roles and increasing political commitment to HiAP is essential. Barriers include limited funding, lack of time and unclear responsibilities. Monitoring and evaluation are essential but complex and fragmented locally. Integration of health equity remains limited and often implicit due to insufficient local data and standardised tools. The local level is crucial for HiAP, enabling tailored cross-sectoral interventions based on detailed knowledge of the territory and stakeholders. HiAP implementation requires sufficient and stable resources to support municipalities, especially smaller and rural ones. The national level should have a HiAP coordinating role by providing methodological guidance, tools, data and facilitating knowledge exchange, while preserving local autonomy and avoiding overly prescriptive approaches.

Key messages

• A comparative analysis of six subnational case studies reveals key drivers and barriers to implementing Health in All Policies across different national contexts.

• The municipal level plays a central role in Health in All Policies, connecting national strategies with community-level action while taking into account local resources and needs.