Insights into living environment policy and health: interview study with 38 policy professionals

Background

The living environment is a key determinant of health, and since policies play a vital role in shaping our living environment they represent a keystone. The notion of health in all policies has been introduced decades ago, yet its implementation appears to drag. This seriously needs to change given the increasing burden on population health and the healthcare system.

Methods

We conducted semi-structured interviews with 38 policy professionals with a focus on health, spatial design and the social domain from 24 Dutch municipalities, both in rural and urban settings. To get an accurate representation of healthier and less healthy municipalities, we used outliers in population health outcomes Health Monitor data to include municipalities. The analysis, guided by the Institutional Analysis and Development (IAD) Framework, explored implementation barriers and facilitators.

Results

Respondents mention the food environment, alcohol consumption, smoking and social isolation as main determinants of environmental stressors. Barriers include political influence, limited capacity, and lack of evaluation. Intersectoral collaboration between health, spatial and social domain is difficult and evidence-based policy making is hampered. Despite these challenges, tangible successes were also noted, highlighting the potential for effective health-promoting environmental policy. Using these inputs we describe the IAD framework and highlight a complex Action Situation due to complex decision making processes.

Conclusions

‘Health in all policies’ is impeded by various constraints, but good examples demonstrate its feasibility. The IAD framework sketches the complexity of the Action Situation and how this can lead to a lack of evaluation, evidence and collaboration in policy making that promotes and protects health in all policies. Further research should investigate whether these findings apply to different geographic contexts and further appraisal and action towards HiAP.

Key messages

• Improving health through the living environment is shaped by various constraints and priorities, and differs by municipality depending on political context, level of urbanisation and resources.

• Achieving effective health in all policies requires structured, supported collaboration. Studying successful policies, intervention, laws and IAD-framework insights is essential for progress.