Local Health Promotion (HP): A Maturity Based Approach to municipalities engagement in HP

Background

Municipalities play a central role in shaping local environments that influence population health, yet their engagement in health promotion (HP) varies widely. In Switzerland, limited formal mandates and diverse local contexts contribute to unequal HP integration. This study examines how municipalities in the canton of Vaud perceive their role in HP, the extent to which HP is embedded in local policies, and the types of support needed to strengthen municipal action.

Methods

A mixed‑methods sequential explanatory design combined an online survey of all 300 municipalities (39% response rate) with 25 interviews and 5 focus groups. An adaptation of the Maturity Model of Health in All Policies guided the analysis. Cluster analysis identified profiles of HP integration, complemented by statistical comparisons and qualitative thematic analysis.

Results

Four distinct clusters emerged: (1) Not engaged (39%), (2) Relying on others (26%), (3) Engaged but isolated (19%), and (4) Engaged and somewhat structured (16%). Municipal size and urban–rural context were strongly associated with maturity levels (p<.001). More mature municipalities (clusters 3 and 4) implemented significantly more measures and expressed high needs for long‑term financing (up to 88%) and local health or social cohesion data (65%), essential for targeted interventions. Less engaged municipalities reported lower needs overall and greater uncertainty, indicating limited awareness, knowledge, and access to expert support.

Conclusions

Municipalities fits in a maturity continuum in HP integration, each presenting distinct barriers and support needs. Tailored strategies—ranging from awareness‑raising for less engaged municipalities to data provision, and intersectoral governance for more advanced ones—are essential to strengthen local HP capacity. These findings inform scalable, context‑sensitive approaches to reinforce municipal action as a key lever for public health.

Key messages

• Municipalities in the Canton of Vaud (Switzerland) show highly heterogeneous engagement in health promotion, requiring tailored support aligned with their maturity level.

• Strengthening local health promotion demands long term funding, data, and capacity building adapted to municipal profiles.