Health is created largely outside the health sector. Engagement in health governance, policy, and intervention development and implementation by sectors other than health is therefore important. Recent calls for building and implementing Health in All Policies, and continued arguments for intersectoral action, may strengthen the potential that other sectors have for health. This review clarifies the conceptual foundations for integral health governance, policy, and action, delineates the different sectors and their possible engagement, and provides an overview of a continuum of methods of engagement with other sectors to secure integration. This continuum ranges from institutional (re)design to value-based narratives. Depending on the lens applied, different elements can be identified within the continuum. This review is built on insights from political science, leadership studies, public health, empirical Health in All Policy research, knowledge and evidence nexus approaches, and community perspectives. Successful integration of health governance, policy, and action depends on integration of the elements on the continuum.


Article metrics loading...

Loading full text...

Full text loading...


Literature Cited

  1. Angell M. 1.  2005. The Truth about the Drug Companies: How They Deceive Us and What to Do About It New York: Random House
  2. Antonovsky A. 2.  1996. The salutogenic model as a theory to guide health promotion. Health Promot. Int. 11:11–18 [Google Scholar]
  3. Barbazza E, Tello JE. 3.  2014. A review of health governance: definitions, dimensions and tools to govern. Health Policy 116:1–11 [Google Scholar]
  4. Baum F, Lawless A, Williams C. 4.  2013. Health in All Policies from international ideas to local implementation: policies, systems and organizations. Health Promotion and the Policy Process C Clavier, E De Leeuw 188–217 Oxford, UK: Oxford Univ. Press [Google Scholar]
  5. Beaglehole R, Bonita R. 5.  1998. Public health at the crossroads: which way forward?. Lancet 351:590–92 [Google Scholar]
  6. Beavers SL. 6.  2002. The West Wing as a pedagogical tool. Polit. Sci. Polit. 35:213–16 [Google Scholar]
  7. Blas E, Gilson L, Kelly MP, Labonté R, Lapitan J. 7.  et al. 2008. Addressing social determinants of health inequities: What can the state and civil society do?. Lancet 372:1684–89 [Google Scholar]
  8. Blum H. 8.  1981. Planning for Health: Generics for the Eighties New York: Hum. Sci. Press
  9. Bowker GC, Star SL. 9.  2000. Sorting Things Out: Classification and Its Consequences Cambridge, MA: MIT Press
  10. Bowman S, Unwin N, Critchley J, Capewell S, Husseini A. 10.  et al. 2012. Use of evidence to support healthy public policy: a policy effectiveness-feasibility loop. Bull. World Health Organ. 90:847–53 [Google Scholar]
  11. Breton E, De Leeuw E. 11.  2011. Theories of the policy process in health promotion research: a review. Health Promot. Int. 26:82–90 [Google Scholar]
  12. Burger MJ, Van der Knaap B, Wall RS. 12.  2014. Polycentricity and the multiplexity of urban networks. Eur. Plann. Stud. 22:816–40 [Google Scholar]
  13. 13. Can. Counc. Soc. Determ. Health. 2015. A Review of Frameworks on the Determinants of Health. Ottawa: Can. Counc. Soc. Determ. Health
  14. Christensen T, Lægreid P. 14.  2007. The whole-of-government approach to public sector reform. Public Adm. Rev. 67:1059–66 [Google Scholar]
  15. Cohen MN. 15.  1989. Health and the Rise of Civilization New Haven, CT: Yale Univ. Press
  16. Commers M. 16.  2002. Determinants of Health: Theory, Understanding, Portrayal, Policy New York: Springer Sci. Bus. Media
  17. Conrad P, Schneider JW. 17.  2010. Deviance and Medicalization: From Badness to Sickness Philadelphia: Temple Univ. Press
  18. Crawford R. 18.  1980. Healthism and the medicalization of everyday life. Int. J. Health Serv. 10:365–88 [Google Scholar]
  19. Crawshaw P, Bunton R, Gillen K. 19.  2003. Health action zones and the problem of community. Health Soc. Care Community 11:36–44 [Google Scholar]
  20. Davies SC, Winpenny E, Ball S, Fowler T, Rubin J, Nolte E. 20.  2014. For debate: a new wave in public health improvement. Lancet 384:1889–95 [Google Scholar]
  21. De Leeuw E. 21.  2011. The Ottawa Charter for Health Promotion 25 years on. Health Promot. Int. 26:ii157–272 [Google Scholar]
  22. De Leeuw E. 22.  2012. Do healthy cities work? A logic of method for assessing impact and outcome of healthy cities. J. Urban Health: Bull. N. Y. Acad. Med. 89:217–31 [Google Scholar]
  23. De Leeuw E. 23.  2015. Intersectoral action, policy and governance in European Healthy Cities. Public Health Panor. 1:175–82 [Google Scholar]
  24. De Leeuw E. 24.  2017. Cities and health. Healthy Cities—The Theory, Policy, and Practice of Value-Based Urban Health Planning E de Leeuw, J Simos New York: Springer [Google Scholar]
  25. De Leeuw E. 25.  2016. From research to policy and practice in public health. Public Health P Liamputtong 213–33 Cambridge, UK: Cambridge Univ. Press [Google Scholar]
  26. De Leeuw E. 26.  2016. The nature of the silent arrow March 14, Glocal Health Consult., Victoria, Aust.: http://glocalhealthconsultants.com/the-nature-of-the-silent-arrow/
  27. De Leeuw E, Clavier C. 27.  2011. Healthy public in all policies. Health Promot. Int. 26:ii237–44 [Google Scholar]
  28. De Leeuw E, Clavier C, Breton E. 28.  2014. Health policy—why research it and how: health political science. Health Res. Policy Syst. 12:1–11 [Google Scholar]
  29. De Leeuw E, Green G, Spanswick L, Palmer N. 29.  2015. Policymaking in European healthy cities. Health Promot. Int. 30:i18–31 [Google Scholar]
  30. De Leeuw E, McNess A, Crisp B, Stagnitti K. 30.  2008. Theoretical reflections on the nexus between research, policy and practice. Crit. Public Health 18:5–20 [Google Scholar]
  31. De Leeuw E, Palmer N, Spanswick L. 31.  2015. City Fact Sheets: WHO European Healthy Cities Network Copenhagen: World Health Organ. Reg. Off. Eur.
  32. De Leeuw E, Peters D. 32.  2015. Nine questions to guide development and implementation of Health in All Policies. Health Promot. Int. 30:987–97 [Google Scholar]
  33. De Leeuw E, Polman L. 33.  1995. Health policy making: the Dutch experience. Soc. Sci. Med. 40:331–38 [Google Scholar]
  34. De Leeuw E, Skovgaard T. 34.  2005. Utility-driven evidence for healthy cities: problems with evidence generation and application. Soc. Sci. Med. 61:1331–41 [Google Scholar]
  35. Delany T, Lawless A, Baum F, Popay J, Jones L. 35.  et al. 2016. Health in All Policies in South Australia: What has supported early implementation?. Health Promot. Int. 31888–98
  36. 36. Dep. Health, Gov. S. Aust. 2011. The South Australian Approach to Health in All Policies: Background and Practical Guide version 2. Rundle Mall, S. Aust.: Health in All Policies Unit, Dep. Health, Gov. S. Aust https://sahealth.sa.gov.au/wps/wcm/connect/cb6fa18043aece9fb510fded1a914d95/HiAPBackgroundPracticalGuide-v2.pdf?MOD=AJPERES&CACHEID=cb6fa18043aece9fb510fded1a914d95
  37. Eckermann L. 37.  2016. Health promotion principles as a catalyst for translating the SDGs into more transformative action. Health Promot. Int. 31:253–57 [Google Scholar]
  38. Ehrenreich B, Ehrenreich J. 38.  1970. The American Health Empire. New York: Random House
  39. Evans RG, Barer ML, Marmor TR. 39.  1994. Why Are Some People Healthy and Others Not?: The Determinants of Health of Populations New York: Aldine de Gruyter
  40. Exworthy M, Hunter DJ. 40.  2011. The challenge of joined-up government in tackling health inequalities. Int. J. Public Adm. 34:201–12 [Google Scholar]
  41. Fafard P. 41.  2008. Evidence and Healthy Public Policy: Insights from Health and Political Sciences Ottawa: Can. Policy Res. Netw.
  42. Finegood DT. 42.  2011. The complex systems science of obesity. The Oxford Handbook of the Social Science of Obesity J Cawley 208–36 Oxford, UK: Oxford Univ. Press [Google Scholar]
  43. Flinders M. 43.  2002. Governance in Whitehall. Public Adm. 80:51–75 [Google Scholar]
  44. Foucault M. 44.  1983. Naissance de la clinique. Une archéologie du regard médical. Paris: Press. Univ. France
  45. Fung A. 45.  2015. Putting the public back into governance: the challenges of citizen participation and its future. Public Adm. Rev. 75:513–22 [Google Scholar]
  46. Goldfrank B. 46.  2012. The World Bank and the globalization of participatory budgeting. J. Public Deliberation 8: Art. 7 [Google Scholar]
  47. Gottlieb LM, Fielding JE, Braveman PA. 47.  2012. Health impact assessment: necessary but not sufficient for healthy public policy. Public Health Rep. 127:156–62 [Google Scholar]
  48. 48. Gov. S. Aust. 2016. Health Lens Analysis Projects. Adelaide: Gov. S. Aust. http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+reform/health+in+all+policies/health+lens+analysis+projects
  49. Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J. 49.  et al. 2006. Lost in knowledge translation: time for a map?. J. Contin. Educ. Health Prof. 26:13–24 [Google Scholar]
  50. Green G. 50.  1998. Health and Governance in European Cities: A Compendium of Trends and Responsibilities for Public Health in 46 Member States of the WHO European Region London: Eur. Hosp. Manag. J. Ltd.
  51. Greenhalgh T, Wieringa S. 51.  2011. Is it time to drop the ‘knowledge translation’ metaphor? A critical literature review. J. R. Soc. Med. 104:501–9 [Google Scholar]
  52. Greer SL, Lillvis DF. 52.  2014. Beyond leadership: political strategies for coordination in health policies. Health Policy 116:12–17 [Google Scholar]
  53. Gusfield JR. 53.  1989. Constructing the ownership of social problems: fun and profit in the welfare state. Soc. Probl. 36:431–41 [Google Scholar]
  54. Hancock T. 54.  1985. Beyond health care: from public health policy to healthy public policy. Can. J. Public Health 76:Suppl. 19–11 [Google Scholar]
  55. Hancock T. 55.  2011. Health promotion in Canada: 25 years of unfulfilled promise. Health Promot. Int. 26:Suppl. 2ii263–67 [Google Scholar]
  56. Heritage Z, Green G. 56.  2013. European national healthy city networks: the impact of an elite epistemic community. J. Urban Health: Bull. N. Y. Acad. Med. 90:Suppl. 1154–66 [Google Scholar]
  57. Hill M, Hupe P. 57.  2006. Analysing policy processes as multiple governance: accountability in social policy. Policy Polit 34:557–73 [Google Scholar]
  58. Hofstad H. 58.  2016. The ambition of Health in All Policies in Norway: the role of political leadership and bureaucratic change. Health Policy 120:567–75 [Google Scholar]
  59. Hood C. 59.  1983. The Tools of Government London: MacMillan
  60. Horton K, Friel S, de Leeuw E, McKeone C, Bolam B. 60.  2015. Fair foundations for health equity. Health Promot. Int. 30:Suppl. 2ii2–7 [Google Scholar]
  61. Howard R, Gunther S. 61.  2012. Health in All Policies: An EU Literature Review and Interview with Key Stakeholders Brussels: Equity Action
  62. Howlett M. 62.  2000. Managing the “hollow state”: procedural policy instruments and modern governance. Can. Public Adm. 43:412–31 [Google Scholar]
  63. Hunt S. 63.  2005. Whole-of-Government: Does Working Together Work Canberra: Aust. Natl. Univ.
  64. Illich I. 64.  1976. Medical Nemesis: The Expropriation of Health New York: Pantheon
  65. Jagosh J, Bush PL, Salsberg J, Macaulay AC, Greenhalgh T. 65.  et al. 2015. A realist evaluation of community-based participatory research: partnership synergy, trust building and related ripple effects. BMC Public Health 15:725 [Google Scholar]
  66. Jansen MW, De Leeuw E, Hoeijmakers M, De Vries NK. 66.  2012. Working at the nexus between public health policy, practice and research. Dynamics of knowledge sharing in The Netherlands. Health Res. Policy Syst. 10:33 [Google Scholar]
  67. Kavanagh D, Richards D. 67.  2001. Departmentalism and joined-up government. Parliam. Aff. 54:1–18 [Google Scholar]
  68. Kelly M, Charlton B. 68.  1995. The modern and the postmodern in health promotion. The Sociology of Health Promotion: Critical Analyses of Consumption, Lifestyle and Risk R Bunton, S Nettleton, R Burrows 78–90 London: Routledge [Google Scholar]
  69. Kickbusch I. 69.  2007. Health governance: the Health Society. See Ref. 78 144–61
  70. Kingsley JY, Townsend M, Phillips R, Aldous D. 70.  2009. “If the land is healthy…it makes the people healthy”: the relationship between caring for country and health for the Yorta Yorta Nation, Boonwurrung and Bangerang Tribes. Health Place 15:291–99 [Google Scholar]
  71. Leppo K, Ollila E, Peña S, Wismar M, Cook S. 71.  2013. Health in All Policies. Seizing Opportunities, Implementing Policies. Helsinki: Ministr. Soc. Aff. Health
  72. Lalonde M. 72.  1974. A New Perspective on the Health of Canadians. A Working Document. Ottawa: Gov. Can.
  73. Lowi TJ. 73.  1964. American business, public policy, case-studies, and political theory. World Polit 16:677–715 [Google Scholar]
  74. Malone RE. 74.  1999. Policy as product. Morality and metaphor in health policy discourse. Hastings Cent. Rep. 29:16–22 [Google Scholar]
  75. Marmor TR, Boyum D. 75.  1999. Medical care and public policy: the benefits and burdens of asking fundamental questions. Health Policy 49:27–43 [Google Scholar]
  76. Marmot M, Allen JJ. 76.  2014. Social determinants of health equity. Am. J. Public Health 104:Suppl. 4S517–19 [Google Scholar]
  77. McIntyre D, Mooney G. 77.  2007. The Economics of Health Equity Cambridge, UK: Cambridge Univ. Press
  78. McQueen D, Kickbusch I, Potvin L, Pelikan J, Balbo L, Abel T. 78.  2007. Health and Modernity: The Role of Theory in Health Promotion New York: Springer Sci. Bus. Media
  79. McQueen D, Wismar M, Lin V, Jones CM, Davies M. 79.  2012. Intersectoral Governance for Health in All Policies: Structures, Actions and Experiences Copenhagen: World Health Organ. Reg. Off. Eur.
  80. Milio N. 80.  1981. Promoting Health Through Public Policy Philadelphia: Davis
  81. Milio N. 81.  2001. Evaluation of health promotion policies: tracking a moving target. WHO Reg. Publ. Eur. Ser.92365–85
  82. Millgram E. 82.  2015. The Great Endarkenment: Philosophy for an Age of Hyperspecialization Oxford, UK: Oxford Univ. Press
  83. Milton B, Attree P, French B, Povall S, Whitehead M, Popay J. 83.  2012. The impact of community engagement on health and social outcomes: a systematic review. Community Dev. J. 47:316–34 [Google Scholar]
  84. Molnar A, Renahy E, O'Campo P, Muntaner C, Freiler A, Shankardass K. 84.  2016. Using win-win strategies to implement Health in All Policies: a cross-case analysis. PLOS ONE 11:e0147003 [Google Scholar]
  85. Mossialos E, Wenzl M, Osborn R, Sarnak D. 85.  2016. 2015 International Profiles of Health Care Systems Washington, DC: Commonw. Fund
  86. Norsigian J, Diskin V, Doress-Worters P, Pincus J, Sanford W, Swenson N. 86.  1999. The Boston Women's Health Book Collective and “Our Bodies, Ourselves”: a brief history and reflection. J. Am. Med. Womens Assoc 54:35–38 [Google Scholar]
  87. Nutbeam D. 87.  1998. Health promotion glossary. Health Promot. Int. 13:349–64 [Google Scholar]
  88. Oliver K, Lorenc T, Innvær S. 88.  2014. New directions in evidence-based policy research: a critical analysis of the literature. Health Res. Policy Syst. 12:34 [Google Scholar]
  89. Peters BG. 89.  1998. Managing horizontal government: the politics of co-ordination. Public Adm 76:295–311 [Google Scholar]
  90. Pickett KE, Wilkinson RG. 90.  2015. Income inequality and health: a causal review. Soc. Sci. Med. 128:316–26 [Google Scholar]
  91. Plsek PE, Greenhalgh T. 91.  2001. Complexity science: the challenge of complexity in health care. BMJ 323:625–28 [Google Scholar]
  92. Polsky C, Stagg K, Gakh M, Bozlak CT. 92.  2015. The Health in All Policies (HiAP) approach and the law: preliminary lessons from California and Chicago. J. Law Med. Ethics 43:52–55 [Google Scholar]
  93. Porter R. 93.  1999. The Greatest Benefit to Mankind: A Medical History of Humanity New York: Norton
  94. Provan KG, Kenis P. 94.  2008. Modes of network governance: structure, management, and effectiveness. J. Public Adm. Res. Theory 18:229–52 [Google Scholar]
  95. Puska P, Ståhl T. 95.  2010. Health in All Policies—the Finnish initiative: background, principles, and current issues. Annu. Rev. Public Health 31:315–28 [Google Scholar]
  96. Putland C, Baum FE, Ziersch AM. 96.  2011. From causes to solutions—insights from lay knowledge about health inequalities. BMC Public Health 11:67 [Google Scholar]
  97. Rissel C. 97.  1994. Empowerment: the holy grail of health promotion?. Health Promot. Int. 9:39–47 [Google Scholar]
  98. Carger E, Westen D. 98. Robert Wood Johnson Found. 2010. A New Way to Talk about the Social Determinants of Health Princeton, NJ: Robert Wood Johnson Found.
  99. Rudolph L, Caplan J, Ben-Moshe K, Dillon L. 99.  2013. Health in All Policies: A Guide for State and Local Governments Washington, DC: Am. Public Health Assoc.
  100. Schön DA. 100.  1973. Beyond the Stable State: Public and Private Learning in a Changing Society London: Harmondsworth Penguin
  101. Schön DA, Rein M. 101.  1994. Frame Reflection: Toward the Resolution of Intractable Policy Controversies New York: Basic Books
  102. Shankardass K, Solar O, Murphy K, Greaves L, O'Campo P. 102.  2012. A scoping review of intersectoral action for health equity involving governments. Int. J. Public Health 57:25–33 [Google Scholar]
  103. Shigayeva A, Atun R, McKee M, Coker R. 103.  2010. Health systems, communicable diseases and integration. Health Policy Plann 25:i4–20 [Google Scholar]
  104. Skok JE. 104.  1995. Policy issue networks and the public policy cycle: a structural-functional framework for public administration. Public Adm. Rev. 55:325–32 [Google Scholar]
  105. Smith K, Schrecker T. 105.  2014. Understanding health inequity and related policy responses: What insights can political and social theories offer? Presented at World Congr. Polit. Sci. , 23rd. July 19–24 Montreal
  106. Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J. 106.  et al. 2012. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health 12:80 [Google Scholar]
  107. Stone D. 107.  2002. Policy Paradox: The Art of Political Decision Making New York: Norton
  108. 108. UNICEF, WHO (World Health Organ.) 1978. Primary Health Care: Report of the International Conference on Primary Health Care, September 6–12, Alma Ata, USSR Geneva: WHO
  109. Van der Geest S, Speckmann JD, Streefland PH. 109.  1990. Primary health care in a multi-level perspective: towards a research agenda. Soc. Sci. Med. 30:1025–34 [Google Scholar]
  110. Warner M, Gould N. 110.  2009. Integrating Health in All Policies at the local level: using network governance to create ‘virtual reorganization by design. .’ In Policy Innovation for Health I Kickbusch 125–63 New York: Springer [Google Scholar]
  111. 111. WHA (World Health Assemb.) 2014. Resolution WHA67.12: Contributing to social and economic development: sustainable action across sectors to improve health and health equity Plenary Meet., May 24 World Health Organ. Geneva:
  112. 112. WHO (World Health Organ.) 1986. Intersectoral Action for Health: The Role of Intersectoral Cooperation in National Strategies for Health For All Geneva: WHO http://apps.who.int/iris/bitstream/10665/41545/1/9241560967_eng.pdf
  113. 113. WHO (World Health Organ.) 1988. Adelaide recommendations on healthy public policy. WHO Adelaide/Geneva: http://www.who.int/healthpromotion/conferences/previous/adelaide/en/
  114. 114. WHO (World Health Organ.) 2011. Education: Shared Interests in Well-Being and Development Geneva: WHO
  115. 115. WHO (World Health Organ.) 2011. Housing: Shared Interests in Health and Development Geneva: WHO
  116. 116. WHO (World Health Organ.) 2011. Social Protection: Shared Interests in Vulnerability Reduction and Development Geneva: WHO http://apps.who.int/iris/bitstream/10665/44876/1/9789241503655_eng.pdf
  117. 117. WHO (World Health Organ.) 2011. Transport (Road Transport): Shared Interests in Sustainable Outcomes Geneva: WHO
  118. 118. WHO (World Health Organ.) 2013. The Economics of the Social Determinants of Health and Health Inequalities: A Resource Book Geneva: WHO http://apps.who.int/iris/bitstream/10665/84213/1/9789241548625_eng.pdf
  119. 119. WHO (World Health Organ.) 2013. Energy: Shared Interests in Sustainable Development and Energy Services Geneva: WHO http://apps.who.int/iris/bitstream/10665/91591/1/9789241506199_eng.pdf
  120. 120. WHO (World Health Organ.) 2013. Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020 Geneva: WHO http://apps.who.int/iris/bitstream/10665/94384/1/9789241506236_eng.pdf?ua=1
  121. 121. WHO (World Health Organ.) 2014. Health in All Policies: Helsinki statement. Framework for country action. WHO Geneva: http://www.who.int/healthpromotion/frameworkforcountryaction/en/
  122. 122. WHO (World Health Organ.) 2015. Health in All Policies Training Manual Geneva: WHO http://apps.who.int/iris/bitstream/10665/151788/1/9789241507981_eng.pdf?ua=1
  123. 123. WHO (World Health Organ.), Health Welf. Can., Can. Public Health Assoc. 1986. The Ottawa charter for health promotion. The move towards a new public health. Adopted at Int. Conf. Health Promot., 1st, Nov. 17–21 Ottawa: http://www.who.int/healthpromotion/conferences/previous/ottawa/en/
  124. Willis E. 124.  1983. Medical Dominance: The Division of Labour in Australian Health Care Scoresby, Aust.: George Allen & Unwin

Data & Media loading...

  • Article Type: Review Article
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error