Elsevier

Health Policy

Volume 114, Issues 2–3, February 2014, Pages 174-182
Health Policy

‘Are we there yet?’ – Operationalizing the concept of Integrated Public Health Policies

https://doi.org/10.1016/j.healthpol.2013.10.004Get rights and content

Abstract

Objectives

Although ‘integrated’ public health policies are assumed to be the ideal way to optimize public health, it remains hard to determine how far removed we are from this ideal, since clear operational criteria and defining characteristics are lacking.

Methods

A literature review identified gaps in previous operationalizations of integrated public health policies. We searched for an approach that could fill these gaps.

Results

We propose the following defining characteristics of an integrated policy: (1) the combination of policies includes an appropriate mix of interventions that optimizes the functioning of the behavioral system, thus ensuring that motivation, capability and opportunity interact in such a way that they promote the preferred (health-promoting) behavior of the target population, and (2) the policies are implemented by the relevant policy sectors from different policy domains.

Conclusion

Our criteria should offer added value since they describe pathways in the process towards formulating integrated policy. The aim of introducing our operationalization is to assist policy makers and researchers in identifying truly integrated cases. The Behavior Change Wheel proved to be a useful framework to develop operational criteria to assess the current state of integrated public health policies in practice.

Section snippets

Background

Integrated public health policies are often advocated, since they are assumed to pave the way to a healthier society [1], [2], [3], [4]. However, it is difficult to evaluate the extent to which health policies are integrated, since a clear operational definition of integrated public health policies is lacking [5].

Many researchers have described integrated public health policies in abstract terms [1], [2], [3], [4], [5], [6], such as ‘health in all policies’ [6], ‘multi-sectoral policy’ [7] and

Methods

Our method was based on four steps: (1) conducting a literature review of publications that propose an operationalization of integrated public health policies and related notions (e.g., health in all policies) using the following search terms: health in all policies, intersectoral action, intersectoral action for health, health governance, health policy, public policy, as well as finding common elements in these publications; (2) identifying gaps in the operationalizations, especially regarding

Literature review of previous operationalizations

Table 1 provides an overview of the previous publications in the field of integrated public health policies [1], [4], [6], [7], [8], [17], [18], [19], [20], [21], [22], [23], [24], [25]. What these publications have in common is that they emphasize: (a) establishing broader goals, not necessarily health, (b) the need for intersectoral action, (c) a focus on social determinants, such as equity, (d) the search for ‘synergies’, based on the assumption that more is achieved together compared to

Discussion

In this article, we have proposed an operationalization of ‘integrated public health policies’ based on two criteria that can be used to assess the extent to which public health policies are integrated. The first criterion is that the combination of policies (e.g., as described in policy documents) includes an array of appropriate interventions that optimize the behavioral system's functioning, thus ensuring that motivation, capability and opportunity interact in such a way as to promote the

Conclusion

We have proposed an operationalization of the concept of integrated public health policies which is based on the Behavior Change Wheel. This operationalization includes two criteria: (1) whether the combination of policies (e.g., as described in policy documents) enables a mix of interventions that make the behavioral system function (in terms of motivation, capability and opportunity), and (2) whether the policy is developed and implemented by the relevant policy sectors from different policy

Competing interests

We declare we have no competing interests.

Acknowledgements

AMH and JH conceived the idea. AMH drafted the manuscript. JH, MJ, SK, JG, SM and NdV helped to refine the manuscript. SM has ensured that the assumptions of the BCW are correctly formulated. MJ and HvO ensured the manuscript is in line with current developments in the health policy field.

References (42)

  • M. Steenbakkers

    Lokaal integraal gezondheidsbeleid: realistische uitdaging of utopie? Een onderzoek binnen gemeenten naar mogelijkheden tot intersectorale samenwerking. [Local integrated health policy: realisticchallenge or utopian dream? A study of opportunities for intersectoral collaboration in local government]

    (2012)
  • B. Head et al.

    Wicked problems: the implications for public management.

    (2008)
  • M.L. Exworthy

    Policy to tackle the social determinants of health: using conceptual models to understand the policy process

    Health Policy and Planning

    (2008)
  • J. Maas et al.

    Integraal gezondheidsbeleid op nationaal niveau. Wat kunnen we leren van de ervaringen uit andere landen? [Integrated health policies at national level. What can we learn from experiences in other countries?]

    (2011)
  • B.W. Head

    Wicked problems in public policy

    Public Policy

    (2008)
  • Y. Trope et al.

    Construal-level theory of psychological distance

    Psychological Review

    (2010)
  • World Health Organization

    The Ottawa charter for health promotion

    (1986)
  • M-J. Aarts et al.

    Feasibility of multi-sector policy measures that create activity-friendly environments for children: results of a Delphi study

    Implementation Science

    (2011)
  • P. Travis et al.

    Towards better stewardship

  • E. Ollila

    Health in All Policies: from rhetoric to action

    Scandinavian Journal of Public Health

    (2011)
  • K. Leppo et al.

    Health in All Policies: seizing opportunities, implementing policies

    (2013)
  • Cited by (0)

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