March 2019. International Case Studies – Wider Determinants of Health

These International Case Studies, funded by the Health Foundation, exemplify where there has been consideration of population health in wider policy development, and identifies the opportunities and approaches which could be applicable in the UK. Using a systems approach, these case studies look at the evidence to understand wider conditions within which interventions are developed; how ideas and solutions came about; and the motivation and social attitudes to interventions.

Canada Case Study 

This case study examines how an effective cross-sectoral coalition, spanning national and regional organisations, can be built around a shared concern, in this case urban planning in Canada. In response to rising obesity levels, the Urban Public Health Network drew together a coalition of organisations and health authorities interested in nurturing health-promoting built environments.

South Australia Case Study

This case study examines the South Australia’s Social Inclusion Initiative as a means of tackling socioeconomic inequalities. Historically, the state of South Australia has lagged behind other states and territories on a range of economic, social and health indictors. The SII was a collection of governance and administrative arrangements, established by a new incoming government in 2002 and modelled on the UK Blair Government’s Social Exclusion Unit, that was designed to facilitate a whole-of-government approach to social inclusion and exclusion.

Paris Case Study

This case study examines how strong leadership at a city level can lead to the development of a diverse range of policies and actions to improve air quality by radically altering the travel behaviour of residents and businesses. In this case, the problem was poor air quality in Paris caused largely by emissions from diesel and petrol-powered vehicles.

Malmö Case Study

This case study examines a health in all policies approach at the city level with the aim of reducing health inequalities. It examines the decision by the Swedish city of Malmö to appoint an independent commission for a socially sustainable city. The objective was to develop a Socially Sustainable Policy for Malmö and give decision-makers evidence-based proposals for strategies to reduce the city’s growing health inequalities.

The Federal Interagency Reentry Council Case Study

This case study examines how federal level action to reduce recidivism was coordinated through a cross-government inter-agency to tackle determinants of health such as access to employment and housing. It examines the processes that led the Department of Justice to establish and implement the US Federal Interagency Reentry Council as a result of high-level, bipartisan political support for the issue.

Pennsylvania Case Study

This case study examines how an NGO focused on food and poverty issues persuaded city and state-level authorities in the US to lead the establishment of a public-private partnership to improve access to food in Pennsylvania. The partnership brought together diverse actors from the business, investment, development and health sectors to collaborate on improving, saving and/or building new food stores in deprived communities across the state.

Norway Case Study

This case study provides an example of how national and local parliamentarians and civil servants used the democratic system of Government to achieve a common goal in the establishment of the Norwegian Public Health Act. The Act enshrines the principle of health in all policies across all levels of government, in order to address the social determinants of health inequalities in Norway.

Netherlands Case Study

This case study examines the process and impact of developing and implementing a coaching programme on inter-sectoral collaboration for public health municipal staff in the South Limburg province of The Netherlands. It explores the degree to which the programme, led by the regional public health service, helped to facilitate inter-sectoral working across the municipality.

Hungary Case Study

This case study examines how a national government, under the direction of the Ministry of Finance, introduced a public health tax on a broad range of unhealthy food and drink products. The aim of the tax was to raise revenues for the health sector and tackle the twin problems of unhealthy diets and associated poor health. It examines the critical factors which led to a variety of successful health outcomes as a result of the tax.