Local government policymaking environment for Health in All Policies: a case study research investigation

Figures & data

Table 1. Demographics of participants within the two case study sites, including role and years of experience in local government.

		Finchville	Roseford
Role in LG	Mayor	1	1
	Elected member	3	5
	CEO	1	0
	Manager	3	6
	Non-management staff	5	0
Years working in LG	>10 years	7	6
	6–10 years	3	3
	0–5 years	3	2
	Unknown/Not answered	0	1
Total number of participants		13	12

Table 2. Summary of themes identified as influencing the policymaking environment of local government to address health determinants.

Theme	Summary of findings
Strong organisational obligation	Decision-makers reported a strong commitment and obligation to respond to local community needs. The organisational commitments were often matched with personal beliefs and values that it was the ‘right thing to do’.
Internal leadership and multiple champions	There was widespread support by management and elected members, though no single key champion seeking opportunities to enable action on the determinants of health.
Difficulty defining health and wellbeing	Defining health, wellbeing, or determinants of health was considered difficult. The term ‘health’ was rarely or never used, and the determinants of health was never explicitly raised in policy decisions. Participants in both sites referred to action on health determinants as a by-product of other policy discussions.
Scope of LG role	The proximity to community was reported as raising the priority on determinants of health, with each LG community considered unique. The role of LG was identified as enabling, mediating and advocating for community wellbeing.
Evidence tends to be anecdotal	A range of evidence sources informed policy decisions, although no performance measures were in place for health and wellbeing outcomes. Scientific data was rarely used to guide decision-making, with a reliance on input by community organisations, census data and complaints by community members.
Mixed response regarding legislation	Mandatory action to address determinants of health was not considered necessary and proposed to narrow the focus and create a compliance approach, rather than having flexibility to respond to local priorities.
Lack of external advocates	External lobbying by community, local media or industry was reported as non-existent. There was no internal lobbying within LG to create a demand for action on determinants of health. Local media were identified as having limited capacity to drive social campaigns and were reported as largely apathetic.
Limited financial and staff capacity	Financial and staff resourcing was considered limited and competing with other priorities, in an environment of ongoing austerity.
Organisational stability	Organisational stability differed across the LG sites, determined by the community who elected representative members. Stability was recognised as necessary for public health planning, given the long-term actions required to see change.
Cooperation with higher tiers of government	The support of higher tiers of government was considered cooperative at a local level. Participants reported a reliance on higher tiers of government for short-term project funding, which was allocated for specific goals, and not always the priority of LG.
Support from other sectors	Cross sector collaborations were evident in Finchville, with formal collaborations around social issues, such as homelessness. Whilst less obvious, participants in Roseford expressed the need for partnerships to address health determinants and gave examples of this happening previously to address youth unemployment.
Role of community in decision-making	The community was reported to play a critical role in policy decision-making, although there were varying levels of community involvement in decision-making.
External events as a trigger for policy	There were few ‘external events’ that influenced decisions, except for LG amalgamations and local elections.

Data availability statement

Due to ethical considerations, supporting data is not publicly available. Participants did not provide informed consent for the data to be shared outside of this study.