title: Health governance by collaboration: a case study on an area-based programme to tackle health inequalities in the Dutch city of the Hague.
abstract: BACKGROUND
  Area-based programmes are seen as a promising strategy for tackling health inequalities. In these programmes, local authorities and other local actors collaborate to employ health promoting interventions and policies. Little is known about the underlying processes of collaborative governance. To unravel this black box, we explored how the authority of The Hague, The Netherlands, developed a programme tackling health inequalities drawing on a collaborative mode of governance.
  
  
  METHODS
  Case study drawing on qualitative semi-structured interviews and document review. Data were inductively analysed against the concept of collaborative governance.
  
  
  RESULTS
  The authority's ambition was to co-produce a programme on tackling health inequalities with local actors. Three stages could be distinguished in the governing process: (i) formulating policy objectives, (ii) translating policy objectives into interventions and (iii) executing health interventions. In the stage of formulating policy objectives, the collaboration led to a reframing of the initial objectives. Furthermore, the translation of the policy objectives into health interventions was rather pragmatic and loosely based on health needs and/or evidence. As a result, the concrete actions that ensued from the programme did not necessarily reflect the initial objectives.
  
  
  CONCLUSIONS
  In a local system of health governance by collaboration, factors other than the stated policy objectives played a role, eventually undermining the effectiveness of the programme in reducing health inequalities. To be effective, the processes of collaborative governance underlying area-based programmes require the attention of the local authority, including the building and governing of networks, a competent public health workforce and supportive infrastructures.
authors.affiliation: 1 Department of Public Health, Academic Medical Centre/University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Thomas
authors.initials: T
authors.lastname: Plochg
authors.forename: Melanie
authors.initials: M
authors.lastname: Schmidt
authors.forename: Niek S
authors.initials: NS
authors.lastname: Klazinga
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
mesh_terms: D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000458:organization & administration*; D006291:Health Policy; D054624:Health Status Disparities; D006801:Humans; D007407:Interviews as Topic; D009426:Netherlands / Q000453:epidemiology; D019982:Organizational Case Studies; D011050:Policy Making; D019037:Urban Health Services / Q000458:organization & administration