title: Measuring stages of health in all policies on a local level: the applicability of a maturity model.
abstract: OBJECTIVE
  Many local governments are trying to establish health in all polices (HiAP), but no sensitive tool is available to measure HiAP growth processes. This study explores the applicability of a general maturity model to classify stages of HiAP and to characterize its manifestations and conditions.
  
  
  METHODS
  Based on other maturity models we have developed a maturity model for HiAP (MM-HiAP), which consists of six maturity levels and 14 corresponding key characteristics. This model was applied to assess HiAP growth processes within 16 municipalities in the Netherlands. We used municipal policies on health inequalities as a case. Empirical data was gathered based on document analysis, a questionnaire and interviews.
  
  
  RESULTS
  Using this model we were able to classify HiAP growth processes by several characteristics, such as the recognition of the importance of HiAP (Stage I; four municipalities), HiAP described in policy documents and collaboration with sectors present (Stage II; seven municipalities), concrete collaboration agreements and structural consultations forms (Stage III; four municipalities), and a broad, shared vision on HiAP (Stage IV; two municipalities). Examples of necessary conditions were sufficient support and resources.
  
  
  CONCLUSIONS
  This study shows that it is possible to apply a maturity model to classify stages of HiAP in municipalities. Use of the MM-HiAP as a formal measuring instrument depends on further operationalization and validation.
authors.affiliation: National Institute for Public Health and the Environment, Public Health and Health Services Division, Centre for Public Health Forecasting, PO Box 1, 3720 BA Bilthoven, The Netherlands. Electronic address: ilse.storm@rivm.nl.
authors.forename: Ilse
authors.initials: I
authors.lastname: Storm
authors.affiliation: Academic Medical Centre University of Amsterdam, Department of Public Health and Epidemiology, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: j.harting@amc.uva.nl.
authors.forename: Janneke
authors.initials: J
authors.lastname: Harting
authors.affiliation: Academic Medical Centre University of Amsterdam, Department of Public Health and Epidemiology, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: k.stronks@amc.uva.nl.
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.affiliation: National Institute for Public Health and the Environment, Public Health and Health Services Division, Centre for Public Health Forecasting, PO Box 1, 3720 BA Bilthoven, The Netherlands; VU University Amsterdam, Department of Health Sciences and EMGO Institute for Health and Care Research, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands. Electronic address: jantine.schuit@rivm.nl.
authors.forename: Albertine J
authors.initials: AJ
authors.lastname: Schuit
mesh_terms: D003299:Cooperative Behavior; D006077:Government Agencies; D006291:Health Policy; D006293:Health Promotion / Q000458:organization & administration; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007373:Interinstitutional Relations; D007407:Interviews as Topic; D009111:Local Government; D017146:Models, Organizational; D009426:Netherlands; D011050:Policy Making; D011634:Public Health; D011787:Quality of Health Care; D011795:Surveys and Questionnaires
keywords: Health in all policies; Local government; Maturity model; Measuring instrument