title: Economic considerations and health in all policies initiatives: evidence from interviews with key informants in Sweden, Quebec and South Australia.
abstract: BACKGROUND
  Health in All Policies (HiAP) is a form of intersectoral action that aims to include the promotion of health in government initiatives across sectors. To date, there has been little study of economic considerations within the implementation of HiAP.
  
  
  METHODS
  As part of an ongoing program of research on the implementation of HiAP around the world, we examined how economic considerations influence the implementation of HiAP. By economic considerations we mean the cost and financial gain (or loss) of implementing a HiAP process or structure within government, or the cost and financial gain (or loss) of the policies that emerge from such a HiAP process or structure. We examined three jurisdictions: Sweden, Quebec and South Australia. Semi-structured telephone interviews were conducted with 12 to 14 key informants in each jurisdiction. Two investigators separately coded transcripts to identify relevant statements.
  
  
  RESULTS
  Initial readings of transcripts led to the development of a coding framework for statements related to economic considerations. First, economic evaluations of HiAP are viewed as important for prompting HiAP and many forms of economic evaluation were considered. However, economic evaluations were often absent, informal, or incomplete. Second, funding for HiAP initiatives is important, but is less important than a high-level commitment to intersectoral collaboration. Furthermore, having multiple sources of funding of HiAP can be beneficial, if it increases participation across government, but can also be disadvantageous, if it exposes underlying tensions. Third, HiAP can also highlight the challenge of achieving both economic and social objectives.
  
  
  CONCLUSIONS
  Our results are useful for elaborating propositions for use in realist multiple explanatory case studies. First, we propose that economic considerations are currently used primarily as a method by health sectors to promote and legitimize HiAP to non-health sectors with the goal of securing resources for HiAP. Second, allocating resources and making funding decisions regarding HiAP are inherently political acts that reflect tensions within government sectors. This study contributes important insights into how intersectoral action works, how economic evaluations of HiAP might be structured, and how economic considerations can be used to both promote HiAP and to present barriers to implementation.
authors.affiliation: Department of Family and Community Medicine, St. Michael's Hospital, 410 Sherbourne Street, 4th Floor, Toronto, Ontario, M4X 1K2, Canada. andrew.pinto@utoronto.ca.|Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. andrew.pinto@utoronto.ca.|Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. andrew.pinto@utoronto.ca.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Pinto
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. agnesmmolnar@gmail.com.
authors.forename: Agnes
authors.initials: A
authors.lastname: Molnar
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. kshankardass@wlu.ca.|Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada. kshankardass@wlu.ca.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. kshankardass@wlu.ca.
authors.forename: Ketan
authors.initials: K
authors.lastname: Shankardass
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. pat.ocampo@utoronto.ca.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. pat.ocampo@utoronto.ca.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: O'Campo
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. ahmed.bayoumi@utoronto.ca.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada. ahmed.bayoumi@utoronto.ca.|Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada. ahmed.bayoumi@utoronto.ca.|Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada. ahmed.bayoumi@utoronto.ca.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Bayoumi
mesh_terms: D003299:Cooperative Behavior; D014943:Global Health; D006076:Government; D006291:Health Policy / Q000191:economics*; D006293:Health Promotion / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D011050:Policy Making; D011792:Quebec; D013021:South Australia; D013548:Sweden