title: Cross-sector cooperation in health-enhancing physical activity policymaking: more potential than achievements?
abstract: BACKGROUND
  The cooperation of actors across policy fields and the need for cross-sector cooperation as well as recommendations on how to implement cross-sector cooperation have been addressed in many national and international policies that seek to solve complex issues within societies. For such a purpose, the relevant governance structure between policy sectors is cross-sector cooperation. Therefore, cross-sector cooperation and its structures need to be better understood for improved implementation. This article reports on the governance structures and processes of cross-sector cooperation in health-enhancing physical activity (HEPA) policies in six European Union (EU) member states.
  
  
  METHODS
  Qualitative content analysis of HEPA policies and semi-structured interviews with key policymakers in six European countries.
  
  
  RESULTS
  Cross-sector cooperation varied between EU member states within HEPA policies. The main issues of the cross-sector policy process can be divided into stakeholder involvement, governance structures and coordination structures and processes. Stakeholder involvement included citizen hearings and gatherings of stakeholders from various non-governmental organisations and citizen groups. Governance structures with policy and political discussions included committees, working groups and consultations for HEPA policymaking. Coordination structures and processes included administrative processes with various stakeholders, such as ministerial departments, research institutes and private actors for HEPA policymaking. Successful cross-sector cooperation required joint planning and evaluation, financial frameworks, mandates based on laws or agreed methods of work, communication lines, and valued processes of cross-sector cooperation.
  
  
  CONCLUSIONS
  Cross-sector cooperation required participation with the co-production of goals and sharing of resources between stakeholders, which could, for example, provide mechanisms for collaborative decision-making through citizen hearing. Clearly stated responsibilities, goals, communication, learning and adaptation for cross-sector cooperation improve success. Specific resources allocated for cross-sector cooperation could enhance the empowerment of stakeholders, management of processes and outcomes of cross-sector cooperation.
authors.affiliation: National Institute for Health and Welfare, Mannerheimintie 166, 00271, Helsinki, Finland. riitta-maija.hamalainen@thl.fi.
authors.forename: Riitta-Maija
authors.initials: RM
authors.lastname: Hämäläinen
authors.affiliation: Department of Public Health, Unit for Health Promotion Research, University of Southern Denmark, Niels Bohrs Vej 9, 6700, Esbjerg, Denmark.
authors.forename: Arja R
authors.initials: AR
authors.lastname: Aro
authors.affiliation: Research Centre for Prevention and Health, The Capital Region of Denmark, Ndr. Ringvej 57, Afsnit 84/85, 2600, Glostrup, Denmark.
authors.forename: Cathrine Juel
authors.initials: CJ
authors.lastname: Lau
authors.affiliation: Administrative and Communication Sciences, Cluj School of Public Health, College of Political, Babes-Bolyai University, Cluj-Napoca, Romania.
authors.forename: Diana
authors.initials: D
authors.lastname: Rus
authors.affiliation: Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, Pisa, 56124, Italy.
authors.forename: Liliana
authors.initials: L
authors.lastname: Cori
authors.affiliation: NHS England, 80 London Road, London, SE1 6LH, United Kingdom.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Syed
mesh_terms: D003299:Cooperative Behavior; D005060:Europe; D005062:European Union; D015444:Exercise; D006076:Government; D006291:Health Policy; D006293:Health Promotion; D006801:Humans; D009938:Organizations; D011050:Policy Making; D017149:Private Sector; D011634:Public Health; D011639:Public Opinion; D017150:Public Sector