Table 3.

Outline of the 16 identified factors influencing HiAP within LG, with a summary of the key findings (review, global, 2011–2021).

Theme	Frequency (n, %)	Key findings	References
Cross-sector relationships	44, 69%	Collaboration across sectors was regularly reported as necessary for HiAP, though challenging to achieve. There was more focus on horizontal collaboration across departments, than vertical collaboration between staff and decision-makers.	(5, 28–70)
Evidence	34, 53%	LG utilizes a wide range of evidence sources. Local data, including community input, was consistently reported as more important than academic sources of evidence.	(30, 32–37, 40, 42–44, 47, 49–52, 55, 57–60, 66, 67, 71–81)
Level of policy priority	26, 40%	Addressing health determinants was reported as a priority for LG, though not always the highest priority, amongst more politically favorable lifestyle programs and other competing LG interests.	(5, 29, 30, 36, 38–48, 51, 53, 54, 59, 64, 68, 70–72, 82, 83)
Understanding of health	24, 38%	The definition and understanding of the term “health” was perceived as ambiguous and complex, and varied amongst decision-makers.	(5, 28–32, 35, 40, 42–44, 46, 51, 60, 62, 65, 68, 69, 71, 72, 82–85)
Funding	23, 36%	Many sources highlighted the challenge of financial constraints, or reliance on higher tiers of government for funding.	(5, 29, 30, 32, 35, 37, 40, 42, 46, 48, 49, 51, 58, 59, 61, 63, 64, 68, 70–72, 75, 82)
Leadership/Political commitment	18, 30%	Support from local management and politicians was reported as a key contributor to local policy success.	(29, 32, 34–36, 38, 39, 46, 49, 53, 59, 60, 62, 64–66, 68, 86)
Champions and policy entrepreneurs	16, 25%	Champions were reported as important in initiating HiAP, although not necessarily existing in LG.	(29, 30, 34–36, 39, 42, 45, 52–54, 58, 63, 71, 81, 86)
Framing	15, 23%	LG decision-makers often referred to “health” as another concept such as liveability, or wellbeing. Rarely was “health” the reason for action on addressing determinants of health.	(28, 30–39, 53, 57, 65, 84)
Role of community	14, 22%	Community input is a key influence in local level policy decision-making. There is some debate over the level of comfort by planners in trust that community will focus on determinants of health, if engaged in the process.	(28, 32, 34, 36, 37, 40, 46, 49, 51, 54, 59, 60, 82, 87)
Role of legislation	14, 22%	Legislation was reported as a contributor to successful initiation and implementation of HiAP, although LG did not always adhere to the mandate, and required sufficient resourcing.	(35, 36, 44–49, 52, 60, 69, 71, 75, 82)
Staff capacity	12, 19%	Capacity of staff time and expertise was reported as a challenge to a HiAP approach.	(29, 32, 36, 46, 49, 53, 59, 61, 67, 73, 78, 88)
Use of tools (e.g., Health impact assessment)	11, 17%	Health impact assessments were reported as useful to assessing possible health impacts across sectors and raising awareness of health determinants amongst policy decision-makers, although challenged by lack of legislation and adequate resourcing.	(33, 43, 48, 54, 57, 61, 62, 66, 69, 71, 89)
Political ideology and decision making	10, 16%	Broader political ideologies, and individual values and beliefs, influenced the commitment to addressing health equity at a local level.	(29, 32, 34, 36, 48, 49, 69, 72, 73, 80)
Responsibility of local government	9, 14%	Health inequalities is accepted as a responsibility of LG, although there is a perceived lack of power or authority to take action.	(5, 39, 40, 43, 44, 51, 53, 69, 72)
Performance measures	9, 14%	Several sources note the lack of, or use of vague performance indicators, contributing to a lack of urgency to address health inequities.	(33, 35, 43, 45, 49, 55, 59, 60, 90)
Organizational structures	5, 8%	There is ongoing debate on a successful governance structure for HiAP in LG, between a centralized unit and cross-department collaborations.	(28, 37, 41, 53, 55)