Between knowing and doing: Explaining the adoption of Health in All Policies in Finland, England and the Netherlands

Health in All Policies (HiAP) is a collaborative approach to policy-making in which health considerations are included in other policy sectors that have an impact on general health outcomes and health inequalities. The adoption of HiAP is typically ascribed to knowledge dissemination, in which research reports are the principal vehicles. Yet the pattern of HiAP adoption across countries over decades cannot be explained by the role of knowledge dissemination only. In this paper we aim to solve this puzzle, by answering the question: Why and in which context is HiAP adopted? To answer we compare three countries in which HiAP has been adopted, differing in terms of institutional contexts and adoption periods, and try to single out the main common denominators (and differences). Finland and England are both early adopters of HiAP. In the Netherlands, HiAP has only been adopted since 2021, even though the knowledge from the Finnish, English and international strategies was incorporated two decades earlier already. We use theoretical tools from political science to analyse the process of adoption in the three cases. We contribute to the literature by raising two main insights: (1) Knowledge dissemination is a necessary basis, but political saliency of health inequality is the deciding factor for the adoption of HiAP. (2) The institutional context determines which actors are the decisive policy entrepreneurs. These findings could help public health researchers to translate their scientific insights into policy practice.