The politics of health: exploring the potential and the limits of health in all policies under multilevel governance.

The Health in All Policies (HiAP) approach has been the main focus for intersectoral action for health and heath equity but has proved challenging as result of other political and economic priorities of governments and the multilevel nature of policymaking. This article explores the role of HiAP in changing politics and policy context. The article takes a critical appraisal on how HiAP has been conceptualized and used to compare concepts associated with HiAP. It assesses the limits and potential for the use and application of different concepts drawing from a realist evaluation in understanding why, how, and for whom and in what context they work for HiAP. Illustrative case studies focus on the substance and provide examples from work with Ministries of Finance, Employment and Education. HiAP can be seen as a flexible overarching approach, which provides scope for action through several concepts and practices for intersectoral work. The comparison shows that definitions matter to the practice of HiAP concerning priorities, ideological premises, and level of governance. Ministries of Finance are crucial for action on equity and social determinants of health. HiAP requires understanding of health policy priorities and competences and capacities in public health and health systems governance as well as in analysis of politics, power, and different contexts of policymaking under multilevel governance. While HiAP aims to ensure health priorities in decision-making of all policies, if and how this is realized, is a political choice.