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Table 1 Definition of sub-systems and system components

From: The implementation of Health in All Policies initiatives: a systems framework for government action

Executive Subsystem: The processes of government responsible for the creation and implementation of legislative mandates related to the implementation of HiAP initiatives.

Policy agenda: The finite set of social and political issues upon which governments act on at a given point in time, which will be shaped by the party organisation(s) who control the government and influenced by extra-governmental factors, and which have implications for the priority of health equity initiatives like HiAP.

Political elites: Actors who, by virtue of some form of formal authority within the government, exhibit a consistent and substantial level of control over the political process and its outcomes, including as they relate to the implementation of HiAP initiatives.

Political ideology: The cluster of ideas, beliefs, values and attitudes that constitute the normative lens through which political elites and party leaders interpret and act upon social and political issues. For example, they have political interests in relation to their opinions about ‘what ought to be when it comes to developing or modifying policies during the implementation of HiAP initiatives. Those opinions may, in turn, be shaped by their experiences and understanding of the real world, and by their more fundamental worldviews and ideological subscriptions, e.g. the role of state or the primacy of individual responsibility.

Intersectoral Subsystem: The processes of government that facilitate the horizontal and vertical coordination of the HiAP policy agenda across various sectors of the government and with extra-governmental partners.

Expert advisors: Expert individuals (often from outside of government) who are formally consulted in planning and executing the implementation of HiAP initiatives. Expert advisors are a type of policy elite, i.e. they have influence over the policy process.

HiAP financial arrangements: Financial arrangements that dictate the magnitude, distribution and sources of funding available for the implementation of HiAP initiatives.

HiAP management: The set of technical processes through which governments generate institutional capacity for implementation of HiAP initiatives.

HiAP mandate: Official legislation and formal strategies containing specific instructions for the implementation of HiAP initiatives (e.g. policy goals, division of responsibility, allocation of resources, processes for monitoring and enforcement), which may change or grow in number over the period of implementation (see Freiler et al. 2013 for additional information).

Intrasectoral Subsystem: The processes of government that facilitate activities such as the pursuit of sectoral objectives, which may be affected by the implementation of HiAP initiatives.

High-ranking civil servants: Bureaucrats who may have authority over the policy process delegated to them by political elites. High-ranking civil servants are a type of policy elite, i.e. they have influence over the policy process, and may be particularly engaged in the technical aspects of implementing HiAP initiatives.

Prior experience with intersectoral action (ISA): A history of working intersectorally on shared policy objectives, which may influence how the implementation of related initiatives, such as HiAP, occurs.

Sectoral ideology: The cluster of ideas, beliefs, values and attitudes that constitute the normative lens through which policy-makers within a given sector interpret and act upon social and political issues such as health equity, and which may vary given sectoral objectives (e.g. healthcare, population health, economic growth, engineering), i.e. a worldview.

Sectoral objectives: Goals and motivations of policy sectors, often delivered through a formal mandate from the executive, which may be affected by a government’s implementation of HiAP initiatives.

Sectoral power: The formal authority allocated to policy sectors in government mandates, indicated in absolute (e.g. directives, budget size) and relative terms across sectors (e.g. relative budget size). Intersectoral coordination of policies in the process of implementing HiAP initiatives may be shaped by the power of the sectors involved.

Workforce capacity for ISA: The extent of expertise among human resources with tools and processes and workforce size dedicated to implementing HiAP initiatives, enabling feasibility (see Freiler et al. 2013 for additional information).

 

Workforce HiAP awareness: An understanding of the need and reasons for an intersectoral approach to address health equity, as part of the process of agenda setting and, ultimately, buy-in for the implementation of HiAP initiatives (see Freiler et al. 2013 for additional information).

Extra-governmental systems: Systems outside of government that can influence HiAP implementation, including as organisations and individuals become partnered to the implementation of HiAP; for example, by participating in planning or executing intersectoral action or in being the subject of some attendant regulatory action. There are also likely to be more indirect influences, such as policy entrepreneurs who advocate or lobby for influence over the implementation process, and cross-national policy and agenda-setting frameworks. Finally, at the global and local levels, there are research programmes and knowledge hubs producing information to support implementation.