The activities, competencies and conditions necessary for public-health policy advisers in a Dutch local government setting to contribute to a healthier living environment: a qualitative multiple-case study

The inclusion of health considerations in the design of the physical living environment can contribute to solving wicked health problems, such as obesity and mental health. Such projects demand an integrated approach and strong collaboration between policy domains. At the level of local government, public-health policy advisers can play an important role in this regard. The aim of this study is to explore how public-health policy advisers in the Netherlands deploy cross-border activities to promote a healthy living environment and to identify the organizational dynamics under which they operate. Drawing on the theory of boundary spanning, a qualitative multiple-case study was conducted in three Dutch pioneering local governments, based on a combination of semi-structured interviews and in-depth project analysis. The results indicate that public-health policy advisers engage in a wide range of boundary-spanning activities at the political-administrative, strategic, tactical and operational levels, including participating in spatial-planning processes, understanding the language of the physical domain and providing the right knowledge about health in relation to the environment. Further, this study demonstrates that creating a healthier living environment is the shared responsibility of the entire local government system, thereby calling for leadership, collective accountability, an integrated approach, coordination, and sufficient staffing capacity. Within this context, policy advisers perform guiding, signaling and connecting roles by undertaking a variety of boundary-spanning activities.