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Table 1 Barriers regarding development and implementation of integrated public health policies, as reported in the literature

From: Proposing a conceptual framework for integrated local public health policy, applied to childhood obesity - the behavior change ball

Content-related barriers Reference
Lack of awareness of the childhood obesity problem in non-health sectors. Aarts et al. [62]
The Dutch Law on Public Health has decentralized the public health tasks to local governments. With regard to jurisdiction, the public health policy domain has a position similar to other jurisdictions such as public safety. In practice, however, public health is not a dominant policy domain: resources for public health are limited, and other jurisdictions (e.g., public safety) are considered important issues, while health promotion is considered less interesting, depending on the political priority given to certain policy domains. Law on Public Health [9]
Breeman et al. [63]
Steenbakkers [64]
‘Wicked’ nature of obesity makes it very unattractive to invest in its prevention. Head [14]
Head and Alford [19]
Decreasing the incidence of childhood obesity is very unlikely within the short timeframe in which most politicians work (determined by election frequencies). Head [14]
Aarts et al. [62]
Romon et al. [65]
Blakely et al. [66]
Difficulty of developing consensus about ways to tackle the problem due to the lack of hard scientific evidence about effective solutions. Han et al. [25]
Aarts et al. [62]
Head [14]
Trivedi et al. [67]
National Institute for Health and Clinical Evidence [68]
Framing of childhood obesity (especially by neo-liberal governments) as an individual health problem instead of a societal problem. Responsibility for achieving healthy-weight promoting lifestyles is thus shifted completely away from governments to individual children and their parents. Hunter [69]
Dorfman and Wallack [70]
Schwartz and Puhl [71]
Lack of political support. Aarts et al. [62]
Ambiguous political climate: governments do not seem eager to implement restrictive or legislative policy measures since this would mean they have to confront powerful lobbies by private companies. Nestle [72]
Peeler et al.[73]
Lack of presence of champions and political commitment Verduin et al. [74]
Woulfe et al. [75]
Bovill [76]
Process-related barriers  
Local government officials lacking the knowledge and skills to collaborate with actors outside their own department. Steenbakkers [64]
Insufficient resources (time, budget). Aarts et al. [62]
Steenbakkers [64]
Woulfe et al. [75]
Lack of membership diversity in the collaborative partnerships, resulting in difficulties of implementation Woulfe et al. [75]
Lack of clarity about the notion of intersectoral collaboration. Harting et al. [17]
Not being clear about the aims and added value of the intersectoral approach. Bovill [76]
Top-down bureaucracy and hierarchy, disciplinarity and territoriality, sectoral budgets, and different priorities and procedures in each sector. Bovill [76]
Inadequate organizational structures. Steenbakkers [64]
Woulfe et al. [75]
Alter and Hage [77]
Hunter [33]
Warner and Gould [2]
Poor quality of interpersonal or interorganizational relationships. Woulfe et al. [75]
Isett and Provan [78]
Top management not supporting intersectoral collaboration. Bovill [76]
Lack of involvement by managers in collaborative efforts. Steenbakkers et al. [79]
Lack of common vision and leadership. Woulfe et al. [75]
Hunter [62]
Innovation in local governance is hampered by: Borins [80]
- asymmetric incentives that punish unsuccessful innovations much more severely than they reward successful ones
- absence of venture capital to seed creative problem solving
- disincentives lead to adverse selection: innovative people choose careers outside the public sector.
Adaptive management – flexibility of management required, focusing on learning by doing. Head and Alford [19]
Holling [81]
Lack of communication and insufficient joint planning. Axelsson and Axelsson [82]
Hierarchical governance instead of network governance Warner and Gould [2]
Barriers are related to the ‘niche’ character of the sectors involved: Jansen [83]
Achieving the unique advantage of collaboration, which is referred to as ‘synergy,’ is harder in diverse groups, but at the same time such diverse groups have the potential to lead to greater synergy compared to collaboration within homogeneous groups. Jansen et al.[84]
Jones [85]
Lasker and Weiss [86]
Miller and
Watson and Johnson [87]
Hendriks et al.[88]
Hoffman et al.[89]
Paulus [90]
Implementation not being considered a dominant part of the planning and policy process Bovill [76]