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Health in All Policies (HiAP) strategy is framed within good governance for health values –equity, transparency, participation- and is targeted towards population health improvement through integrated public policies that work to maximize positive health impacts and minimize those negative. A key way to achieve this goal is through intersectoral action on health (IAH). The local level has many responsibilities for the social determinants of health (SDH) at the urban level and constitutes a critical area for health promotion. However, the available knowledge about IAH experience at the local level is scarce in the Spanish context. Policy context and objective: The last Bilbao Town Hall Government term called for the development of the 1st Health Local Plan (2019-2024). To achieve this, two information gathering phases were developed: 1) a participative process with social and community agents and health professionals, that allowed the definition of the Plan axes and main objectives; 2) an IAH process at the city council in order to define the necessary future actions. The objective of this presentation is to describe the main lessons learned, as well as the challenges identified in the second phase.  Highlights: With regard to lessons learned, three milestones were relevant for the setting and the legitimization of the IAH: 1) the Mayor’s commitment to leading the Health Plan; 2) building alliances with the directors of municipal departments; 3) the joint work sessions with municipal departmental officers in order to review their planned actions and to make recommendations towards the Health Plan objectives. The joint work sessions included an SDH explanation. The positive approach adopted in highlighting the health contributions of their actions, was a facilitator for the IAH. Another factor that was perceived as favourable by the officers was the offer of support given by the Health Department to carry out health impact assessments of those actions with the potential to improve health. Regarding the identified challenges, we found a lack of knowledge about the SDH at the local administration level. The prevailing sectoral structure and culture, as well as the lack of shared objectives and intersectoral work tools constituted another IAH challenge. Finally, there is great potential for improvement in the effective implementation of the good governance values. Transferability: These findings could be meaningful for other local governments and other decision-making levels, given the early stage of development of the Health in All Policies strategy in the Spanish context. Conclusions: The potential for improving the IAH development in the Spanish context is significant. To take full advantage of the lessons learned, and advance the implementation of the IAH, it is important to both understand the contextual challenges related to the institutional characteristics, especially in the early stages of implementing the good governance values, and to make use of the proven facilitators of the IAH.

international journal of integrated care

Moving towards integrated local policies for health: facilitators and challenges for the implementation of Health in All Policies in the Spanish context