Geographically-based approaches to the integration of health promotion into health systems: a comparative study of two Health Action zones in the UK

Health Action Zones (HAZs) were introduced in the UK in the late 1990s as a whole system approach to public health and health care. Resources were targeted in historically deprived subregional units of England. Based on process evaluations undertaken in their fourth year of operation, the approaches taken by two HAZs were compared. Each had different histories of intersectoral cooperation and strategic approaches to integration. Both operated in a rapidly changing policy and organizational environment. This undermined attempts to sustain a consistent vision and eventually led to the demise of HAZs as subregional units. The approaches chosen by these two HAZs to integrate health promotion into health systems cannot be divorced from the political, historical and geographical contexts in which they were initiated. What the experiences of the two HAZs demonstrate is that while subregions and localities can potentially benefit from a whole systems perspective, there are deep-seated structural problems that constrain progress. Their experience demonstrates that context is of key importance in understanding the outcomes of any intervention aimed at promoting health.