Bridging systems for health equity: a scoping review of municipal–public health partnerships

Abstract

Abstract Background Municipalities influence population health outcomes both directly (e.g., fluoridation, road safety, and tobacco control) and indirectly through broader social, cultural, and environmental determinants of health such as housing, transportation, income, and social services. While intersectoral partnerships with public health systems are promoted as a policy tool for addressing complex health inequities, evidence on their models, effectiveness, and outcomes remains limited. Methods This scoping review aimed to map the literature on municipal–public health partnerships, with a focus on partnership models, reported outcomes, and the barriers and facilitators shaping their success. From 1,392 records, 105 studies were included. Results Two broad partnership models emerged: (1) ad-hoc, project-based collaborations, and (2) institutionalized collaborations, including intergovernmental relations, Health in All Policies, and strategic planning arrangements. Barriers included inadequate funding (48 studies), cultural and relational mismatches (33), system fragmentation and data-sharing challenges (32), and additional sub-themes under governance or leadership gaps. Facilitators included community engagement (34), capacity building (33), and sub-themes related to strong leadership or policy champions. Most studies (65%) focused solely on the implementation process of partnerships, while only nine studies (8%) examined health outcomes, reporting associations with improvements in areas such as smoking cessation and transportation equity. Municipal–public health partnerships are diverse yet under-evaluated, with the literature still dominated by process-focused studies and limited outcome or impact assessments. Conclusion Recent evaluation guidance calls for broader outcome, impact, economic, and mixed-methods approaches, not only causal designs, so partnerships can be meaningfully assessed for their contributions to health equity and population health outcomes.