'Punching above their weight': a qualitative examination of local governments' organisational efficacy to improve the social determinants of health

Objective: The World Health Organization calls upon local government worldwide to play a greater role in improving public health by improving the social determinants of health. This research aimed to determine how local governments in Victoria, Australia, conceptualised their organisational efficacy to address public health with reference to their statutory obligations. Methods: Sixteen in-depth interviews were conducted with Victorian local government health planners. Thematic analysis was used to determine the importance of state health priorities and the perceived organisational efficacy of local government to address health via social determinants. Results: While there were disparities between state and local priorities for health, local government believes it can make an important contribution to improving health through 'upstream' approaches. Conclusions: Victorian local government has strongly adopted the socio-ecological model of health and is aware of the important role that its diverse policy and program areas play in creating healthy communities. The Victorian State Government's priorities, which adopted a more 'downstream' approach, were less influential. Implications for public health: State governments' priority settings should be responsive to local governments' unique local knowledge of health priorities. There is value in legislating a social determinants role for local government, provided it is supported by state and national government policies that facilitate public health.