How Intersectoral Priority Setting Can Support Action on Social Determinants of Health: A Qualitative Case Study From Pakistan’s Federal Health Ministry

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Background: Intersectoral actions can improve population health and reduce health inequities by addressing social determinants of health. Priority setting methods are used by health ministries to rationalize resource allocation within the sector, but not for intersectoral actions. Methods: We conducted a qualitative case study of an intersectoral priority setting exercise—a novel use of priority setting methods—undertaken by Pakistan’s Federal Ministry of Health between 2019–2022. Drawing on theories of agenda setting and priority setting, we examined the priority setting process through key informant interviews. We explored the perceived appropriateness of the priority setting approach and the challenges encountered during its implementation across sectors. Results: Our findings reveal that the process of intersectoral priority setting is deeply influenced by its political and institutional context. According to respondents, existing institutional structures and norms in Pakistan are not optimally suited to support intersectoral actions for health, although there is growing recognition of their importance. Regardless of sector, all respondents view engaging in intersectoral actions as part of the health ministry’s responsibility for population health. Priority setting, thereby, is viewed as a way of clarifying the health ministry’s intersectoral agenda. However, intersectoral priority setting methods are seen as underdeveloped in terms of available evidence, standardized economic and policy evaluation, and deliberative mechanisms. Respondents suggest that to implement the prioritized intersectoral agenda, the health ministry must effectively navigate the political space outside the health sector, such as by highlighting shared benefits, grounding the intersectoral agenda in local needs, and leveraging the political dynamics of other sectors. Moreover, this political engagement must be complemented by competence in evidence generation and communication to influence cross-sectoral policy dialogues. Conclusion: Using a priority setting approach, health ministries can systematically advance intersectoral health agendas by building political coalitions around shared priorities supported by rigorous evidence and analysis.

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