• Purpose: Identify where the greatest gaps and opportunities lie. Move from a visible issue to a well-framed problem that can be addressed within your mandate. This step should not be done in isolation, early engagement with stakeholders helps ensure the problem is understood from multiple perspectives and builds ownership from the outset (see Brief 3 for building cross-sectoral alliances).

You may start from:

• A population-level concern (e.g. widening health inequalities), or
• A specific setting (e.g. children’s wellbeing in schools, lack of accessible green space in urban redevelopment).
• Conducting a full-scale equity assessment may not be possible in every case, in that case focus on understanding:
  • Who is most affected?
    • This can also be disaggregated to different attributes such as age, sex, gender, ethnicity, socio-economic status
  • What are the root causes?
  • Which system barriers (financial, institutional, regulatory) maintain the problem?
• Where possible, involve key stakeholders at this stage to co-define the problem. This helps validate and refine the problem definition, uncover system interdependencies and blind spots, and build shared ownership and accountability for future action.

• Some tools you could use:
  • Problem Tree analysis or Theory of Change – to identify pathways from root causes to desired outcomes.
  • WHO Health Inequality Data Repository – disaggregated data to identify inequities.
  • EU Social Scoreboard – tracks progress on social fairness and inclusion, linked to the European Pillar of Social Rights.
• Action: Define the problem in a way that is specific, contextual, and actionable. Map vulnerable populations, quantify unmet needs, and align findings with national or regional health strategies. Investigate whether similar initiatives exist and how they are funded. This shared understanding will directly inform alliance-building (see Brief 3) and incentive alignment (see Brief 4).
• Illustrative example: A local organisation advocating for accessible green and blue spaces may begin by mapping which neighbourhoods lack access, which populations are most affected, and how this connects to mental health, physical inactivity, or heat vulnerability. A simple root-cause analysis may reveal planning rules, fragmented funding streams, or lack of cross-sector coordination as underlying barriers.

• Purpose: Strengthen your case for action by showing what happens if the problem is not addressed, and how early disease prevention can create long-term social, economic and health value. Go beyond direct financial costs and consider the wider social value of action, including impacts on wellbeing, equity, and community resilience.

When possible, try to estimate:

• What the problem currently costs society (e.g. healthcare use, lost productivity, social care needs)
• How these costs can grow if nothing changes
• What improvements could be achieved through preventive action

• Some tools you could use:
  • Social Value E-guide for Public Health by World Health Organization Collaborating Centre on Investment for Health and Well-being and Public Health Wales to understanding and capturing the social value of the interventions.
  • OECD SPHeP (Strategic Public Health Planning) Model – used to predict the health and economic outcomes of the population of a country or a region up to 2050.
  • The healthiar R package is a calculation tool for quantifying and monetising the burden of disease attributable to different environmental exposures
  • Health Economic Assessment Tool (WHO/Europe) – for quantifying economic returns from walking and cycling.

• Action: Compare the costs of inaction (social, economic, and ethical) with potential benefits of early intervention. Even approximate estimates (e.g. avoidable hospitalisations, productivity losses, social care costs) can make the value of disease prevention more visible. This step helps translate a public health issue into an investment argument, which can support discussions with decision makers and potential investors (see Brief 5).

• Purpose: Identify solutions that are feasible, evidence informed and capable of delivering measurable and equitable outcomes. This step builds on the problem definition and should continue to involve stakeholders to ensure relevance, feasibility, and ownership.
• Some tools you could use:
  • EU Best Practice Portal on Public Health - a European Commission platform that curates and validates evidence-based practices in health promotion, and disease prevention, offering implementation guidance.
  • National level public health best practice portals
  • INHERIT database – to identify interventions that generate co-benefits for health, equity, and environment.
  • Health Inequalities Portal - a repository of data, promising practices, and policy resources to reduce health inequities in Europe.
• Action: Select one or a small number of interventions with clear outcome pathways. Ensure community participation is built into design and delivery. Clarify how the intervention connects to long-term sustainability (see Brief 7).

• Purpose: Ensure fairness, transparency and accountability in resource allocation.  Equity does not always need to be the starting point — but it should always be a consideration. Ask:
  • Whose needs are not being met?
  • Who benefits most?
  • Who might be unintentionally excluded?
  • Could this intervention widen inequalities?
• Some tools you could use:
  • Norwegian model for ethical priority setting in health care
  • Health Impact Assessment guidance (e.g., Public Health Scotland)  
  • WHO Fair Choices Framework for universal health coverage.
• Action: Document decision criteria, include affected populations in deliberations, and ensure that resource allocation decisions are transparent. Health Impact Assessment would help to understand whether the intervention could worsen health inequalities rather than improve health.

Within the EURO-HEALTHY initiative, Lisbon applied a spatial health equity framework to assess variations in health outcomes across the metropolitan area. Combining quantitative indicators and participatory stakeholder workshops, the city identified key drivers of inequities such as housing quality, air pollution, and access to green space. The results informed targeted investments in sustainable urban planning and social housing, supported by EU structural funds, illustrating how evidence-based assessments can guide cross-sectoral prevention strategies.

Finland has a long-standing HiAP tradition, with intersectoral committees and programs that bring together health, education, agriculture, municipalities, and civil society to address upstream health determinants. Tools like impact assessments, shared budgets, and strategies such as Health 2015 reflect institutional commitment. While full integration of health into all sectors (including environment, taxation, etc.) varies by policy area, Finland’s experience illustrates how diagnosing systemic causes and engaging diverse partners can move disease prevention beyond the health sector and foster a more whole-of-government investment mindset.