Strengthening health promotion at the local level: insights from Swiss municipalities (canton of Vaud) across urban and rural contexts.

OBJECTIVES: In response to growing interest in local action to promote public health, this study explores how municipalities perceive their role in health promotion (HP), how far HP is integrated into municipal policies, and what support is needed to strengthen local action. METHODS: An online survey was distributed to 300 municipalities in the Canton of Vaud (February - April 2025). Complete responses from 110 municipalities (39% response rate) were included in the analyses. An adaptation of the Maturity Model of Health in All Policies (MM-HiAP) guided the cluster analysis used to identify profiles of municipal engagement in HP. RESULTS: Four clusters were identified: Not engaged (39%), Relying on others (26%), Engaged but isolated (19%), and Engaged and somewhat structured (16%). Among the key factors influencing HP integration, municipal size and the presence of committed local leadership emerged greatly. Moreover, clusters revealed specific resources and needs, suggesting that support should be adapted to these specific needs. CONCLUSION: The study provides a framework for strengthening municipal engagement in HP along a maturity continuum, with implications for policy, practice, and future research across diverse local contexts.