Universal targeting in local public health: a comparative study of Polish cities

Abstract Population health is shaped not only by global and national processes but equally by decisions taken at the local level. Yet comparatively little is known about why municipal public health policies differ. This study examines how structural conditions, previously found to influence local policymaking, combine with the presence or absence of universal targeting in public health policies across Poland’s 23 largest cities. Using fuzzy-set Qualitative Comparative Analysis and building on the Local Welfare Regimes perspective, the analysis consistently links universal targeting in municipal public health policy to a combination of strong civil society, substantial representation of women in city councils, and the absence of an unhealthy population. As one of the first explicit applications of the LWR theory with fsQCA, the study contributes to debates on universal targeting, confirming that it can be implemented in a range of ways, while simultaneously highlighting the risk of Matthew Effects.