Healthy Cities Network and Social Network Program: Knowing, Evaluating and Learning Health promotion is increasingly concerned with acting on social determinants of health. The spatial diversity, the local specificity and the context-dependency of the concrete relations between social determinants and health inequities represent a relevant challenge for scientific knowledge and public action. The analysis of the causalities relating social determinants and avoidable ill-health represents a major scientific challenge. The relative ‘small scale’ of local contexts (making quantitative approaches of little help), the challenge of capturing causal relations (requiring knowledge about substantive causality) and the production of knowledge about ‘conditions of possibility’ for action on social determinants (requiring knowledge on structures, mechanisms and causal powers), are examples of the challenges ahead. On the other hand, action on social determinants requires knowledge about conditions for policy integration and cross-sectoral action, political willingness and health literacy to meet health objectives involving non-health sectors. These kinds of concerns might be underlying the option for ‘realist synthesis’ in the Evaluation of Phase V of the WHO European Healthy Cities Network. This means the option for a critical realist epistemological position as well as an option for the assumptions of realist evaluation and for the potential ‘revisiting’ of the same implicit theories in other programs. That is the case of the close relationships between the Healthy Cities Network and the Portuguese Social Network Program aiming at combating poverty and social exclusion in all Portuguese localities. The program was formally evaluated. The conditions for context-dependent policy integration, cross-sectoral action and multilevel collaborative governance were analyzed. The program was ‘made concrete’ in each locality involving the ‘skilled acting’ of the actors involved. Some local networks were researched on the basis of an ‘extended case method’ approach and interviews were undertaken in order to capture the sense for multilevel collaborative governance in anti-poverty action.

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Health Promotion,Acting on Social Determinants of Health,Local Context,Realist Evaluation