Objective: Gain knowledge about municipalities’ setting approaches by studying four Swedish municipalities’ and how they practices settings in their organized and conducted local health promotion.Methods: A multiple case study design with content analysis of key person interviews and documents. Results: The municipalities stressed the importance of enable the inhabitants’ and staffs’ possibilities to maintain and achieve better health. In the case an explicit local health policy existed the focus was on specific target groups e.g. children, problem areas e.g. alcohol or on health outcomes as e.g. decreases in days of sick leave. Dependent on the nature of the problem, the strategies implicitly focused on intersectoral collaboration within the municipal administration and sectors or/and with external actors as official authorities, private companies, NGOs and neighboring municipalities, as well as between different levels and professions. Health promotion actions implemented were mainly established in more traditional and locally well-known local settings as schools, workplaces, family centers or libraries, but there were examples on efforts to create new venues to enable social wellbeing and supportive settings. Conclusions: The setting approach is consistent with the municipalities’ views and possibilities to handle complex public health issues, hence the setting approach is still going strong. Locally prioritized health issues based on local needs and prerequisites are preferably performed in traditional settings. The development and sustainability is seen as possible and achievable by intersectoral collaborations with engaged and committed actors in established arenas. Challenges in the municipalities’ setting approaches are related to factors like sectorial pipe-line organizations and e.g. confidentiality regulations in collaborations between the municipality and health care sector.