Municipalities’ setting approaches in local health promotion – A Swedish case study

Vestfold, June 19th, 2013

Elisabeth Jansson, PhD studentCo-authors: Elisabeth Fosse, Per Tillgren

Study background

The results of this study are secondary findings from the doctoral studies I conduct at Mälardalen University in Västerås, Sweden

*Jansson, Tillgren (2010) **Jansson, Fosse, Tillgren (2011)

Objectives

E Fagersta

SträngnäsSala

Oxelösund

4 municipalities’ setting approaches in their local health promotion

Methods

A multiple case study

Content analysis

Key person interviews – politicians, executives & officials

Documents – annual reports, policies & plans etc.

Data collected in 2006 & 2012

E

Analysing procedure in 2006 & 2012

1

Single Case D

Sala

Single Case C

Fagersta

Single Case B

Oxelösund

Single Case A

Strängnäs

Cross-case analysis A, B, C, D5

432

ResultsPublic health policies Target groups Settings

●Alcohol, tobacco & Children & youths School

drug prevention 4/4 Adults Health care

Municipality employed Workplace

●Rehabilitation 3/4 Municipality employed Workplace

Primary health care centre

●Equality 4/4 Municipality employed Workplace

●Public health 1/4 Whole society School

Workplace

Library

Primary health care centreNew venues

Results

Strategies●Schools & workplaces are mainly used as location for ad hoc health promotion interventions & programs

●Family centres are the settings where intersectoral collaboration, multiple strategies & a holistic view of health were common (3/4)

Advantages●Entrance & access channel for vulnerable groups●Enables easier communication between municipal organization & population

Results

“The municipality’s power source, that's really the three F's [forces], associations & churches & businesses.

From organizing a health week per year to more of this everyday, in general.

Then these venues, as I can see as an extremely important public health issue, whether they play bridge or read the hymn book, or whatever they do.”

(C-Politician)

Results

”The library has been this kind of activity location. Where we held a health day e.g. with the theme heart. We have done it together with the pharmacy & primary health care centre. [… ]

We have turned us into the public & the program consisted of activities & you can try out & you can get information.”

(A-Executive)

Results

The municipalities doesn’t explicitly express health promotion or settings as an objective or strategy

Politicians saw intersectoral collaboration as a strategy to improve the municipality public health in different settings

Executives & officials expressed both opportunities & obstacles in intersectoral collaboration in setting based local interventions

The municipality organizational structure in horizontal or vertical management affected setting approaches more than political governance profile

Conclusions

The setting approach is consistent with the municipalities’ views & possibilities to handle complex public health issues

Locally prioritized health issues based on local needs & prerequisites are preferably performed in traditional settings

The development & sustainability is seen as possible & achievable by intersectoral collaborations with engaged & committed actors in established settings

Challenges in the municipalities’ setting approaches are related to factors like sectorial pipe-line organizations & e.g. confidentiality regulations in collaborations between the municipality & health care sector

Finally, a quot on the road…

“I believe very strongly in this structural stuff when it comes to children & youths. I mean you look, yes I can keep long lectures, but ... then, what saves many children, it's the school, the school is one of the biggest health factors.”

(A-Official)

Thank you!

Elisabeth JanssonMälardalen UniversitySchool of Health, Care and Social WelfareVästerås, Sweden

elisabeth.jansson@mdh.se

Västerås

Stockholm

References

Jansson, Fosse & Tillgren (2011) National public health policy in a local context: implementation in two Swedish municipalities. Health Policy 103(2-3):219-27

Jansson & Tillgren (2010) Health promotion at local level: a case study of content, organization and development in four Swedish municipalities. BMC Public Health 3;10:455