Public health issues at the regional level in Sweden

The county administrative councils

The county administrative councils represent the government at the regional level and have coordinating and overall sectoral responsibility for the national public health policy areas as well as a supervisory role so that organizations in the counties follow national laws and regulations. In 2007, the county administrative councils were assigned to identify and report to the government all roles and tasks in the public health area. The majority of the councils reported that their organizations had a direct or indirect influence on all public health issues, with the exception of area 6 (the health-promoting health and medical services area), which falls upon the county councils. According to the administrative councils there was a need for a more clarified mission, a more complete responsibility, and an increased competence so that the role of the administrative councils in the public health areas could be further developed.

The county councils and regions

The county councils and regions are responsible for collaborative efforts in the regions, with the emphasis on health, dental and medical care as well as regional development. In Skåne and Västra Götaland, the county councils have been reorganized to regions (directly elected regional delegates). In other counties, the municipalities and county councils have organized regional cooperative bodies (with indirect representation) that, on their own initiative, cooperate for an increased regional development. These exist in about 14 counties.  In many areas the regional cooperative bodies have taken over assignments from the county administrative councils.  The county councils provide the counties’ municipalities and other users with knowledge foundations in public health areas and produce public health plans, policies and programs in broad cooperation with other actors. Some county councils have agreements with municipalities and distribute funds to municipality services or projects.

Debate about regional borders

In Sweden there is currently a debate about regional borders. It is uncertain whether the current border divisions will remain, but there are signals pointing to the amalgamation of several county councils into larger regions. In the public debate, a new regional border division has been promoted by arguments claiming reductions in administrative expenses, not the least of which includes the financing and control of the health and medical services. Other arguments have professed the need for larger regions in Sweden in order to achieve greater political influence in the context of the EU. Others have claimed that new regions are needed to provide a growth engine in each region, while yet others see opportunities in strengthening government ties in the country. The outcome is as of yet unclear, and it’s effects on public health uncertain.

A national investigation has nonetheless recently proposed that public health issues should remain a regional developmental issue. The Swedish National Institute of Public Health, in their comments to the investigators, have emphasized the need for public health to be included in regional developmental assignments as well as recommending more systematic efforts with prevention and health-promoting measures in the health and medical services.