2010-05-13
The Swedish National Institute of Public Health (SNIPH) is participating in the EU-project, DETERMINE, which is a three-year (2007-2010) initiative aiming to contribute to reducing health inequalities in Europe.
The DETERMINE project is related to the work of the WHO Commission on Social Determinants of Health (2005-2008). A part of the DETERMINE project has focused on identifying what tools decision makers need to be willing and able to participate in multi-sectoral efforts to reduce health disparities.
Interviews with Swedish policymakers in 2008 brought to light that best practices in municipal public health work could be one such tool. This report contains a description and analysis of interviews with representatives from eight Swedish municipalities - Malmö, Kristianstad, Växjö, Nynäshamn, Botkyrka, Örebro, Falun and Umeå. The municipalities were selected based on criteria concerning
goals and policies on reducing health inequities, organisation and management as well as operations and concrete action. The findings from the interviews include the following:
Good and fair health is generally accepted by representatives of the municipalities as a prerequisite for positive development in each municipality. This view is particularly distinct among the local politicians who were interviewed. The interviewed municipalities all have an explicit overall goal of attaining a high and equal level of health in the population as expressed in a Public Health Strategy or the equivalent that has been adopted by the City Council. All of the municipalities also have a plan for public health work and how it should be conducted.
Developing goals and action plans is seen as a process where it is important to involve multiple stakeholders and to integrate the process with other ongoing development within the municipality.
Models for the management and coordination of public health work vary among the municipalities interviewed. Three management levels were identified: management through municipal and nominated politicians, co-ordinated management through a network of civil servants from the various municipal operations, and management within each respective operation by managers whom have been assigned a public health responsibility. Most municipalities charge their executive administrations with the task of adapting the municipality’s overall strategic goals to fit their own operations to then be able to tie the goals to the monitoring of executive operations.
Several sectors and operations are involved in public health work, both “social” and “technical” . With variations between the different municipalities, activities are targeted at the conditions for growth of children and young people , educational conditions, job opportunities, occupational health, environments and products. Other activities concern sexual health, youth participation, physical activity, diet and food, tobacco, alcohol and drugs, and healthy aging for the elderly and future elderly. A crucial issue in many municipalities is the health of municipal employees.
Promoting health among the staff provides positive spill-over effects on the population in general, since the municipality often employs a substantial part of the local population. All of the municipalities collaborate with various organisations and other public actors, mainly county councils and other municipalities.
One conclusion of this study is that the eight municipalities that have been interviewed can be regarded as good examples of municipalities with public health work that may reduce health disparities. Their strength lies mainly in the local coordination and management of the work, in their development of public health work in several different activities, in their interaction with other actors, and in the follow-up and development of ideas.
Another conclusion is that the meaning of the goal of ‘health on equal terms’ needs further clarification, and that people's living conditions, particularly with regard to education, employment and economic resources, need to be emphasized more and highlighted among the public health efforts along with activities geared toward healthrelated lifestyles. Public health efforts also need to be supported by the measurement of health and determinants of health from a gender perspective.
A further conclusion is that local experience and the development of ideas can be
transferred to other municipalities in the sense that they are good examples of public health work that can reduce health disparities and inspire other municipalities in their efforts to develop local public health policy.
updated Friday, August 13, 2010
