2009-06-02
Summary of a publication in Swedish
In January 2009, the Swedish National Institute of Public Health (SNIPH) was instructed by the government to identify and analyze how Swedish national authorities, with support from the ‘EU Programme of Community action in the field of Public Health 2008-2013’ (hereafter referred to as the Public Health Programme), can contribute to the implementation of the national public health policy. The assignment also included suggesting priorities that would be of benefit for the EU as well as contribute to Swedish implementation of the national public health policy. Lastly, the assignment was to include suggested priorities for the EU’s work with the Public Health Programme in 2010.
The EU Public Health Programme provides an opportunity for sharing of knowledge and coordination of health interventions by funding transnational projects and initiatives such as conferences and networks. The programme’s objective, like the Swedish public health policy, is to influence health determinants, and has the overall goal of reducing inequalities in health. When it comes to contributing to the implementation of the Swedish public health policy, however, the analysis in this report demonstrates the limitations of the programme. The Public Health Programme does not cover all of objectives of the national public health policy since it mainly focuses on health threats such as communicable diseases and lifestyle-related issues. Regarding structural objectives for public health on a societal level, for example, it is rather EU policy as a whole that may have the strongest effect on Swedish public health development. Moreover, the Public Health Programme’s financial contribution is relatively sparse compared to EU programmes in other policy areas.
A survey of Sweden’s participation in the Public Health Programme shows that there are just a few Swedish authorities and universities that have led projects in the last six years. It is notably the Karolinska Institute (KI) and the Swedish Institute for Infectious Disease Control (SMI) who have managed projects, but also SNIPH, Umeå University and the Nordic Council Secretariat have been co-ordinators. The projects have mainly been comparative studies and surveys of practices and interventions.
Interviews with representatives from Swedish authorities who have been active in the Public Health Programme reveal the overall impression of involvement in the programme as being largely positive. Most rewarding was the knowledge gained to support national efforts. The European added value was defined as the projects providing an opportunity to compare different countries, as being cost effective and as creating valuable networks of contacts. In addition, interviewees experienced issues discussed at the EU level as gaining a higher degree of legitimacy.
At the same time, there are a number of formal and informal factors that negatively affect Swedish participation in the Public Health Programme. At times, there is a lack of clear support in government instructions and decrees to participate in EU projects. In addition, national authorities often lack capacity and resources, for example, for co-financing and the demanding administration that is often linked to EU projects. Clearer directives to participate in the programme issued from respective ministries, coupled with increased sharing of experiences among authorities, is likely to increase Swedish participation in the Public Health Programme.
With regard to priority areas that would benefit the EU and also contribute to the implementation of Swedish public health policy, these are largely dependent on the way in which these areas should contribute. In some areas of health, it can be highly significant for the successful implementation public health work in Sweden to influence and change EU policy in the long term, while in others, it is primarily about the rapid creation of networks or the acquirement of comparable data. Depending on the purpose of participation in the Public Health Programme, the priority areas are divided into three levels.
Level 1: direct effect – encompasses those actions which most markedly and in the short-term may have a direct impact on Swedish conditions and thus contribute to the implementation of the national public health policy in an immediate way. On this level, priorities include clearly cross-border issues such as communicable diseases, terrorist threats and joint risk management exercises.
Level 2: has an indirect but important policy impact and offers added value for Sweden in the longer term. Such actions include influencing policies and promoting Swedish political positions. There is an intrinsic value in influencing the direction of EU policy, as in the long run, it will also benefit Sweden.
Level 3: encompasses long-term work for a common welfare. These actions include the added value of solidarity with other EU Member States, which is favourable for Sweden in the long term, since a European union characterised by inequality and unequal resources is both unsustainable and economically challenging for all of it member states. In several areas of public health, Sweden, for example, has the opportunity to contribute knowledge.
The areas proposed for work with the EU Public Health Programme in 2010 are grouped according to the above-outlined levels and also relate to the priorities in the health field agreed upon by the Swedish Presidency of the EU in autumn of 2009. Within the first level, health threats such as climate change impacts on health, and antibiotic resistance are suggested priority areas. On level two, healthy ageing and injury prevention work related to alcohol consumption are the proposed areas to prioritise in regards to strengthening Swedish policy positions at the EU level. Finally, within level three - long term work for a common welfare - the main priority suggested is combating poverty and social exclusion linked to health inequalities.
updated Thursday, June 04, 2009
