Marit Helgesen NHPRC2013
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This document discusses multilevel governance of health promotion in Norway and other Nordic countries. It finds that while municipalities traditionally provide welfare services, their role in health promotion varies. Two models are identified: one where municipalities autonomously implement health promotion, and another where it is integrated into healthcare services. Overall, municipalities play an important but differing role in health promotion across Nordic states, guided by a multilevel governance approach with national policies implemented locally according to regional needs and capacities.
Marit Helgesen NHPRC2013
- 1. Multilevel governance of health promotion – on the role of municipalities Examples from Norway Marit K. Helgesen Norwegian Institute for Urban and Regional Research (NIBR)
- 2. Change in governance • How is health promotion governed? • Is there a role for municipalities? • Do they have the necessary capcity? • How are policies framed? • Are there similarities and differences?
- 3. Content of speech • Nordic welfare state and municipalities • Health promotion and dterminants for health • Theoretical perspective: – Multi-level governance – The cooperative turn • Multi-level governance of health promotion in the four Nordic countries • The cooperative turn: two models of health promotion in municipalities?
- 4. Decentralised character of welfare states • Service provision traditionally a municipal responsibility within limits of national governmental regulations • Municipalities have a dual role – Implement national policy goals – Local democratic arena – prioritizing of funding • Important role in the provision of welfare services
- 5. Health promotion • Health in the public sphere affect health positively: – Infrastructure for sanitation – Building of welfare state • Individual lifestyles in focus – Patients take part in producing their own health • Changing theoretical backdrop health promotion
- 6. Source: Dahlgren and Whitehead 1991 Determinants for health
- 7. Multi-level governance • Change from: • Hierarchy: command and control targeting content of services • New Public Management: contracts, performance- and strategic management measures targeting results • New Public Governance: designing and framing networks targeting processes
- 8. Cooperative turn • Change from hierachy towards network modes of governance • Bringing together diverse actors across sectors and levels of formal authority • National state taking the interest of actors at lower levels into consideration • Combine central intervention with local self regulation
- 9. Capacity as municipal size • D: 98 municipalities, average of 55 000 inhabitants, 5 regions • S: 290 municipalities, 21 elected county authorities • F: 320 municipalities, wanted average of 20 000 inhabitants not reached, samkommuner • N: 428 municicpalities, 19 elected county authotrities, average of 10 000 inabitants – about 100 municipalities with 3000 inh. or less
- 10. Capacity as competence • D: citizen-oriented prevention in municipalities, patient-oriented shared with regions • S: both levels to carry out health promotion, established political or administrative board, county autorhorites often take the role as initiators • F: municipalities decides on health promotion • N: included in municipal planning, have public health coordinator
- 11. Legal instruments • D: health promotion included in law on health and care, agreements between municipaliteis and regions • S: health promotion in law on health and care • F: act on health promotion and health and care • N: acts on health promotion and health and care, agreements between municipaliteis and regions
- 12. Economic instruments • D: municipal co-funding of hospital admissions, motivate health promotion initiatives • S: municipalities fund their health promotion • F: grants are given to fund trials and reforms • N: municipal co-funding of hospital admissions, motivate health promotion initiatives
- 13. Pedagogical steering instruments • D: statistical tool focus healt behavior, individual diseases and self-assessed health • S: follow ups on national goals publicized, hp in cooperation with county councils • F: «Welfare Compass» information on various determinants for health, state agencies provide policy support • N: «Health profiles» information on various determinants for health, state agencies provide policy support, hp in cooperation with county councils
- 14. PHA regulation: health profiles and local knowledge on determinants for health • Health profiles basis of knowledge on health determinants • Provided by Public Health Institute, issued once a year, statistical indicators accommodated to the local level • Municipalities and counties complete by qualitative indicators for local areas • Input for planning • Few national guidelines and exmples
- 15. Knowledge base Planning Decisions on planning goals Interventions and measures Evaluation Source: Paulsen and Moltumyr, Kommunetorget.no The systematic health promotion
- 16. HCMA: Healthy living centers • Defined as health care • Target population in need of changing health behavior; groups at risk • Pedagogical instrument, voluntary for municipalities • Municipalities can apply for special grants • Evidence based, thorough elaborated guidelines
- 17. Multi-level governance • Building on the traditions of decentralised service provision in all Nordic countries • A clear role for municipalities in health promotion • Similar between countries: to provide the contingencies of prevention and the services of which health promotion can be a part
- 18. The cooperative turn: two models of health promotion in municipalities? • Cooperative turn: municipal self regulation • Two models: S and F apparently more autonomous in their implementation of health promotion • D and N: health promotion the twin practice of health care • Economic NPM incentives motivate municipal self regulation to establish health promotion as health care service in the municipal health sector
- 19. Thank you for your attention