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Marit Helgesen NHPRC2013

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Multilevel governance of health promotion – on the role of municipalities

Multilevel governance of health promotion – on the role of municipalities


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  • 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