This document summarizes a study on the setting approaches used in local health promotion by four Swedish municipalities. Interviews and documents from the municipalities were analyzed. The results showed that schools and workplaces were mainly used for ad hoc health programs. Family centers enabled intersectoral collaboration and a holistic view of health. Politicians saw intersectoral collaboration as a strategy to improve public health across settings. Organizational structures affected setting approaches more than political governance. Challenges included sectoral divisions and confidentiality regulations between municipalities and healthcare.

1. Municipalities’ setting approaches
in local health promotion –
A Swedish case study
Vestfold, June 19th
, 2013
Elisabeth Jansson, PhD student
Co-authors: Elisabeth Fosse, Per Tillgren

2. Study background
The results of this study are secondary findings from the doctoral
studies I conduct at Mälardalen University in Västerås, Sweden
*Jansson, Tillgren (2010)
**Jansson, Fosse, Tillgren (2011)

3. Objectives
E Fagersta
Strängnäs
Sala
Oxelösund
4 municipalities’ setting approaches in their local health promotion

4. Methods
A multiple case study
Content analysis
Key person interviews – politicians, executives &
officials
Documents – annual reports, policies & plans etc.
Data collected in 2006 & 2012
E

5. Analysing procedure in 2006 & 2012
1
Single Case
D
Sala
Single Case
C
Fagersta
Single Case
B
Oxelösund
Single Case
A
Strängnäs
Cross-case analysis A, B, C, D5
432

6. Results
Public health policies Target groups Settings
●Alcohol, tobacco & Children & youths School
drug prevention 4/4 Adults Health care
Municipality employed Workplace
●Rehabilitation 3/4 Municipality employed Workplace
Primary health care centre
●Equality 4/4 Municipality employed Workplace
●Public health 1/4Whole society School
Workplace
Library
Primary health care centre
New venues

7. Results
Strategies
●Schools & workplaces are mainly used as location for ad
hoc health promotion interventions & programs
●Family centres are the settings where intersectoral
collaboration, multiple strategies & a holistic view of health
were common (3/4)
Advantages
●Entrance & access channel for vulnerable groups
●Enables easier communication between municipal
organization & population

8. Results
“The municipality’s power source, that's really the three F's
[forces], associations & churches & businesses.
From organizing a health week per year to more of this
everyday, in general.
Then these venues, as I can see as an extremely important
public health issue, whether they play bridge or read the
hymn book, or whatever they do.”
(C-Politician)

9. Results
”The library has been this kind of activity location.
Where we held a health day e.g. with the theme
heart. We have done it together with the pharmacy &
primary health care centre. [… ]
We have turned us into the public & the program
consisted of activities & you can try out & you can
get information.”
(A-Executive)

10. Results
The municipalities doesn’t explicitly express health promotion or
settings as an objective or strategy
Politicians saw intersectoral collaboration as a strategy to improve the
municipality public health in different settings
Executives & officials expressed both opportunities & obstacles in
intersectoral collaboration in setting based local interventions
The municipality organizational structure in horizontal or vertical
management affected setting approaches more than political
governance profile

11. Conclusions
The setting approach is consistent with the municipalities’ views &
possibilities to handle complex public health issues
Locally prioritized health issues based on local needs & prerequisites are
preferably performed in traditional settings
The development & sustainability is seen as possible & achievable by
intersectoral collaborations with engaged & committed actors in
established settings
Challenges in the municipalities’ setting approaches are related to factors
like sectorial pipe-line organizations & e.g. confidentiality regulations in
collaborations between the municipality & health care sector

12. Finally, a quot on the road…
“I believe very strongly in this structural stuff when it comes to children &
youths. I mean you look, yes I can keep long lectures, but ... then, what
saves many children, it's the school, the school is one of the biggest health
factors.”
(A-Official)

13. Thank you!
Elisabeth Jansson
Mälardalen University
School of Health, Care and Social Welfare
Västerås, Sweden
elisabeth.jansson@mdh.se
Västerås
Stockholm

14. References
Jansson, Fosse & Tillgren (2011) National public health policy in
a local context: implementation in two Swedish municipalities.
Health Policy 103(2-3):219-27
Jansson & Tillgren (2010) Health promotion at local level: a case
study of content, organization and development in four Swedish
municipalities. BMC Public Health 3;10:455