Governing health equity in Scandinavian municipalities: The inter-sectorial challenge.

AIMS: Local governments in the Scandinavian countries are increasingly committed to reduce health inequity through 'health equity in all policies' (HEiAP) governance. There exists, however, only very sporadic implementation evidence concerning municipal HEiAP governance, which is the focus of this study. METHODS: Data are based on qualitative thematic network analysis of 20 interviews conducted from 2014 to 2015 with Scandinavian political and administrative practitioners. RESULTS: We identify 24 factors located within three categories; political processes, where insufficient political commitment to health equity goals outside of the health sector and inadequate economic prioritization budget curbs implementation. Concerning evidence, there is a lack of epidemiological data, detailed evidence of health equity interventions as well as indicators relevant for monitoring implementation. Concerted administrative action relates to a lack of vertical support and alignment from the national and the regional level to the local level. Horizontally within the municipality, insufficient coordination across policy sectors inhibits effective health equity governance. CONCLUSIONS: A shift away from 'health in all policies' based on a narrow health concept towards 'health equity for all policies' based on a broader concept such as 'sustainability' can improve ownership of health equity policy goals across municipal sectors.

Inter-Sectoral Collaboration in Municipal Health Centres: A Multi-Site Qualitative Study of Supporting Organizational Elements and Individual Drivers.

INTRODUCTION: Community health centres accommodating different professional groups are expected to improve inter-sectoral collaboration between primary care providers. This study aimed to identify what has been done to support inter-sectoral collaboration between municipal professionals and general practitioners in health centres, and to explore the interactions that emerge between these professionals at the operational level. METHODS: The study was a multi-site qualitative study carried out in four municipal health centres in a Danish region. The study was based on documents and qualitative interviews with general practitioners, and municipal professionals and administrators in each of the health centres. A content analysis was conducted. RESULTS: The study found that little attention had been given to the organizational prerequisites for enhanced inter-sectoral collaboration in the health centres. Even though some health centres had employed coordinators, these did not play a significant role as facilitators of collaboration partly due to a lack of political and managerial attention. At the operational level, inter-sectoral collaboration was limited to ad hoc interactions between professionals. Although these interactions could be useful, they did not evolve into more systematic forms of collaboration. CONCLUSION: The gap between policy visions and actual implementation efforts found in this study suggests that a more active and focused engagement from the political-administrative level is needed if the visions of increased inter-sectoral collaboration in health centres are to be realised.

Voluntary associations and co-production of health promoting activities for older adults: Experiences and policy lessons from Denmark.

Demographic transitions in Europe accentuate the need to develop innovative solutions for healthy ageing. One increasingly popular policy approach is co-production between local governments and voluntary community associations (VCOs) to promote activities for health and wellbeing among older adults. While co-production has been studied from the perspective of local governments there is limited knowledge regarding how voluntary associations perceive their conditions. This study aims to fill this gap using survey data from voluntary associations in Denmark. The investigation is based on an electronic survey (n = 263) of VCOs engaged in activities relevant for healthy ageing in three Danish municipalities. The survey addressed 13 issues and potential problems within four categories - ''members and volunteers', 'economics, 'media and the public' and '´politics and the local government'. The paper presents a relatively positive picture of the potentials in municipal-VCO collaboration. However, we also find that a sizeable number of VCOs point to problems and obstacles particular in regards to recruitment of members and economics. While the municipalities in our study have all developed strategies to support VCOs and to promote coproduction it seems that there are deficits in the implementation of the strategies. This leads us to conclude that municipalities must pay close attention to the issues and conditions for VCOs in order to succeed with their policy initiatives in this area.

Co-location as a Driver for Cross-Sectoral Collaboration with General Practitioners as Coordinators: The Case of a Danish Municipal Health Centre.

The issue of integrated care and inter-sectoral collaboration is on the health policy agenda in many countries. Yet, there is limited knowledge about the effects of the different policy instruments used to achieve this. This paper studies co-location as a driver for cross-sectoral collaboration with general practitioners (GPs) acting as coordinators in a municipal health centre. The purpose of the health centre, which is staffed by health professionals from municipal, regional and private sectors, is to provide primary health services to the citizens of the municipality. Co-locating these professionals is supposed to benefit e.g., elder citizens and patients with chronic diseases who frequently require services from health professionals across administrative sectors. Methodologically, the analysis is based on qualitative data in the form of semi-structured interviews with the health professionals employed at the health centre and with administrative managers from municipal and regional government levels. The study finds that co-location does not function as a driver for cross-sectoral collaboration in a health centre when GPs act as coordinators. Cross-sectoral collaboration is hampered by the general practitioners' work routines and professional identity, by organisational factors and by a lack of clarity concerning the content of collaboration with regard to economic and professional incentives.