Ambiguous expectations for intersectoral action for health: a document analysis of the Danish case

Abstract

Ideas about intersectoral action and policymaking for health (ISA) are prominent among public health professionals. They are often presented as effective ways to address root causes of poor health and health inequality, and as such the best way to promote population health. The implementation of such ideas has proven difficult though. In this paper we argue that neo-institutional theory can help us conceptualize implementation challenges by pointing to implicit expectations and contradictions associated with the ISA idea itself. With Denmark as empirical case, we conducted a document analysis of recommendations for municipal ISA. The analysis shows how the recommendations provide a very abstract conceptualization of ISA that does not give much practical guidance for action. We show how ISA is discursively constructed with buzzword qualities as the natural way to organize health promotion, by being presented as a means to produce better quality services, more cost-effective operations, and ensure the future of the welfare state, while at the same time hardly changing much at all. By applying the lens of institutional logics we show how ISA, although being vaguely defined, offer ambiguous normative and symbolic repertoires for action. We discuss the implementation challenges associated with this advocacy rhetoric and suggest that the domination of the corporation logic may appear to reduce the political character of ISA and potentially conflict with the ideals of health as a matter of social justice and human rights.

Elusive implementation: an ethnographic study of intersectoral policymaking for health

“…In the Danish context, we find that Townville represents an exemplary case. Correspondingly, the inconsistent demands are somewhat similar to the contradicting logics found in Holt et al [ 53 ]. Whereas the Danish context is unique, we find that the ‘myth’ of intersectoralism may represent more general implications for intersectoral policymaking.…”

Legitimising Inter-Sectoral Public Health Policies: A Challenge for Professional Identities?

“…Inspired by new institutionalism, we regard organisations and their agents to be dependent on their institutional environment and on gaining legitimacy not only to succeed economically but also to survive [8][9][10]. To examine HiAP, other scholars have used institutional perspectives, such as path dependency and rationalised myth [11][12], institutional logics [13] and translation of organisational ideas [14][15]. By contrast, studies that apply a legitimacy perspective have been difficult to find.…”

The (failed) promise of intersectoral working groups and other rituals in Scandinavian public health

“…Something similar is at stake in the -equally ritualistic -production of documents that are meant to guide and support public health officers. In this volume, Holt, Waldorf, Tjørnhøj-Thomsen, and Rod (2018) present an analysis of documents containing recommendations for intersectoral action for health in Danish municipalities. Such documents constitute a particular genre where the ambition to reduce health inequalities is decoupled from political ideals, such as social justice, and presented primarily as a technical matter which can be solved through clever organizing.…”