Governance for public health and health equity: The Tröndelag model for public health work

Abstract

Background: Multi-sectoral governance of population health is linked to the realization that health is the property of many societal systems. this study aims to contribute knowledge and methods that can strengthen the capacities of municipalities regarding how to work more systematically, knowledge-based and multi-sectoral in promoting health and health equity in the population. Methods: Process evaluation was conducted, applying a mixed-methods research design, combining qualitative and quantitative data collection methods. Results: Processes strengthening systematic and multi-sectoral development, implementation and evaluation of research-based measures to promote health, quality of life, and health equity in, for and with municipalities were revealed. A step-by-step model, that emphasizes the promotion of knowledge-based, systematic, multi-sectoral public health work, as well as joint ownership of local resources, initiatives and policies has been developed. Conclusions: Implementation of systematic, knowledge-based and multi-sectoral governance of public health measures in municipalities demand shared understanding of the challenges, updated overview of the population health and impact factors, anchoring in plans, new skills and methods for selection and implementation of measures, as well as development of trust, ownership, shared ethics and goals among those involved.

Addressing Inequity: Evaluation of an Intervention to Improve Accessibility and Quality of a Green Space

“…Benches have been placed along the path, inviting people to rest and admire the scenery. To create a better sense of place, information boards on local wildlife and history and a selection of historical artefacts have been installed at the side of the path [46,47]. Moreover, the path has been designed according to the principles of universal design (defined by the Norwegian Disability Act of 2005), meaning that the design and composition is so that it can be accessed and used by all people regardless of their age, size, ability, or disability.…”

“…This study draws on register data from two population surveys conducted in 2014 (before the path was opened) (n = 989) and in 2018 (two years after the opening of the path) (n = 2,072) [41,47]. All participants were adult residents in the municipality (≥18 years old).…”

Can the Theory of Salutogenesis Offer a Framework to Enhance Policy Coherence during Policy Development and Implementation in Municipalities?

“…Receiving input and knowledge about central aspects and mechanisms might help to outline one's own professional role in the collaboration. Moreover, including joined learning activities and knowledge-sharing enables processes that draw on the specialized knowledge of collaborators, and contributes to better-informed decisions and motivation among stakeholders [16,17,28] Informationsharing both between sectors and levels is a crucial step to establish a common ground and ensure that stakeholders find meaningful perspectives that enables them to work towards the common goal from their specific position and represents a chance to increase understanding about different roles and responsibilities across stakeholders [2].…”

“…Thus, when specific sectors, levels or actors are assigned responsibilities, these should be accompanied by relevant resources to ensure manageability. As post-new public management strategies include to distribute fundings according to earlier achievements, it should be ensured that contributions to common goals are made visible at the point (sector and level) from which they are addressed [28]. Thus, measurable outcomes at each level and in each sector would be defined to make contributions visible.…”

The Overarching Concept of Salutogenesis in the Context of Health Care

“…In some countries, like Norway, we have through the last years seen a growing number of practical interventions in public health and health care that has been based in the general salutogenic model or other resource-based models [12]. It has also been observed how practical salutogenic work solutions have been used in health care among young in schools [13], for elderly both in nursing homes [14] and as an intervention approach in care situations among elderly outside nursing homes [15].…”