Child health promotion : Analyses of activities and policy processes in 25 Swedish municipalities

摘要

The Swedish municipalities are important actors that offer appropriateenvironments for healthpromoting activities directed at children andadolescents. Enhanced understanding on how such activities develop isneeded to improve local public health action. The overall objective ofthis thesis was to describe potential explanatory factors in municipalhealth-promoting measures directed at children and adolescents, in orderto facilitate for national actors to support healthpromoting action inthe municipalities.In the first three papers of this thesis the intentions of 25 Swedishmunicipalities to promote children and adolescents' health are described.Safety promotion (Study I), health promotion in preschools (Study II) andhealth promotion in schools (Study III) were of primary interest. In thenext step policy processes and factors that might explain municipalpublic health action were analysed (Study IV). Finally, data from Study 1were used to test correlations between municipal safety-promotingactivities and health outcome (Study V).Although intentions to promote children's health were in general quitewell developed, there were some exceptions and variations among themunicipalities. Significant correlations between municipalhealthpromoting activities and outcome variables were revealed oninjuries (Study V) but not on youth behaviour (Study III). Municipalsocio-economic status, measured as proportion adults with more than 12years of education, did not predict the level of healthpromotingmeasures, whereas municipal growth seemed to have a hampering effect.These results were consistently observed in Studies I-III. Faster growingmunicipalities reported fewer safety-promoting measures, a lower fractionof preschool staff with a university degree and a lower fraction offull-time employed teachers with a university degree than slower growingmunicipalities.Five potential explanatory factors for policy process development wereidentified in Study IV: financial problems, perceived local needs,external funding, national and international policy documents andpresence of a local public health sector. Politicians, public officialsand nongovernmental organisations were important actors in differentphases of the policy process, with strong commitment, professional skillsand powerful position in the organisation as main characteristics. Thehealth sector in general, epidemiological statistics and evidence-basedmethods were seldom mentioned in Study IV.Potential policy implications based on the results presented in thisthesis are that disseminating public health-related knowledge throughinternational and national policy documents and supportinginstitutionalisation of a local public health sector might be usefulmethods to stimulate and support municipal public health action. Further,means to introduce and distribute epidemiological statistics andevidence-based methods to the municipalities ought to be considered.Increased and improved cooperation between public health sciences andpolitical sciences (e.g., by integrated courses and shared researchprojects) could be helpful in developing public health research withinthe municipal arena.