An investigation on inter-organizational municipal health promotion and primary disease prevention
Often the idea or concept of Health in All Policies (HiAP) is presented as a way for health promotion and disease prevention to be most efficient. It rests on a broad concept of health that includes social determinants such as education, food supply, living conditions, employment, pollution etc. Health is considered to be a function of a dynamic interplay between both individual features, social relations and the broader societal circumstances. This broad concept of health entails that health promotion interventions cannot be the responsibility of the health sector alone. Instead a wide range of sectors need to work in collaboration to promote population health.
In Denmark, local government is responsible to ensure healthy settings and provide preventive measures and activities. To solve this task intersectoral action for health and HiAP is often presented as an organizational solution. However the broad concept of health can make the boundaries of health interventions seem endless. This leaves municipalities with an organizational challenge about how to place a clear responsibility for what is basically a vague and rather indeterminate task. This makes HiAP appear at the same time as an organizational solution as well as a complex challenge.
Aim and project design
The PhD is explorative and studies the processes of organizing health promotion in the municipal setting. It aims to investigate the rationales of intersectoral action for health and HiAP, how the phenomenon of HiAP is practiced in Danish municipalities, as well as look into implications of how HiAP is shaping and being shaped by local organization and practice.
The study design is inspired by neo-institutional theory on organizational recipes and translation (Røvik, 2001). The PhD consists of 3 part studies using different, but supplementing methods.
Document analysis of 20 national policies and guidelines and 10 local health policies to shed light on rationales linked to HiAP, the actual intersectoriality (på “tværs-hed”) presented and how the documents construct HiAP as a solution to certain problems.
Interviews with 46 employees and managers in 10 municipalities to learn how they organize local efforts and their criteria and arguments for choosing certain organizational solutions as well as their experiences with transversal policies, organizational structures as well as collaborations on specific projects and interventions.
Ethnographic field work in 2 or 3 municipalities focusing on how they practice intersectoral action for health, centering on how it might or might not structure actions and provide meaning, when it is perceived as beneficial or difficult, and what are the dilemmas and ambiguities when practicing HiAP and intersectoral action for health at the local level in the municipal health promotion arena.
Overall, the study aims to provide new insights to the processes and complexities involved in organizing health promotion and prevention at the local level, as well as contribute to the discussion on strategies for implementing HiAP and cross sector collaboration for health.
The research period runs from Feb. 2013 to Feb. 2016