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Jansson, Elisabeth
Publications (10 of 12) Show all publications
Jansson, E., Fosse, E. & Tillgren, P. (2016). Is there a gap in the health equity expressed in policy and practice. In: : . Paper presented at 8th Nordic Health Promotion Research Conference, Jyväskylä, Finland, June 20-22, 2016.
Open this publication in new window or tab >>Is there a gap in the health equity expressed in policy and practice
2016 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Objectives

The aim was to study the occurrence and how equality in health was expressed in policy and activities in four Swedish municipalities in the years 2006 and 2012.

Methods

A deductive content analysis of interviews with local municipal key persons, politicians and chief executives and policy documents in the form of annual reports, in four strategically selected municipalities in the region of Mälardalen in Sweden.

Results

In the documents, terms of equality, justice and vulnerable groups did not occur. However, these themes were mentioned by politicians and officials in most of the municipalities studied, and the issues of vulnerability and exclusion occur in both documents and interviews in most municipalities. These issues were conceptualized as various support measures, such as social and economic support, integration efforts, appropriate housing, promotion of employment and to provide security and a safe childhood. These issues occurred in all the documents and in some of the interviews. Priority groups in all municipalities were children, young people and older people but also immigrants. Barriers mentioned were the lack of qualified personnel such as social workers and support staff in schools.

Conclusions

Equality, health equity and reducing the gaps are not explicitly stated in the study of the municipalities. But the insight that disadvantaged groups needs support through actions and tailored training programs and work based on the individuals’ different conditions was emphasized.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mdh:diva-32620 (URN)
Conference
8th Nordic Health Promotion Research Conference, Jyväskylä, Finland, June 20-22, 2016
Projects
Health promotion in local context
Available from: 2016-08-23 Created: 2016-08-23 Last updated: 2017-02-02Bibliographically approved
Jansson, E., Fosse, E. & Tillgren, P. (2011). National public health policy in a local context: implementation in two Swedish municipalitis. Health Policy, 103(2-3), 219-227
Open this publication in new window or tab >>National public health policy in a local context: implementation in two Swedish municipalitis
2011 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 103, no 2-3, p. 219-227Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: In 2003 the wide-ranging Swedish National Public Health Policy (SNPHP), with a focus on health determinants, was adopted by the Swedish parliament. In the context of multilevel governance, SNPHP implementation is dependent on self-governed municipalities and counties. The aim of the study is, from a municipal perspective, to investigate public-health policies in two municipalities. METHODS: Content analysis of documents and interviews provided a foundation for an explorative case study. RESULTS: The SNPHP at national level is overriding but politically controversial. At local level, a health-determinants perspective was detectable in the policies implemented, but none regarding to health equality. At local level, the SNPHP is not regarded as implementable; rather, limited parts have, to varying degrees, been reconciled with local public-health goals, according to municipal needs and conditions. A success-promoting factor in the two municipalities was the presence of committed and knowledgeable actors/implementers. Also, the municipality with a more centrally controlled and stable party-political leadership succeeded better in implementing structural and intersectoral community-wide policies for coordinated local health promotion. CONCLUSIONS: The contents of national and local public-health policies differ, and municipalities that have implemented their own local health policies do not seem to regard the SNPHP as justifiable or adoptable. If the SNPHP overall aim regarding equal health is to be achieved homogeneously in Swedish municipalities, its contents and purpose need clearer management and negotiation, so that implementation of the national policy locally is understandable and motivated.

Place, publisher, year, edition, pages
Elsevier, 2011
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mdh:diva-10098 (URN)10.1016/j.healthpol.2011.08.013 (DOI)000297872400014 ()21956048 (PubMedID)2-s2.0-80255123759 (Scopus ID)
Available from: 2010-08-09 Created: 2010-08-09 Last updated: 2018-10-16Bibliographically approved
Jansson, E. & Tillgren, P. (2010). Health promotion at local level: A case study of content, organization and development in four Swedish municipalities. BMC Public Health, 10(Article Number: 455)
Open this publication in new window or tab >>Health promotion at local level: A case study of content, organization and development in four Swedish municipalities
2010 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, no Article Number: 455Article in journal (Refereed) Published
Abstract [en]

Background: Several health determinants are related to local conditions and prerequisites at community level. For this reason, strengthening community action has been one of five strategies implemented in health promotion since the end of the 1980s. Such action includes setting priorities, making decisions, planning strategies, and implementing them to achieve better health. The aim of this paper is to obtain a deeper understanding of content, organization and processes in the development of local health promotion.

Methods: A qualitative multiple case study of four Swedish municipalities. The cases were analyzed in accordance with the principles of cross-case study analysis, and a content analysis of documents and interviews was conducted in two steps. First, a manifest content analysis was performed to identify present and former actors and measures. Thereafter, a latent content analysis was performed to investigate structures and processes in local contexts.

Results: The results of the inductive content analysis showed development of local health promotion in three phases: initiation, action, and achievement. Strengthening factors were local actors, health statistics and events. Hindering factors were lack of resources and vague objectives. External factors, e.g. national policies, were not perceived as prominent influencing factors. Media reports were regarded as having had an influence, but only to some extent. The content of local health promotion has developed from ad-hoc lifestyle and behaviour-related actions into structural, intersectoral actions related to determinants of health.

Conclusions: The municipalities have organized and developed their health promotion targets, actions and priorities on the basis of local needs and prerequisites. The three phases in the identified health promotion processes were experienced and documented as being subject to greater influence from internal rather than external strengthening and hindering factors in their local contexts.

Place, publisher, year, edition, pages
London: BioMed Central Ltd, 2010
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mdh:diva-8086 (URN)10.1186/1471-2458-10-455 (DOI)000281864200004 ()20682052 (PubMedID)2-s2.0-77955109389 (Scopus ID)
Available from: 2010-02-11 Created: 2010-02-11 Last updated: 2017-12-12Bibliographically approved
Jansson, E., Fosse, E. & Tillgren, P. (2010). Jansson E, Fosse E, Tillgren P. The local perspective on the implementation of a national public health policy in Sweden – a case study from two municipalities. Abstract accepted for oral presentation at Symposium How to transfer public health research into practice – Challenges in implementation research. Stockholm, Sweden 2010-11-15—16.. In: : . Paper presented at Challenges in implementation research. Stockholm, Sweden 2010-11-15—16..
Open this publication in new window or tab >>Jansson E, Fosse E, Tillgren P. The local perspective on the implementation of a national public health policy in Sweden – a case study from two municipalities. Abstract accepted for oral presentation at Symposium How to transfer public health research into practice – Challenges in implementation research. Stockholm, Sweden 2010-11-15—16.
2010 (English)Conference paper, Published paper (Other academic)
Abstract [en]

The local perspective on the implementation of a national public health policy in Sweden – a case study from two municipalities

Author names (surname, initials): Elisabeth Janssona,b, , Elisabeth Fossec, Per Tillgrena,b

Affiliations:

School of  Health, Care and Welfare, Mälardalen University, Box 883, SE-721 23 Västerås, Sweden

b Department of Public Health Sciences, Karolinska Institutet, Norrbacka, SE-171 76 Stockholm, Sweden

c Department of Health Promotion and Development, University of Bergen, Christiegt. 13, 5015 Bergen, Norway

 Background:

 In 2003 the Swedish parliament adopted a wide-ranging national objective for public health, focusing specifically on health determinants. It is envisaged that the overall objective will be achieved through the efforts of different bodies, including agencies, county councils and municipalities. Responsibility for implementation is located at regional and local level, without any specified guidelines or, for example, economic incentives for how the work should be performed.

 

This study’s intention is, from a bottom-up perspective, to investigate public-health policies in two municipalities, and to see whether municipal policies can be related to the national objective.  The bottom-up perspective focuses on the actors, the people responsible for implementation, and on the process as seen from their own perspective. The implementers play a key role, as mediators of empirical knowledge and bases for decisions to the national decision-makers. Thus, in the implementation of national policy at local level, decision-makers are dependent on the decisions made and priorities set by the municipalities in their own local settings, as these are related to competing or similar laws, policies, stakeholders and needs. Local and committed actors have an important function in the implementation process. Serious commitment and occupying a position of power are important aspects of success, but so too is professional expertise. At the same time, local actors’ opportunities to act and implement national targets within their own organization is restricted by surrounding structures, e.g. the party-political (partisan) composition of the municipality and its administrative organization, and also the presence or not of formal or informal support networks.

 

Methods:

 Scrutiny of documents and interviews provided a foundation for a qualitative case study.

Results:

The results reveal a loose fit between policy implementation and the national public health policy. The local level does not regard the national objective as implementable; instead, it has, to varying degrees, chosen to redefine its goals according to municipal needs and conditions. A success-promoting factor in the two municipalities was the presence of committed and knowledgeable actors/implementers. Also, the municipality with a more centrally controlled and stable party-political leadership succeeded better in implementing structural and intersectoral community-wide policies for coordinated local public-health promotion.

 

Discussion /Conclusions:

Problems that accompany major, ambitious and non-specific goals, like those in the Swedish public health policy, are that they risk being integrated into a solely symbolic structure, entailing formal adoption but with only a superficial finish.  Below the surface, the informal, original organization remains in the administrations, which hinders implementation.

Swedish municipal self-governance, with its enhanced scope for local action, offers an opportunity for communities to shape their own politics and policies. But, at the same time, this acts as a barrier to opportunities for decision-makers at national-government level to influence and guide the municipalities towards the national objective of more organized and structured health promotion focusing on the determinants of health enhanced knowledge of the policy, and of its specific focus on health determinants, is needed to increase understanding/motivation to implement the national policy locally.

 

 

 

 

National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-10643 (URN)
Conference
Challenges in implementation research. Stockholm, Sweden 2010-11-15—16.
Available from: 2010-10-28 Created: 2010-10-28 Last updated: 2017-04-06Bibliographically approved
Jansson, E. V., Fosse, E. & Tillgren, P. (2010). National public health policy in a local context: implementation in two Swedish municipalities. In: How to transfer public health research into practice: Challenges in implementation research. Paper presented at Implementation Research Symposium 2010, Stockholm, Nov 15-16, 2010..
Open this publication in new window or tab >>National public health policy in a local context: implementation in two Swedish municipalities
2010 (English)In: How to transfer public health research into practice: Challenges in implementation research, 2010Conference paper, Published paper (Refereed)
Abstract [en]

Background: In 2003 the Swedish parliament adopted a wide-ranging national objective for public health, focusing specifically on health determinants. It is envisaged that the overall objective will be achieved through the efforts of different bodies, including agencies, county councils and municipalities. Responsibility for implementation is located at regional and local level, without any specified guidelines or, for example, economic incentives for how the work should be performed.

This study’s intention is, from a bottom-up perspective, to investigate public-health policy in two municipalities, and to see whether municipal policies can be related to the national objective.  The bottom-up perspective focuses on the actors, the people responsible for implementation, and on the process as seen from their own perspective. The implementers play a key role, as mediators of empirical knowledge and bases for decisions to the national decision-makers. Thus, in the implementation of national policy at local level, decision-makers are dependent on the decisions made and priorities set by the municipalities in their own local settings, as these are related to competing or similar laws, policies, stakeholders and needs. Local and committed actors have an important function in the implementation process. Serious commitment and occupying a position of power are important aspects of success, but so too is professional expertise. At the same time, local actors’ opportunities to act and implement national targets within their own organization is restricted by surrounding structures, e.g. the party-political (partisan) composition of the municipality and its administrative organization, and also the presence or not of formal or informal support networks.

Methods: Scrutiny of documents and interviews provided a foundation for a qualitative case study.

Results: The results reveal a loose fit between policy implementation and the national public health policy. The local level does not regard the national objective as implementable; instead, it has, to varying degrees, chosen to redefine its goals according to municipal needs and conditions. A success-promoting factor in the two municipalities was the presence of committed and knowledgeable actors/implementers. Also, the municipality with a more centrally controlled and stable party-political leadership succeeded better in implementing structural and intersectoral community-wide policies for coordinated local public-health promotion.

Discussion /Conclusions: Problems that accompany major, ambitious and non-specific goals, like those in the Swedish public health policy, are that they risk being integrated into a solely symbolic structure, entailing formal adoption but with only a superficial finish.  Below the surface, the informal, original organization remains in the administrations, which hinders implementation.

Swedish municipal self-governance, with its enhanced scope for local action, offers an opportunity for communities to shape their own politics and policies. But, at the same time, this acts as a barrier to opportunities for decision-makers at national-government level to influence and guide the municipalities towards the national objective of more organized and structured health promotion focusing on the determinants of healthInc reased knowledge of the policy, and of its specific focus on health determinants, is needed to increase understanding/motivation to implement the national policy locally.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mdh:diva-10520 (URN)
Conference
Implementation Research Symposium 2010, Stockholm, Nov 15-16, 2010.
Available from: 2010-10-26 Created: 2010-10-26 Last updated: 2017-04-06Bibliographically approved
Jansson, E., Zetterquist, S., Karlsson Vestman, O. & Tillgren, P. (2009). Evaluating the implementation of a county council policy in two municipalities - methodological strategies and tools.. In: : . Paper presented at The 6th Nordic Health Promotion Research Conference The Role of Health Promotion in the Transition of the Nordic Welfare States 20-22 August 2009, Gothenburg..
Open this publication in new window or tab >>Evaluating the implementation of a county council policy in two municipalities - methodological strategies and tools.
2009 (English)Conference paper, Published paper (Refereed)
Abstract [en]

 

Background: In year 2004 the Stockholm County Council (CC) approved a policy to reduce overweight and obesity. The implementation at local level started in two pilot municipalities during a two years period and resulted in several subprojects. Program theory (PT) is a methodology used to understand and identify key components in complex programs.

 

Objectives: To highlight strategies and tools applied in planning and conducting an implementation evaluation of a CC policy in two municipalities.

 

Methods: A descriptive process analysis of identified obstacles and solutions in all phases of the evaluation. Work notes, minutes from the steering group and the evaluating group meetings where analyzed to recapture the evaluation process.

 

Result: PT was used to get an understanding of the components of the policy, the projects and their interrelations. Three separate PT where developed, one for the CC policy and one for the project in each municipality. To get a general idea of the projects and to organise the vast amount of documentation a form was developed for the project managers to fill in. To identify stakeholders and actors, organisational charts (OC) were developed for the project’s organisations including CC representatives. The evaluation’s data collection was based on principles for triangulation (documents, survey and interviews). The PT and OC where used in the purposeful sample of respondents. The PT and OC also worked as a component when reporting the results.

 

Conclusion: PT is a useful tool to clarify the intentions and relations between levels of implementation when evaluating complex, multilevel programs. Using multiple means for data collection is a helpful strategy to generate both general and in depth understanding of a policy’s implementation. PT and OC are useful tools to make sure everyone has the same understanding of the policy’s components and organisation when communicating with stakeholders and respondents in all phases of the evaluation process.

National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-8077 (URN)
Conference
The 6th Nordic Health Promotion Research Conference The Role of Health Promotion in the Transition of the Nordic Welfare States 20-22 August 2009, Gothenburg.
Note

Konferensdatum 20-22 augusti 2009

Available from: 2010-02-11 Created: 2010-02-11 Last updated: 2017-04-06Bibliographically approved
Zetterquist, S., Jansson, E., Tillgren, P. & Karlsson Westman, O. (2008). Utvärdering av implementeringsprocessen för ”Ung & Sund i Sigtuna kommun” och folkhälsoprojektet i ”Ett gott liv för alla i Upplands Väsby kommun" en delutvärdering av Stockholms läns landstings Handlingsprogram övervikt och fetma 2004.. Eskilstuna: Mälardalens högskola
Open this publication in new window or tab >>Utvärdering av implementeringsprocessen för ”Ung & Sund i Sigtuna kommun” och folkhälsoprojektet i ”Ett gott liv för alla i Upplands Väsby kommun" en delutvärdering av Stockholms läns landstings Handlingsprogram övervikt och fetma 2004.
2008 (Swedish)Report (Other academic)
Place, publisher, year, edition, pages
Eskilstuna: Mälardalens högskola, 2008. p. 93
Keywords
Mälardalen Evaluation Academy, MEA, Mälardalens Utvärderingsakademi
Identifiers
urn:nbn:se:mdh:diva-4545 (URN)978-91-86135-04-1 (ISBN)
Available from: 2008-12-22 Created: 2008-12-17 Last updated: 2013-12-19Bibliographically approved
Jansson, E. & Tillgren, P. (2007). Local politicians and Officials perspective on Health Promotion activities in four municipalities in Sweden..
Open this publication in new window or tab >>Local politicians and Officials perspective on Health Promotion activities in four municipalities in Sweden.
2007 (English)Manuscript (preprint) (Other (popular science, discussion, etc.))
Abstract [en]

Introduction: In the Swedish National Public Health Policy (SNPHP) from year 2003 the overall aim is "to create social conditions which ensure good health for the entire population". The policy includes three levels of determinants for health; structural factors, living conditions and lifestyles.

The aim of this study was to gain knowledge about local politicians and officials definitions of local health promotion and activities in comparison with the SNPHP.

Method: An empirical study based on semi structured interviews with 35 local government politicians and officials in four Swedish municipalities was conducted in year 2006. Content analysis has been used as the analytical approach to get systematic information from the transcripts of the interviews in order to gain deeper understanding of how the interviewed described local health promotion.

Findings: The interviewed key persons define health promotion as wide-ranging incorporation of several actors in order to improve populations living conditions such as safe and healthy environments. Lifestyle issues mentioned is e.g. alcohol and tobacco prevention. Prioritized target groups for actions are children and adolescents. Politicians speak more about responsibility and structural issues and local officials talk more about community action.

Conclusion: Local politicians and officials define health promotion as an extensive population-oriented phenomenon dependent of factors related to SNPHPs three levels of determinants for health. Also highlighted is the guiding principles of the Ottawa Charter such as intersectorial and community action.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mdh:diva-3673 (URN)
Available from: 2007-08-24 Created: 2007-08-24 Last updated: 2017-04-06Bibliographically approved
Wallin, E., Jansson, E. & Tillgren, P. (2007). Sustainable Development and Public Health – Could it be combined?. In: : . Paper presented at The 13th International Sustainable Development Research Conference. Västerås, Sweden, June 10-12..
Open this publication in new window or tab >>Sustainable Development and Public Health – Could it be combined?
2007 (English)Conference paper, Published paper (Refereed)
Abstract [en]

Background: The WHO policy framework - Health for all in the 21st century – in the European region provides Health Promotion and thereby Public Health practitioners with an agenda that includes and highlights equity (health as a resource for all humans regardless of background), environmental aspects (influences peoples health and possibilities of being healthy) and economic aspects (the ability and possibility of making healthy choices). These dimensions are also the pillars of sustainable development. Besides these similarities the two concepts seems to cohere on several key points in their fundamental visions and strategies; long-term view, interdisciplinary collaboration, holistic approach including system thinking, democracy and participation etc. Although, are the concepts really coherent in their definitions and explanations of these visions and strategies?

The objective is to study similarities and differences between the concepts of health promotion and sustainable development in Swedish national documents for public health and sustainable development between 1992 and 2006.

Method: A systematic review of a strategically sample of governmental public health and sustainable development documents including a manifest content analysis to get an understanding of how health promotion and sustainable development as concepts are described.

Expected results: Preliminary results indicate that the concepts have different approaches to a few of the similar key points, especially participation and democracy. The final results will help to clarify the relationship between the concepts of health promotion and sustainable development and will be presented at the conference.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mdh:diva-3674 (URN)
Conference
The 13th International Sustainable Development Research Conference. Västerås, Sweden, June 10-12.
Available from: 2007-08-24 Created: 2007-08-24 Last updated: 2017-04-07Bibliographically approved
Jansson, E. & Tillgren, P. (2006). Bracht et al five stage model.: A planning tool for case study rsearch.. In: : . Paper presented at The 5th Nordic Health promotion Research Conference. Esbjerg, Denmark. June 15-17 2006.
Open this publication in new window or tab >>Bracht et al five stage model.: A planning tool for case study rsearch.
2006 (English)Conference paper, Published paper (Refereed)
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-3587 (URN)
Conference
The 5th Nordic Health promotion Research Conference. Esbjerg, Denmark. June 15-17 2006
Available from: 2007-07-24 Created: 2007-07-24 Last updated: 2017-04-06Bibliographically approved
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