Child health promotion : analyses of activities and policy processes in 25 Swedish municipalities
Author: Guldbrandsson, Karin
Date: 2005-10-21
Location: Aulan, plan 2, Norrbacka, Karolinska Institutet
Time: 9.00
Department: Institutionen för folkhälsovetenskap / Department of Public Health Sciences
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Thesis (1.232Mb)
Abstract
The Swedish municipalities are important actors that offer appropriate
environments for healthpromoting activities directed at children and
adolescents. Enhanced understanding on how such activities develop is
needed to improve local public health action. The overall objective of
this thesis was to describe potential explanatory factors in municipal
health-promoting measures directed at children and adolescents, in order
to facilitate for national actors to support healthpromoting action in
the municipalities.
In the first three papers of this thesis the intentions of 25 Swedish municipalities to promote children and adolescents' health are described. Safety promotion (Study I), health promotion in preschools (Study II) and health promotion in schools (Study III) were of primary interest. In the next step policy processes and factors that might explain municipal public health action were analysed (Study IV). Finally, data from Study 1 were used to test correlations between municipal safety-promoting activities and health outcome (Study V).
Although intentions to promote children's health were in general quite well developed, there were some exceptions and variations among the municipalities. Significant correlations between municipal healthpromoting activities and outcome variables were revealed on injuries (Study V) but not on youth behaviour (Study III). Municipal socio-economic status, measured as proportion adults with more than 12 years of education, did not predict the level of healthpromoting measures, whereas municipal growth seemed to have a hampering effect. These results were consistently observed in Studies I-III. Faster growing municipalities reported fewer safety-promoting measures, a lower fraction of preschool staff with a university degree and a lower fraction of full-time employed teachers with a university degree than slower growing municipalities.
Five potential explanatory factors for policy process development were identified in Study IV: financial problems, perceived local needs, external funding, national and international policy documents and presence of a local public health sector. Politicians, public officials and nongovernmental organisations were important actors in different phases of the policy process, with strong commitment, professional skills and powerful position in the organisation as main characteristics. The health sector in general, epidemiological statistics and evidence-based methods were seldom mentioned in Study IV.
Potential policy implications based on the results presented in this thesis are that disseminating public health-related knowledge through international and national policy documents and supporting institutionalisation of a local public health sector might be useful methods to stimulate and support municipal public health action. Further, means to introduce and distribute epidemiological statistics and evidence-based methods to the municipalities ought to be considered. Increased and improved cooperation between public health sciences and political sciences (e.g., by integrated courses and shared research projects) could be helpful in developing public health research within the municipal arena.
In the first three papers of this thesis the intentions of 25 Swedish municipalities to promote children and adolescents' health are described. Safety promotion (Study I), health promotion in preschools (Study II) and health promotion in schools (Study III) were of primary interest. In the next step policy processes and factors that might explain municipal public health action were analysed (Study IV). Finally, data from Study 1 were used to test correlations between municipal safety-promoting activities and health outcome (Study V).
Although intentions to promote children's health were in general quite well developed, there were some exceptions and variations among the municipalities. Significant correlations between municipal healthpromoting activities and outcome variables were revealed on injuries (Study V) but not on youth behaviour (Study III). Municipal socio-economic status, measured as proportion adults with more than 12 years of education, did not predict the level of healthpromoting measures, whereas municipal growth seemed to have a hampering effect. These results were consistently observed in Studies I-III. Faster growing municipalities reported fewer safety-promoting measures, a lower fraction of preschool staff with a university degree and a lower fraction of full-time employed teachers with a university degree than slower growing municipalities.
Five potential explanatory factors for policy process development were identified in Study IV: financial problems, perceived local needs, external funding, national and international policy documents and presence of a local public health sector. Politicians, public officials and nongovernmental organisations were important actors in different phases of the policy process, with strong commitment, professional skills and powerful position in the organisation as main characteristics. The health sector in general, epidemiological statistics and evidence-based methods were seldom mentioned in Study IV.
Potential policy implications based on the results presented in this thesis are that disseminating public health-related knowledge through international and national policy documents and supporting institutionalisation of a local public health sector might be useful methods to stimulate and support municipal public health action. Further, means to introduce and distribute epidemiological statistics and evidence-based methods to the municipalities ought to be considered. Increased and improved cooperation between public health sciences and political sciences (e.g., by integrated courses and shared research projects) could be helpful in developing public health research within the municipal arena.
List of papers:
I. Guldbrandsson K, Bremberg S (2004). A study of safety-promoting activities for children and adolescents in 25 Swedish municipalities. Health Promot Int. 19(2): 215-26.
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II. Guldbrandsson K, Bremberg S (2005). Municipal intentions to promote preschool childrens capabilities and health: a descriptive study of 25 Swedish municipalities. Early Childhood Education Journal. [Accepted]
Fulltext (DOI)
III. Guldbrandsson K, Bremberg S (2005). Two approaches to school health promotion: focus on health-related behaviours and general competencies. An ecological study of 25 Swedish municipalities. [Submitted]
IV. Guldbrandsson K, Bremberg S, Back H (2005). What makes things happen? An analysis of the development of nine health-promoting measures aimed at children and adolescents in three Swedish municipalities. Social Science & Medicine. [Accepted]
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V. Sellstrom E, Guldbrandsson K, Bremberg S, Hjern A, Arnoldsson G (2003). Association between childhood community safety interventions and hospital injury records: a multilevel study. J Epidemiol Community Health. 57(9): 724-9.
Fulltext (DOI)
Pubmed
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I. Guldbrandsson K, Bremberg S (2004). A study of safety-promoting activities for children and adolescents in 25 Swedish municipalities. Health Promot Int. 19(2): 215-26.
Fulltext (DOI)
Pubmed
View record in Web of Science®
II. Guldbrandsson K, Bremberg S (2005). Municipal intentions to promote preschool childrens capabilities and health: a descriptive study of 25 Swedish municipalities. Early Childhood Education Journal. [Accepted]
Fulltext (DOI)
III. Guldbrandsson K, Bremberg S (2005). Two approaches to school health promotion: focus on health-related behaviours and general competencies. An ecological study of 25 Swedish municipalities. [Submitted]
IV. Guldbrandsson K, Bremberg S, Back H (2005). What makes things happen? An analysis of the development of nine health-promoting measures aimed at children and adolescents in three Swedish municipalities. Social Science & Medicine. [Accepted]
Fulltext (DOI)
Pubmed
View record in Web of Science®
V. Sellstrom E, Guldbrandsson K, Bremberg S, Hjern A, Arnoldsson G (2003). Association between childhood community safety interventions and hospital injury records: a multilevel study. J Epidemiol Community Health. 57(9): 724-9.
Fulltext (DOI)
Pubmed
View record in Web of Science®
Issue date: 2005-09-30
Rights:
Publication year: 2005
ISBN: 91-7140-399-X
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