| dc.description.abstract | The overall aim of the Coordination Reform, which was implemented in Norway January 1st in 2012, is to ensure that patients receive proper treatment – at the right place and right time. The reform is also anticipated to reduce the demand for specialized health care, by transferring more responsibility to the municipalities and to increase emphasis on health promotion, disease prevention and early intervention in the course of a disease at the municipal level. The Public Health Act, which is part of the Coordination Reform, is a legal means to regulate the municipalities’ responsibility for public health and disease prevention (§ 4): “The municipality shall promote the population's health and well-being, and good social and environmental conditions; contribute to the prevention of mental and somatic illnesses, disorders or injuries; contribute to reducing social inequalities in health; and contribute to the protection of the population against factors that may have a negative impact on health”. The current report presents results from a study that is part of the project “Process evaluation of the Coordination Reform” (Prosessevaluering av Samhandlingsreformen: Statlige virkemidler, kommunale innovasjoner), which is a collaboration between the Department of Health Management and Health Economics at the University of Oslo; The Center for Care Research, East, at Gjøvik University College; The Norwegian Institute for Urban and Regional Research; and Norwegian Social Research at Oslo and Akershus University College. The aim of the report is to address whether the Coordination Reform has affected priority setting and coordination of municipal public health work in the period 2013-2015. Our focus is on three topics: (1) the municipal planning work; (2) organization and use of resources; and (3) development of preventive and health promoting measures. We ask: In what way does the Coordination Reform contribute to a stronger anchoring of public health work in the municipal planning work? To what extent and how do municipalities ensure the cross-sectorial nature of public health work and their collaboration with external authorities? Has the Coordination Reform brought about a change in municipalities’ use of resources for public health work? Can we detect tendencies towards a trend-shift in the development of public health measures in municipalities? Chapter 2 provides an overview of the data and methods. Data are derived from a survey in 76 municipalities (2014), a review of the planning work of 27 municipalities (2014), and a case study including informants from three municipalities (2015). The results in Chapter 3 are based on the review of the planning work in 27 municipalities and the responses from the informants in the three case-municipalities. In December 2014, the planning work of two thirds of the 27 municipalities provided an overview of their population health by applying the available health profiles. However, the planning work gave to a limited extent an overview of local factors and environmental developments that can influence population health. According to informants from the three case-municipalities, public health work has become an increasingly prominent priority area in municipal planning work after the launch of the Coordination Reform, as it has become a distinct dimension in all political issues that are being processed. Chapter 4 describes the extent to which the Coordination Reform has influenced municipalities’ use of resources and the organization of public health work. Approximately three of ten municipal managers indicated an increase in the municipality’s use of resources on public health work. Also, informants from the three case-municipalities indicate an increase in the use of resources after the launch of the Coordination Reform. However, none of the informants report that the resources are spent on new or an increasing number of preventive or health promoting measures. The increase in resource use seems to be dedicated to organization and planning work, such as creating new positions for public health coordinators, producing health charts, participating in plan forums, and/or working groups for public health. Results from the case study also suggest a strong collaboration between municipalities and county authorities. The Coordination Reform seems to have contributed to increased clarity in the roles of the different partners in this collaboration. So far, the Reform appears to have had little effect on the cross-sectorial public health work within the municipalities. This is probably because the cross-sectorial focus was related to various other conditions and trends that operated prior to and close to the launch of the Coordination Reform, such as establishing positions for public health coordinators. The results of chapter 5 illustrate that the Coordination Reform and the related Public Health Act may have contributed to a broader understanding of public health measures in the municipalities. Public health measures now include more health promoting measures, not only disease preventive ones. Informants from the 76 municipalities consider cardiovascular diseases (including diabetes) and obesity to have the greatest preventive potential. Physical activity and dietetic instructions, often within the so-called “frisklivssentralen”, are reported as the most common measures to prevent these conditions in the population. Some informants from the case-study experience an increase in measures reflecting health-promoting factors and addressing social inequality, but are uncertain whether this is because of the Coordination Reform or part of a trend that already started earlier. The main findings of the report are summarized and discussed in Chapter 6. So far, The Coordination Reform has: Contributed to a stronger anchoring of public health in the municipal planning work. Increased municipalities’ resource spending on organizing and planning public health work. Had limited implications for cross-sectorial public health work. Contributed to a broader understanding of public health measures. Until now, the effects of the Coordination Reform are most pronounced in the planning stages, in the development of local public health plans and municipalities’ planning work. This is in line with signals that the Reform wants to send, which are further emphasized in the new White Paper on Public Health (Meld. St. 19 2014-2015). To what extent the anchoring of public health work in municipal planning also leads to more and new health promoting measures across sectors remains a topic for future research. | en |
