Mental ill-health is one of the major health and social challenges in Norway, and needs to be addressed. However, municipalities are unsure about which measures are effective. The Norwegian Government has therefore initiated a program for public health work in the municipalities with a focus on mental well-being and drug prevention.
By Hildegunn Brattvåg and Ellen Paulssen
Since 2012, the Public Health Act has placed a clearer responsibility on municipalities to implement cross-sectorial public health interventions. It aims to ensure that public health work is knowledge-based, systematic, and long-term. Municipalities have responsibility for health and well-being through its ordinary activities, such as schools, day care centers, culture, and transport. The Act builds on a broad determinant perspective on public health work; an overview of public health and health determinants is the starting point for evidence based public health activities. Based on a local assessment of the public health challenges, public health policy development must be an integral part of ordinary societal and spatial planning and administration processes in counties and municipalities, and in other social development strategies. The central government plays an important role in supporting the public health work of municipalities and county authorities.
In 2014-2015 The Office of the Auditor General investigated the state of public health activities. One of the findings was that several municipalities are unsure about which policies and measures are effective in addressing major public health challenges, such as mental ill-health.
In a white paper on public health in 2015, the Government launched the idea of a program for public health work in municipalities. The Norwegian Association of Local and Regional Authorities was an important driving force in this initiative. In 2016 the program was introduced as a ten-year commitment. The Norwegian Institute of Public Health and The Norwegian Directorate of Health were asked to play a central role in implementing the program. The goals of the program are to:
- Develop the municipalities efforts to promote health and well-being of the population;
- Strengthen long-term and systematic public health work in the municipalities;
- Integrate mental health as part of local public health work and promote local drug prevention work;
- Build capacity and disseminate knowledge of measures that strengthen mental resilience in children’s and young people.
Further, the program consists of five elements:
- Knowledge-based development of measures;
- Capacity building and sharing of experience across municipalities and counties;
- Development and implementation of data (overview of public health and health determinants);
- Strengthened cooperation between actors- nationally and locally;
- Coordination of government policies and instruments aimed at municipalities.
The first element, knowledge-based development of measures is the core element in the program. County Councils apply for grants from the Norwegian Directorate of Health, and funding is distributed to municipalities wishing to develop measures to promote mental well-being and drug prevention. Measures on mental well-being, in this context, means universal measures for promotion of social support, inclusion, belonging, coping etc. The measures must be evaluated. Children and young people are a prioritised target group for in trials and evaluations of new measures.
Several municipalities are now in the process implementing new initiatives, based on an overview of the population’s health and determinants of health in their area.
County Councils coordinate the work in the counties and are responsible for involving research institutions. The program has so far created a lot of synergies – especially between counties, municipalities, and research centers/universities/colleges.
The national program, consisting of the five elements above, is under evaluation and will be measured according to the stated objectives. In 2016 a baseline was established, based on a survey to all the municipalities and counties. A follow-up evaluation will focus on the process of how the municipalities develop and evaluate measures, and the support they receive from the county councils and research. The a survey halfway through the program period will be in relation to the baseline, and will focus on the status for the goals of the entire program.
The county councils receiving grants are undertaking comprehensive, and in some ways, new tasks – especially when it comes to cooperation with research institutions and to ensuring that measures can be evaluated. A well-known research institute follows the work of counties and municipalities in order to give national health authorities input and knowledge. This knowledge will be used in the future work of the program, and to support the public health activities of municipalities and county authorities in general and when the program has come to an end.