Abstract
Health promotion efforts in municipalities demands extensive collaboration, between sectors (multi-sector) as well as between levels (multi-level). To develop, adopt and implement policies that contribute to reduce health inequity demands for policy coherence: consistent approaches across sectors and levels. In this conceptual paper, we discuss how the theory of Salutogenesis, and its inherent concept of coherence, can contribute to structure such collaboration processes in coherent ways, and contribute to experiences of policy coherence for both collaborators (practitioners and stakeholders) and inhabitants. We discuss how challenges with fragmented knowledge as well as lack of resources and motivation might be met through an explicit application of Salutogenesis core concepts. First, we argue that framing HP-efforts in terms of positive goals that can be achieved can contribute to motivation for change. Next, we discuss how the concepts of comprehensibility, manageability and meaningfulness can be applied to describe challenges, and plan for coherent policies and processes vertically (between levels) and horizontally (between sectors). Last, we discuss limitations and challenges with this approach, including the need to further develop the theoretical foundation of Salutogenesis, and how it can be applied at a setting- and/or policy-level.
Highlights
Health promotion (HP) aims at improving the upstream-conditions for health and health equity through addressing the settings of everyday life where people “live, work, love and play” [1,2]
When it comes to health promotion and health equity, “what” we do might be less important than “how” we do it: even if everyone agrees on shared goals, might differing understandings and positions, applicable resources to aspire these goals and personal or professional values and interests hazard for coordinated efforts, and contribute to perceptions of incoherence during collaboration for stakeholders, as well as incoherent outcomes for inhabitants
Salutogenesis aims to provide HP with an overarching theoretical framework that focuses on resources, assets and positive outcomes; with a strong emphasize growing with challenge and learning processes [24]
Summary
Health promotion (HP) aims at improving the upstream-conditions for health and health equity through addressing the settings of everyday life where people “live, work, love and play” [1,2] This emphasizes the key role local governments and municipalities play in respect to population health. To achieve HiAP and promote population health locally implies extensive collaboration and cooperation processes within and between local (municipal) actors and sectors This is linked to the growing realization that sectorspecific policies often are too narrow to address underlying causes of specific challenges [9]; while framing societal challenges as “wicked problems” might either contribute to paralysis (as the challenges seem overwhelming), or to an over-estimation about what can be done about these challenges [9]. We want to explore how the theory of Salutogenesis and the concept of sense of coherence can be applied to increase policy coherence during the development, planning and implementation of HP policies in municipalities
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