Trickle-down policies: Utilizing strategic plans to facilitate local public health work

Abstract

Abstract Background The main weight of health promotion strategies are outlined internationally, but carried out locally. More knowledge is needed about how municipalities and communities can be supported in building capacity for carrying out systematic, local Public Health Work. This study explores how strategic recommendations from national/international levels can contribute to the facilitation of systematic, local health promotion work through conscious utilization of juridical and strategic municipal documents. Methods An in-depth hierarchical document analysis was carried out in selected municipalities. A contextual content analysis of central terms was conducted the aim to understand how these were addressed across document-type and municipality. Findings Central aims and strategies from health promotion have “trickled-down” into national and municipal documents. Variations in how intentions are anchored and implemented in the municipal context occur: if and how they were addressed, linked to higher-level aims and operationalized in ways that enabled collaborative action (including the allocation of resources). Obligatory activities (e.g. establishing a local knowledge-base) were more likely to be implemented locally; however, variations occured regarding how these were followed-up subsequently. Discussion Global health promotion aims and strategies can contribute to facilitate for local public health work. Differences in how the planning literature was utilized might facilitate for different outcomes. To enable coherent approaches across sectors and actors, top-down approaches have to be combined with local competence-building and enable collaborative action. Framing spatial tasks in ways that highlight their contribution to achieve overarching goals can built competence across stakeholders, and enable systematic approaches over time. Key messages • Utilizing local strategic documents can facilitate for the realization of global and national health promotion intentions. • To enable coherent approaches across sectors and actors, top-down approaches have to be combined with local competence-building and enable collaborative action.