Governing people's lives. Strategies for improving the health of the nations in England, Denmark, Norway and Sweden.
Public health strategies reflect governments' wish to make people's lives longer and healthier. This can either be achieved by influencing the frames of people's lives and activities or the way they behave, i.e. to try to 'conduct their conduct'. In this paper the motivations for and methods of four national public health strategies are analysed. They are the English, the Norwegian, the Danish and the Swedish. Four questions are addressed: i) how is the governing activities aimed at improving the health of the population justified; ii) which issues are defined as problems; iii) which causes of the problems are identified; and iv) which governing techniques are suggested to solve the problems. The English and Danish programmes focus on mortality while the others give high priority to non-lethal diseases and conditions. The Danish programme mainly aims at making people conduct themselves in a more healthy way, i.e. change their behaviour, often guided by health professionals. The Norwegian paper has empowerment as its central strategy. The strategy is based on the assumption that if people get more power over their own lives they will become more healthy and behave in a more healthy way. The Swedish emphasis is on changing people's living conditions and much less is said about the role of the individual. The English programme launches a national contract where individuals and authorities should work both to change people's behaviour and their living conditions. All strategies deal with the increasing social inequality in health, the English and Swedish strategies more than the others. There does not seem to be a specific Nordic model in this field of welfare state politics.
Vallgårda
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Department of Health Services Research, Institute of Public Health, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen, Denmark. s.vallgarda@pubhealth.ku.dk
D004739:England / Q000453:epidemiology; D005260:Female; D015438:Health Behavior; D006291:Health Policy; D006293:Health Promotion / Q000458:organization & administration*; D006305:Health Status Indicators; D006801:Humans; D008017:Life Expectancy / Q000639:trends; D008297:Male; D011209:Power, Psychological; D015980:Public Health Practice; D012111:Residence Characteristics; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D012935:Social Justice