title: National public health policy in a local context--implementation in two Swedish municipalities.
abstract: OBJECTIVE
  In 2003 the wide-ranging Swedish National Public Health Policy (SNPHP), with a focus on health determinants, was adopted by the Swedish parliament. In the context of multilevel governance, SNPHP implementation is dependent on self-governed municipalities and counties. The aim of the study is, from a municipal perspective, to investigate public-health policies in two municipalities.
  
  
  METHODS
  Content analysis of documents and interviews provided a foundation for an explorative case study.
  
  
  RESULTS
  The SNPHP at national level is overriding but politically controversial. At local level, a health-determinants perspective was detectable in the policies implemented, but none regarding to health equality. At local level, the SNPHP is not regarded as implementable; rather, limited parts have, to varying degrees, been reconciled with local public-health goals, according to municipal needs and conditions. A success-promoting factor in the two municipalities was the presence of committed and knowledgeable actors/implementers. Also, the municipality with a more centrally controlled and stable party-political leadership succeeded better in implementing structural and intersectoral community-wide policies for coordinated local health promotion.
  
  
  CONCLUSIONS
  The contents of national and local public-health policies differ, and municipalities that have implemented their own local health policies do not seem to regard the SNPHP as justifiable or adoptable. If the SNPHP overall aim regarding equal health is to be achieved homogeneously in Swedish municipalities, its contents and purpose need clearer management and negotiation, so that implementation of the national policy locally is understandable and motivated.
authors.affiliation: School of Health, Care and Welfare, Mälardalen University, Box 883, SE-721 23 Västerås, Sweden. Elisabeth.Jansson@mdh.se
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Jansson
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Fosse
authors.forename: Per
authors.initials: P
authors.lastname: Tillgren
mesh_terms: D002947:Cities; D006077:Government Agencies / Q000458:organization & administration; D006291:Health Policy; D006801:Humans; D011057:Politics; D016730:Program Development; D011635:Public Health Administration / Q000379:methods*; D012041:Regional Medical Programs / Q000458:organization & administration*; D013548:Sweden