Denmark - HEPA Policy Making
There is an increasing focus on health and health promotion in the local political system in Denmark. Part of this increasing focus can be explained by the structural reform and the new municipal tasks described in the Health Care Act of 2007, where the national, regional and local authorities each have their field of responsibility in relation to healthcare services and health promotion in Denmark including promotion of physical activity. Also the general growing awareness of health related challenges plays a role.
The Parliament and the government are responsible for passing laws and developing general policies. The Ministry of Health is the principal health authority, which presents specific action plans on how to implement the Parliament’s health policies. A recent example is the seven national goals for the population’s health presented by the Ministry of Health in 2014 (14), of which one specifically addresses physical activity. The board responsible for healthcare is the Danish Health and Medicines Authority, which among other tasks offers professional guidance to the state as well as regional and local healthcare authorities. Guidance is reflected in a number of different initiatives. During 2012 and 2013 the National Board of Health has developed 11 so called ‘prevention packages’ addressing different aspects of health prevention: alcohol, physical activity, hygiene, indoor climate at schools, food and meals, mental health, obesity, sexual health, sun protection, drugs and tobacco. The aim of these packages is to provide municipalities with professional recommendations in each of the areas. Related to this, the Ministry of Health and Prevention has established ‘Centre for prevention in Practice’ with the aim of helping municipalities to implement the prevention packages. The center is organized as a part of ‘Local Government Denmark’ (The national membership and interest organization for municipalities).
The major area of responsibility for the regions in Denmark is provision of public health service – especially operating and developing the hospital sector and administrating the general practitioners. In relation to physical activity, the region’s role mainly concerns the coordination of cultural activities and the maintenance of nature areas such as lakes and forests, which can affect physical activity. Danish Regions is the joint association for the regions, which represents the regions and coordinates activities between national and local level.
In Denmark, local governments are relatively autonomous authorities with elected councils in control of the local executive structure; with exclusive powers and an independent source of taxation; with a high degree of decision‐making freedom, regulated to a large degree through rather broad formulated legislation (16). In relation to REPOPA it is of specific interest that the area of health promotion and prevention did not become a municipal task until 2007. Therefore, it is still a new relative new area for the Danish municipalities.
The municipalities are primarily responsible for social services and some healthcare services in addition to e.g. primary and secondary education, cultural activities and urban planning (9). Within healthcare the municipalities’ responsibilities within healthcare include prevention, rehabilitation, eldercare, children’s dental care and substance abuse treatment. Thus, municipalities have the main responsibility for establishing services and physical frames, e.g. green areas and cycle or walking paths, to promote physical activity, as it falls under their responsibility of health promotion.
Municipalities are also obliged to settle agreements with the regional level to secure the coordination of care across hospitals, general practice and municipalities. These agreements are to be approved by the National Board of Health.
The municipalities’ activity-based contribution to the regions creates an economic incentive for them to work with health promotion and thereby reduce their inhabitants’ use of healthcare services. Within the usually broad frames of the national plans for health promotion, each municipality has a large degree of freedom to carry out health promotion initiatives suited for the conditions and needs in their specific municipality. Local Government Denmark is the joint association for the municipalities, which assists them with counseling and support, e.g. in relation to the implementation of the health promotion packages.
The political and administrative structures regarding the tasks given to the municipalities after the structural reform in 2007 vary significantly among the municipalities. There are three different overall models for organization of health related tasks: In some municipalities the new tasks are handled in a separate health department, other municipalities have chosen a model where the new tasks are incorporated in a larger department – for instance together with social care. This is the most widespread model among the Danish municipalities. Finally, some municipalities have placed all health related tasks in the central administration of the municipality (17).
Ref Type: Online Source
(14) Ministeriet for Sundhed og Forebyggelse. Sundere liv for alle. Nationale mål for danskernes sundhed de næste 10 år. 2014.
(15) Sundhedsstyrelsen. Forebyggelsespakke - Fysisk aktivitet. 2012.
(16) Kersting N, Vetter A. Reforming Local Government in Europe. 2003.
(17) Hansen EB, Jørgensen TS. Organisering af forebyggelse og sundhedsfremme - Erfaringer fra kommunernes første år. 2008.