Health promoting settings in primary health care - "hälsotorg": an implementation analysis

by Lovisa Wallenberg
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Sweden, like many other western countries, faces increasing rates of lifestyle related diseases and

corresponding rise in costs for health care. To meet these challenges, a number of efforts have been introduced at

different societal levels. One such effort is “Hälsotorg“ (HS). HS is a new health promotion setting that emerged in

collaboration between the Swedish County Councils and Apoteket AB, a state-owned pharmacy company. HS’s

overall aim was to improve population health and facilitate inhabitants’ responsibility for self-care. A new National

Public Health Policy, introduced in 2008, emphasizes more focus on individual’s needs and responsibility as well as

strong need for county councils to provide supportive environment for individual-centred health services and

increased health literacy among the population. In light of this policy, there is a need to examine existing settings

that can provide supportive environment for individuals at community level. The aim of this study was to explore

HS’s policy implementation at local level and analyse HS’s activities, in order to provide a deeper understanding of

HS’s potential as a health promoting setting.

Methods: Materials included a survey and key documents related to the development and nature of HS on local

and national levels. A policy analysis inspired by Walt and Gilson was used in data analysis. In addition, an analysis

using the principles of health promotion in relation to HS policy process and activities was also carried out.

Results: The analysis illuminated strengths and weaknesses in the policy process, its actors, contextual factors and

activities. The health communication approach in the analysed documents contained health promoting intentions

but the health promoting approach corresponding to a health promoting setting was neither apparent nor shared

among the stakeholders. This influenced the interpretation and implementation of HS negatively.

Conclusions: The analysis indicates that HS has potential to be a valuable health promotion setting for both

population and individuals, given the strong intentions for a health and empowerment building approach that is

expressed in the documents. However, for a more sustainable implementation of HS, there is need for an in- depth

understanding of the health promotion approach among HS stakeholders.

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Lovisa Wallenberg
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