The impact of economic recession on municipal expenditure on public health in Denmark Elizabeth Headley 1-2 Henrik Brønnum-Hansen 1 Lau Caspar Thygesen 1 Marie Bergmann 1 1 National Institute of Public Health of Denmark, University of Southern Denmark 2 School of Public Health and Preventive Medicine, Monash University, Australia

Background Why study the impact of the financial crisis on municipal expenditure on public health? Expenditure on public health is an important indicator of a country’s commitment to the health of its population. Lack of research examining variation in government expenditure on public health over the course of the Global Financial Crisis. In 2007 in Denmark, responsibility for health promotion and prevention transferred from the county level to the municipal level, with no formal monitoring of changes public health funding in the light of the economic recession.

Objective Overall: To inform decision making about public health funding, specifically targeted towards municipalities that have a funding deficit for health promotion and prevention Specifically: Firstly to determine the changes in the budgets, income and expenditure on health promotion and prevention since Secondly to determine to what extent the changes are related to the economic recession. Hypothesis The financial crisis has restricted governmental funding for health promotion and prevention in Danish municipalities.

Methods Quantitative analysis: We ascertained the temporal trends for budgets, income and expenditure on ‘health promotion and prevention’ before and after the economic recession. Data source: ‘Statistiks Danmark’ Qualitative analysis: Telephone interviews: representative sample of municipalities (20 out of 98). Questions investigated the underlying municipal rationale for spending patterns, and the extent to which the financial crisis has influenced the income for health promotion and prevention. Thematic analysis of interview responses.

Results

Proportion of total budget and total expenditure on ’health promotion and prevention’ Income: Health promotion and prevention

Results Qualitative interviews: Near-consensus agreement that the financial crisis has influenced the types and the degree of interventions able to be undertaken. The financial crisis has been a peripheral, but decisive factor in influencing the income received for health promotion and prevention at the municipal level.

Implications & future direction Public health is given a high priority, in spite of the financial crisis. Expenditure on health promotion and prevention increased between , as a deliberate action to offset the negative health impacts of the recession. “Zero growth” public spending policy until Greatest challenge for Denmark is to implement the most cost-effective and efficient ways of addressing the public health needs of the Danish population.

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