A more Health Promoting Health Service - one part of the new Swedish National Public Health Policy Margareta Kristenson The Swedish Network for HPH Lars Weinehall Umeå University Sweden Ingrid Ström National Board of Health and Social Welfare, Sweden

Swedish National Committee for Public Health Com- mittees of experts Reportofexperts: Goal proposals ” Firststep”: Orientation Report Year 1998 ”Second step”: Preliminary Health Policy Objectives, Year 1999 ”Third step”: National Objectives for Public Health Year 2000 Circulated for comments Circulated forcomments Preparations by Ministry of Health Government Bill on National Domains of Objectives to be decided by Parliament 2003 From ideas to Government Bill

Allergy Accidents Health economi Health Service Integration Elderly people Children/adolescent Mental health Life style 2 - habits Life style 1 - drug abuse Environmental factors Social relations Ekonomic welfare Work life Committees of Experts

The expert report on Health Service was built on Values and strategies in the HPH Network Litterature reviews Consultations with professionals in health services and public health

One overall national public health aim: To reduce health inequalities. Many sectors and players are responsible 11 domains of objectives Decision by the Swedish Parliament 2003

All the health policy objective proposed by the National Public Health Committee were developed and formulated from a health determinant perspective. Focus on determinants

Economic and social security 2 Secure and favourable conditions during childhood and adolescence 3 Healthier working life 4 Healthy and safe environments and products. 5 A more health promoting health service. 6 Effective prevention against communicable diseases 7 Safe sexuality and good reproductive health 8 Increased physical activity. 9 * Reduced use of tobacco and alcohol and a society free from illicit drugs and doping and a reduction in the harmful effects of excessive gambling Reduced use of tobacco and alcohol * 11 Good eating habits and safe food 10 Participation and influence in society 1

…because of its specific competence, authority and wide scale contact with the population, the health service is of considerable importance for long-term health development. A more health promoting health service is therefore afforded its own objective. Health promotion and disease prevention shall be an integral part of health service and a component of all treatment and care.

Promote a positive health development in individuals and groups –1 A: Develop disease prevention interventions in the health service –1 B: Develop health promotion interventions in the health service Promote equal health development in the population –2 A: Actively disseminate knowledge on health and health determinants –2 B: Aktivly participate in community-oriented interventions Promote positive health development among health service staff Use health orientation as a strategy for a more effective health service Målområde 6: Objective area 6 : A more health promoting health service

What has happened ?

Pros Strong political interest. Health orientation included in steering documents in a majority of County Councils. The Federation of County Councils has developed a work plan for the implementation of Target 6 The National Board of Health and Welfare increasilgly uses a health promoting perspective National Quality Registers: focus on Health Outcomes

(Soon in English!) Towards a more health promoting health service Background document Government Bill Indicators (sugg.) Example of application

The Swedish Network for HPH Growing in size Expanding workplan Closer collaboraion with national agencies Widening scope (?)

The Swedish Network for HPH Outcome measuring (SF-36 and EQ5D) in routine health services Thematic work on lifestyle intervention in a salutgenic perspective Activity-database Indicators for HPH in hospitals yearly accounts - benchmarking

” A shift of perspecitives: towards a more health promoting health service ” 10:th conference of the Swedish HPH network In Uppsala April 6-8, 2005, in collaboration with Federation for County Councils National Board of Health and Welfare.

Problem areas: Knowledge Attitudes Skills Economism

Next step.. Influence decisionmakers so that purchasing systems and agreements support a health orientation of health services

and More research is needed on the interphase between health service research, public health and behavioral medicine