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Table 1 Context of the three country cases

From: Unravelling networks in local public health policymaking in three European countries – a systems analysis

  The Netherlands Denmark Romania
National political and administrative structure
Political system Parliament Democracy; representatives in the Parliament are chosen every 4 years Decentralised administrative system The executive power is represented by the Government, led by a Prime Minister, designated by the President of the state
Administrative structure National authorities develop and present national planning policies and provide guidance for regional (regions) and local (municipal) level Decentralised administrative system with part of the tasks transferred from national to the local level, which affects health, and HEPA policies on local (municipal) level, ‘make the healthy choice the easy choice’ National level facilitates guidance and policies for regional and local level 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 organisation 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 The National Government develop policies that are implemented at county and local level by the ministries representatives and by the public administrative authorities Although efforts are made for decentralisation the administrative system is still centralised, with minimal autonomy for county and local level structures in regards for policies development
Responsibility HEPA Regions are accountable for planning, healthcare and recreation; municipalities are accountable for education, planning,welfare and social affairs Regional level being responsible for healthcare services and local (municipal) level for health promotion The policy state, that the responsibility for the implementation of the policy is a common responsibility, which go across each of the sectors in the municipality; the policy does not mention concrete implementation initiatives, but state that such initiatives will be announced yearly According to the law, the Ministry of National Education is the Governmental structure responsible for organising the physical education and sport activities in the pre-university and university system The ministry of Youth and Sport and its structures (i.e. national sport federations, ounty youth and sport directions) are responsible for organising the performance sport and the sport for all at national level The Ministry of Health (through the National Institute of Public Health) has a role in evaluating the health status and health-related behaviour of school aged population – including PA levels
Who develops the local public health policy, including HEPA The policymaking process follows a 4-year prevention cycle, based on the Public Health Act. For local level, this means that every municipality, which is an autonomous authority with an elected city council, writes their own local policy document based on the national policy document (main priorities and recommendations) and on the epidemiologic information collected by the Community Health Services of the local health situation Municipalities are autonomous authorities with elected councils 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 The county representatives of the national governmental structures have the role of administrating and implementing the governmental programs in the fields of HEPA and physical education and sport (i.e. the County Youth and Sport Department) and education (i.e. the County School Inspectorate, Children Palace, School Sports Club) Local and county public administrative authorities also assume some marginal responsibilities in maintaining and promoting population health, but very few (if none) responsibilities related to HEPA promotion; private and civil society representatives are also involved in HEPA promotion, not as part of any structured policy, but by implementing targeted programs (e.g. running, cycling, etc.)
Size of the city: Average size municipality Average size municipality Highly populated municipality with a high student population
Setting: Local Local Local/county
Stage policy plan: New developed health policy, working towards an implementation plan New developed health policy and needed an implementation plan HEPA policy plan was in the development phase
Focus policy plan Focus on the Dutch national umbrella policy ‘Youth on Healthy Weight’ (in Dutch: JOGG) and the national health policy ‘Health close to the people (2011)’, with main focus youth and physical activity Focus of the plan was on physical activity promotion, with the target group children and young adults and citizens with special needs and chronic diseases One of the working groups on physical activity was specifically at local level and focusing on the development of the local HEPA Strategy for 2014–2020, ‘Sport and Community’
Theme Specific HEPA policy General health policy, including HEPA Sports policy, including HEPA
Responsible local public health policy The administrative level of the municipality was accountable for the HEPA policy plan; the responsibility of implementation of JOGG was assigned to the Regional Sport Service Primarily the administrative level in the sector Health and Care was responsible for health promotion, but responsibility of the implementation of the policy is a common responsibility, which goes across each of the sectors in the municipality None of the stakeholders is specifically responsible for the implementation of the policy plan