RHP&EO is the electronic journal of the International Union for Health Promotion and Education

Can The Public Sector Create A Supportive Environment?

Anna Swift-Johannison

Department of Community Medicine, Orebro County Council, Drottninggatan 48, S-702 22 Orebro, Sweden

Ljunarsberg, in the midst of an area which traditionally provided Sweden with its wealth has for decades suffered unemployment, brain chain and a decrease in health among its inhabitants. In 1993 senior politicians in the municipal as well as the county levels decided on increasing efforts to support the health of the citizens. A public health project was launched, and a health planner was later employed.

The Swedish Institute for Public Health has allocated funds to the Department of Community Medicine in Orebro to follow, document and evaluate this work. This paper is based in that work, and its purpose is to, with basis in this case study and in the theory of community and organizational development, try to add knowledge to the process of how to create a supportive environment.

Data for this study has been collected trough a number of methods, though the mayor part of these have been qualitative. I have worked with interviews and participating observation, but I have also collected information on outcome through questionnaires.

The results show that if a public health project is launched in an open environment this will quickly amalgamate with existing processes in the community. Local agents will make use of, and sometimes exploit, the resources according to their needs and desires. These may, or may not, be beneficial to the process of strengthening public health. A public health project runs a great risk of becoming a loose appendix to the well fare work which is the purpose and task of the public sector, rather than adding a further nuance the present restructuring of the welfare society

Discussion: It is close to naive to believe that an increase in public health can be achieved by simply initiating a public health project or by the employment of a health planner. Building a supportive environment takes a very conscious steering effort, built on a careful analysis of the situation and of the aims of the process. Public health workers need to build forceful alliances among well fare workers, for eg in the social sector, in housing and town planning. There is a great need for public health workers to acquire skills in community work and in organizational development. In order to strengthen supportive environments public health work must move away from activities, into the public organizations changing them from the inside, and at the same time out in the communities, facilitating them to raise their voices, formulating their needs and improving control of their situations.

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