Enablers and barriers in municipal public health work

Background: In 2016, the Office of the Auditor General found that insufficient knowledge and cross-sectoral coordination hindered municipalities´ efforts to strengthen their public health work. In response, the ten-year national initiative, Program for Public Health Work in Municipalities, was launched in 2017 and implemented in Central Norway by Trøndelag County. To support and evaluate municipal public health work over time, the program established a cross-sectoral research group that has studied, among other aspects, enablers and barriers in municipal public health work.

Methods: A longitudinal interview study was conducted with municipal actors involved in public health work from 12 municipalities, at the program’s outset and again after three years. In total, 72 interviews were conducted with 60 informants. Data were analyzed using thematic analysis.

Results: Through the longitudinal study, we observed enablers and barriers to public health work across three main categories: 1) Knowledge – including what is perceived as public health knowledge, the knowledge available within the municipal organization, its content, and how it is developed. 2) Organizational factors – both formal (e.g., where responsibilities are placed and anchored, authority held by public health officers, and how participation is organized) and informal (e.g., values, attitudes, informal relationships and networks, channels of influence, and municipal actors involved in public health, either as private initiatives or through voluntary organizations). 3) Broader structural factors – which municipalities have limited ability to influence, such as regulatory requirements, force majeure (e.g., pandemics), or loss of key personnel.

Conclusion: Participating municipalities have generally developed and utilized enablers, strengthening their public health work over the program period, showing that sustained focus and follow-up are key success factors. Municipalities with structured, intersectoral, and knowledge-based public health work tend to exhibit several enabling factors within the categories above, though not necessarily all. The most influential enabling factors can differ between municipalities. Municipalities with multiple strong enablers can compensate for barriers that arise.

Main messages: (i) Enablers and barriers within the overarching categories knowledge, organizational factors, and broader structural factors shape municipal public health work, with the most influential enablers varying across municipalities. (ii) Sustained focus and multiple strong enablers allow municipalities to overcome barriers, supporting effective and resilient public health practice.