From Ad-Hoc Projects to Systematic Governance in Public Health Work

Background: The Program for Public Health Work in Trøndelag promotes systematic, knowledge informed governance across 33 municipalities, prioritizing reduced social health inequalities, strengthened cross sector collaboration, and sustained political anchoring. Built on cooperation between regional authorities, municipalities, and R&D partners, its aim is to replace ad hoc, emotion driven responses with long term, adaptive structures integrated into municipal planning and budgeting. The methodology rests on longitudinal co-creation and follow up research, including the development and evaluations of local measures, monitoring of mental health, substance use and inequality trends, organizational assessments of processes and role distribution, and continuous formative process evaluations of municipal activities and local–regional co creation. The municipalities received individualized follow up from an R&D actor.

Method: This study explored whether, and how, ad hoc, emotion driven measures can be replaced with long term adaptive structures. It draws on interview data from regional actors (n = 11) and document analyses of local measure evaluation reports (n = 15), analyzed using qualitative content analysis.

Results: Findings show a gradual shift from fragmented, short term solutions toward more systematic and resilient structures, enhancing municipalities’ ability to manage staff turnover, economic fluctuations, and disruptions such as pandemics. Strengthened collaboration across actors has improved the precision of prioritizing and following up local measures. While evaluation competence has increased, full implementation capacity is still emerging, and several structural challenges persist. The professionalization of municipal public health work—supported by the Trøndelag Model for Public Health Work’s seven step methodology—has enabled a shared evidence based language and strengthened scientific rigor through collaboration with R&D institutions. Public health considerations are now more consistently integrated into non health sectors such as transport and land use planning, where they appear as formalized assessment criteria. Despite these advances, resource constraints and high staff turnover continue to create dependency on individual “champions,” leaving initiatives vulnerable.

Conclusion: Systematic public health work must be embedded in core organizational structures to avoid intuition driven and isolated efforts. The Program supports knowledge based practice through shared tools and competence, but maintaining this capacity requires continuous effort. Long term realization depends on reducing person dependency and establishing permanent structures within formal planning and budgeting.