Local enactments of national health promotion policies: A Danish case.

Governments of welfare states are firmly committed to public health, resulting in a substantial number of public health policies. Given the multilevel structure of most welfare systems, the influence of a public health policy is related to its ability to spread geographically and move across organisational levels. Visiting, observing, and interviewing 15 policy workers from 10 municipalities during a 2-year period, this study investigated what happened to a Danish national health promotion policy as it was put into practice and managed in the Danish municipalities. The analysis reveals that the policy was practiced in at least 5 different ways: as an ideal, a cookbook, a tangible artefact, a creative deconstruction, and a mapping. The various practices each enacted a different version of this policy, and some of these enactments brought unintended but valuable effects. Without recognising the concrete enactments and their locally experienced effects, our understanding of national public health policies risks becoming detached from praxis and unproductive. Public health policy makers must pay methodological and analytical attention to the policies' multimodality and their concrete locally experienced effects.