Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark.
Int J Health Plann Manage. 2019 Jan;34(1):e219-e229. doi: 10.1002/hpm.2638. Epub 2018 Sep 10.
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.
福利国家的政府坚决致力于公共卫生，因此制定了大量公共卫生政策。鉴于大多数福利制度的多层次结构，公共卫生政策的影响与其在地理上的传播能力和在组织层面上的迁移能力有关。本研究在两年期间访问、观察和采访了来自 10 个城市的 15 名政策工作者，调查了丹麦国家健康促进政策在丹麦城市中实际实施和管理时会发生什么。分析结果表明，该政策至少以 5 种不同的方式实践：作为理想、食谱、有形的人工制品、创造性的解构和映射。各种实践都体现了这一政策的不同版本，其中一些实施带来了意想不到但有价值的效果。如果不认识到具体的实施及其在当地的经验效果，我们对国家公共卫生政策的理解就有可能脱离实践，变得没有成效。公共卫生政策制定者必须在方法和分析上注意政策的多模态及其在当地的具体经验效果。
