• Louise Kallestrup
4. term, Public Administration and Social Science (Master Programme)
Due to the fact that citizen level health policy has been a municipal task since the municipal reform in 2007, this master thesis falls between the categories of health policy and municipal policy. The thesis sets out with an introduction to the consequences of the initiation of the municipal reform within the health area, including the guidelines of the new law on health. In light of the current health debate, there is an overview of the public health of the Danish population, focusing on the generally unhealthy way of life and the consequently low average age and poor health. The mediocre health condition has given rise to substantial health debates both politically and among the population, and concurrently it has increased the political focus that surrounds the parts of health policy called prevention and health promotion. As a consequence of the municipal reform, prevention and health promotion have become municipal tasks inasmuch as the municipalities are seen to be the natural authorities when citizen issues are concerned. The public sector in Denmark is based on the idea of task solution at a decentralized level with special areas of responsibilities at each level. This gives the municipalities open opportunities to formulate their own policies independent of state and without deference to other municipalities. As such, the municipal autonomy gives the municipalities every opportunity to formulate local policies adjusted to citizen needs and requests, and thus to shape unique policy formulation within, for instance, the health field. As part of the implementation of this first generation municipal health policies, many municipalities have chosen to set up a health profile, holding a detailed description of the general citizen health condition. The profile studies turned out to be quite similar and the regional differences fairly small. Furthermore, most of the municipalities have formulated health policies based on the same four factors (diet, smoking, alcohol and exercise – in Danish shortened to KRAM) which inevitably leads to policies with many similarities. Because of this homogeneity in the policy formulation, this master thesis will be a study of municipalities’ approach to the health tasks as well as the factors and political figures that play important roles within the field of politics and in the decision-making process. The homogeneity among the municipal health policies has captured my interest because I find it interesting to look at the existing facts and study why the municipalities apparently imitate each other and why this phenomenon has had such a big impact on the health policy field. Because of the decentralized task solution, is it natural that the municipalities develop their own unique policies within the health field based on citizen needs and requests, which will presumably generate great diversity in the policy formulation. As such, I will study and analyze the health policy field on the basis of this research question: How are the municipalities able to shape a health policy which is adjusted to the citizens’ specific needs and requests? The approach to the master thesis is to make use of qualitative methods using three municipalities in North Jutland as case studies. To obtain the best possible understanding of the issue, I have chosen to use three theories: new institutionalism, coalition models and negotiation models, and furthermore analyze whether or not there is a use of rationality. Using these theories will provide a general overview of the issues discussed in this thesis as well as of the relevant political figures in the decision-making process, all of which has not yet been researched. This master thesis analyzes and discusses how theory can contribute to explain and characterize decision-making processes in the municipal world. The result of the analysis is that decision-making processes in the chosen case municipalities are characterized by the absence of political disagreements and incremental initiatives, and that they are centered around the fact that the municipalities have acted upon what they experienced to be surrounding expectations and norms of the field, rather than what seemed to be rational. The municipalities consider the health profiles and the KRAM factors as institutionalized recipes with full legitimacy at both administration and policy-maker level. The analysis furthermore shows that the municipalities adjust the potential of the KRAM factors to their local conditions, and in this way both the administration and the politicians play an important role in the formulation of each municipality’s health policy. On the basis of the above, it is feasible to draw the conclusion that the answer to the research question is that the municipalities are able to adjust the health policies to the citizens needs and requests by adopting institutionalized and legitimized recipes like the KRAM factors and health profiles, and then simply adjusting the content to the local conditions of each particular municipality.
Publication date2008
Number of pages102
Publishing institutionInstitut for Politik, Økonomi og Forvaltning, AAU
ID: 14689839