What makes things happen? An analysis of the development of nine health-promoting measures aimed at children and adolescents in three Swedish municipalities

The Swedish municipalities offer important environments for health promotion. However, national actors need increased knowledge on how to support the development of public health measures in the municipalities. The aims of this study were to describe the development of municipal health-promoting measures directed at children and adolescents and to identify factors that might explain the development of such measures. Fifty semi-structured interviews and written documentation gathered from three municipalities in Stockholm County resulted in nine case studies. A policy process matrix, based on the actor-structural approach, was constructed to categorise the data. Five aspects contributing to the trajectory of municipal health-promoting measures aimed at children and adolescents were often mentioned in the data set. These are financial problems, perceived local needs, access to external funding, statements in national and international policy documents and the presence of a local public health sector. Politicians, public officials, and non-governmental organisations were the most mentioned actors, with heavy commitment, professional skills, and powerful position referred to as prevalent characteristics. Public health core concepts such as epidemiological statistics and evidence-based measures were rarely mentioned. The health care sector did not seem to have had any direct influence on municipal health-promoting measures. The dissemination of knowledge about public health related international and national policy documents and support for the institutionalisation of a local public health sector might be useful ways to support municipal public health measures.