Litet barn som kastar upp höstlöv i luften
Foto: Scott Webb

System transformation in data-driven municipalities

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The way forward becomes increasingly clear as Ending Childhood Obesity (ECHO) now moves from the initial phase, with current situation analysis and dialogues, towards practical implementation of preventive measures.

The mapping of the current situation, which has taken place through literature studies, surveys and interviews with various actors as well as dialogue with municipalities and regions, has provided several important insights that will permeate the work going forward. It is fundamental that efforts should be made at all levels of society, that the municipality and its associated region is a suitable arena for implementation and that what is done needs to be data-driven.

Efforts at all levels

Both research and practical experience show that in order to achieve societal change in a preventive direction, it is necessary to work at all different levels in society. Today, most of the efforts take place at the individual level, but in order to achieve lasting changes and system transformation, they need to take place at several levels in parallel.

The ECHO strategy is based on the model Wider Determinants of Health (Dahlgren and Whitehead, 1991), which highlights five different levels that are important for an individual’s health.

  • Biological factors, such as genetics, age and sex
  • Lifestyle factors, such as diet, exercise and sleep
  • The network around the individual, such as family, friends and association life
  • Living and working conditions, such as where an individual lives and works
  • Overall level of society, such as legislation

Transferred to childhood obesity, there is a clear connection between in which areas children grow up, the parents’ level of education and whether they have a job or not, the parents’ own health and which country they were born in.

As many of the factors can not be directly affected by the individual, it is very important not to place the main responsibility on the child and its family, but to create structures around the child and the family, at all levels, that support good health and an equal health start in life. This may, for example, be about ensuring that there are good recreational areas close to the child, that there is support in the wider network in the local community and that the legislation promotes healthy choices.

-The first insight for the continued work within ECHO is therefore that society needs to change in the direction of prevention through efforts that need to be made at all levels in society, says Peter Bergsten, professor at Uppsala University and national coordinator for Ending childhood obesity.

The municipality as arena of intervention

The second insight is that the municipality and its region constitute such a diversified and complex system that it is the most suitable arena for better understanding and implementing system transformation. It is also clear that the initiative and ownership of the change that the system transformation entails needs to be in the municipality.

-When it takes place through an external organization or as a temporary project that lasts for a while, the endurance will not be very good, says Peter Bergsten.

ECHO’s role is therefore primarily to be a dialogue partner that, together with the municipality and the region, examines the specific conditions and needs that exist in the municipality. Based on the dialogue, ECHO can then contribute, support and facilitate. Other actors in the local community are also invited to a further dialogue on initiatives at all levels of society.

-Solutions need to be worked out in dialogue, with input from ECHO where our knowledge and competence can contribute, but with the municipality and the region as the driving party, says Peter Bergsten.

It is also important to raise the level of knowledge about what are the root causes of childhood obesity, how multifaceted the problem is and how the solutions therefore need to take place at different levels in society. By creating a network between the municipalities and the regions that collaborate with ECHO, inspiration and knowledge exchange can also take place between the participating municipalities and the regions.

Data-driven transformation

The third insight is that data collection at different levels is necessary to develop the efforts and constantly learn what works and what does not work. Although BMI and other direct health data at the individual level play an important role, other types of data from different levels in society are also needed. An example could be how much of a municipality’s or region’s budget is spent on preventive measures compared with healthcare measures.

-During ECHO’s first year, we have made an extensive inventory of which data may be relevant to use, which registers are available and how accessible they are. Now we move on to investigate how ECHO can access more data in a secure way and which still ensures the individual’s integrity, says Peter Bergsten.

It is also a matter of continuously obtaining a basis for decisions. Instead of looking at figures that are compiled in a report once a year, the municipalities should regularly have quick and easy access to data online. For municipalities that choose to move to a more data-driven decision-making in the health area, there are also great opportunities to transfer the working method to other areas, for example for infrastructure planning or crime prevention work.

Five pilot municipalities

The goal for ECHO during 2022 is to start implementing initiatives for the prevention of childhood obesity in close collaboration with five pilot municipalities and their associated regions.

-We have several interesting dialogues with, among others, Ånge municipality in Region Västernorrland and Säffle, Filipstad and Storfors in Region Värmland, and a number of other municipalities in other parts of Sweden, says Peter Bergsten.

Scale up

For the first three years, the work will take place together with the pilot municipalities and their associated regions. The next step is to scale up to 50 municipalities, to finally reach all of Sweden’s 290 municipalities. For this to be possible, it is important to create a program with efforts that have a clear measurable effect, are lasting and can be replicated. At the same time, everything that is done needs to be adapted to the local context.

-In our dialogues, we already see that each municipality and region is unique, and that measures that are good in one municipality can be expected to need to change in another. In order to have effect and duration, we need to keep this in mind, while at the same time ensuring that everything that is done is evidence-based and data-driven. These are the kind of initiatives we hope to be able to develop in the coming years, concludes Peter Bergsten.