Tackling-health-inequities-from-concepts-to-practice-The-experience-of-Vastra-Gotaland

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etween. Legislation is the main responsibility of the state, thus formingthe framework of the welfare institutions. The municipalities areresponsible to a large extent to deliver these core welfare institutionssuch as schools, child care, elderly care, etc. The municipality has a highlevel of autonomy versus the state and the region and may decide, withinthe legal framework provided by the Riksdag (Swedish Parliament), howto allocate the available resources. They also have the right to decideon taxes. The region, as a governmental structure between the state andthe municipality, is responsible by law for the organization of healthcare but has also taken over some of the authorities from the state, suchas regional infrastructure, transportation and creating opportunities forsustainable growth. The Regional Council also has the right to decideon taxes.Internal organizational structures and mandatesThe regional administrative organization is thus part of a fairly decentralizedgovernmental structure in Sweden, sharing the responsibility to organizemajor parts of the welfare institutions with the municipalities.The public health sector within the regional administration is dividedinto two parts, the Public Health Committee, and the Health and MedicalCare Committees (HMCCs). Whereas the former is a political committeeserving directly under the Regional Executive Board on strategic publichealth issues, the latter is a decentralized political entity responsible fororganizing local health care and public health (from 2015 onwards therewill be five such HMCCs). They are accountable to the Regional Counciland a part of the purchaser–provider system (Fig. 1).Since the health care sector in the region is organized under apurchaser–provider system, the operative public health organizationis administered by the HMCCs, responsible for both health care andpublic health. Due to the autonomy of the municipalities, local publichealth plans are negotiated between the regional “purchasers” andeach municipality.6 Tackling health inequities: from concepts to practice.
Fig. 1. Political organization of Region Västra GötalandRegionalCouncilHealth andmedical careRegionalExecutive BoardRegional development(Purchaser and providersystem within regionaldevelopment – divided intosubareas)Health andMedical CareCommittee(Purchaser andprovider system withinhealth and medicalcare as well as publichealth)Public HealthCommittee(Strategic advisoryboard within the publichealth area)Human RightsCommitteeRegional DevelopmentCommitteeCultural AffairsCommitteeSource: adapted and reproduced by permission from Region Västra Götaland (10,11).The mandateIn light of the WHO Commission on Social Determinants of Health, as wellas other events, 1 the Regional Council, in 2010, commissioned the PublicHealth Committee to coordinate work to produce a regional action plan toreduce health inequalities within the region. The Commission to create anAction Plan for Health Equity in Västra Götaland, hereafter referred to as theCommission, should base its work on the conclusions from the previous workof the WHO Commission.A Political Steering Group, hereafter referred to as the Steering Group, wasformed and agreed on a target and scope for the action plan:to contain proposals of concrete initiatives/measures – locally, regionally andnationally – which are most likely to reduce health inequity in Västra Götaland.Each actor then decided in their own organization on which of the proposedinitiatives/measures should be implemented, as well as when and how they shouldbe implemented. (4)1A more comprehensive description of motivations that led to this process is in Section 4.Section 2. Setting the scene7
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Page 6 and 7: ForewordIt has been called the Swed
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Page 11 and 12: Executive summaryThis publication,
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Tackling-health-inequities-from-concepts-to-practice-The-experience-of-Vastra-Gotaland

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