Jönköping County Council is an elected regional health authority serving around 340,000 people in southern Sweden.
Over the past 20 years, Jönköping County Council has pursued a population-based vision for its citizens of ‘a good life in an attractive city’. It plans, funds and provides health services for this population, working in partnership with local government in the county’s municipalities. It has considerable autonomy and tax-raising powers by virtue of Sweden’s system of devolved government.
Improving older people's health
Jönköping County Council is best known for its work on quality improvement and developing integrated health and care services. Staff and clinical teams have been encouraged to work together to think about how they can deliver the best outcomes for a fictional elderly resident, Esther, enabling them to map services that people receive across different settings and explore how they can be improved across systems. The benefits of this approach have included significant reductions in hospital admissions, days spent in hospital and waiting times for specialist appointments.
Other services aimed at improving older people’s health include Jönköping’s Passion for Life programme, which recently won the European award for social innovation in ageing. It is based on a series of group meetings called ‘life cafés’, where people come together to collectively discuss how they can improve different aspects of their health and wellbeing. Life cafés are held in different locations depending on the topics being discussed – for example, in a gym if the topic is physical activity, or in a restaurant if the theme is diet and nutrition. Some of these life cafés have also focused on intergenerational activities and the specific needs of minority groups.
Understanding the needs of different population groups
As well as integrating care and prevention services for older people like Esther, Jönköping County Council has taken a broad approach to planning and delivering services across the whole of the population it serves. It uses population-level data to understand the needs of different population groups, and uses a dashboard of indicators to monitor health outcomes across and within local populations.
These indicators focus on a range of areas, including rates of obesity, alcohol consumption, physical activity, quality of diet, social deprivation, violent crime, school truancy and educational outcomes, as well as a range of measures of people’s physical health. The Council then works in partnership with local government in Jönköping’s municipalities to plan and deliver services to improve population health in each locality.
In particular, Jönköping County Council has developed targeted strategies for four main population groups: children and young people, people with mental health conditions, people living with drug and alcohol addiction, and older people. Professionals from different sectors are brought together to design and implement new approaches to improving people’s health across each of these groups.
One example is Jönköping’s collaborative programme for younger people with mental health conditions, which involves primary care and social care services, schools and the police, as well as a range of other local partners. Public health is seen as a core part of designing and delivering interventions across each of these population groups, rather than a separate strand of activity.
To support people to manage their own health across the population, ‘learning cafés’ (similar to the life cafés described above) have been set up that connect people with similar conditions and draw on the expertise of ‘expert patients’.
The impact of Jönköping County Council’s population-based approach is evidenced by its consistent high performance across a range of public health indicators when compared with other parts of Sweden – including in relation to life expectancy, self reported health status and emotional wellbeing.