2023-04-192022/23:SoU20 · p.1SoUHealth & social services

Organization of public health work

A public health act and a clearer division of responsibility in public health work

What's at stake: An unclear division of responsibility between the state, regions and municipalities can make coordinated public health work harder, and clearer regulation could in particular strengthen efforts against men's violence against women. The issue affects everyone who depends on coordinated public health efforts in their municipality or region.

Case texts and AI reasoning are AI-translated from the Swedish originals; the Swedish text is authoritative.

What the vote decides

The question is whether the Riksdag should call on the government to introduce a public health act and a new target area on men's violence against women to clarify the division of responsibility in public health work, or whether the existing cross-sectoral goal and follow-up structure is sufficient.

Yes Yes — the committee proposal

The committee notes that a cross-sectoral goal and follow-up structure with eight target areas already exists, that the Public Health Agency has developed a support structure for coordinated efforts between authorities, and that the county administrative boards support regional implementation. It also notes that a new action programme against men's violence against women is to be drawn up. Against this background, the committee does not consider it necessary for the Riksdag to take its own initiative on the organisation of public health work, and rejects the motions.

No No — the reservations

Reservation 1 (V, MP)

The reservation (V, MP) calls for Sweden to introduce a public health act that more clearly sets out responsibility for public health work at local, regional and state level, for the division of responsibility between municipalities and regions to be clarified and the link to environmental goals strengthened, and for "men's violence against women and violence in close relationships" to be introduced as a new target area in national public health policy. The reasoning is that clearer regulation would clarify what the goals are, how they are to be followed up, and who is responsible for what.

Summarised from the committee report. Party labels in the summary come from the report, not from the vote.

VSMPCLKDMSD
YesNoAbstainAbsent

What do the votes mean here?

Yes The committee proposal: rejecting the motions (keeping things as they are).

No Backing the counter-proposal: reservation 1 by V, MP.

Abstain The party marks a position of its own that is not one of the two final alternatives.

What each plan points to — and how the party voted

For each party: the vote its own election manifesto and party programme point to in this case, next to how the party actually voted. A plan can only point to Yes or No; a party can also abstain.

PlanVoteConfidenceEvidence
Vown reservationNoNo 0/21/0/3follows the planconfidence: mediumnot addressed
SNoYes 91/0/0/16departs from the planconfidence: mediumderived
MPown reservationNoNo 0/16/0/2follows the planconfidence: mediumderived
CNoYes 21/0/0/3departs from the planconfidence: lowderived
LNoYes 14/0/0/2departs from the planconfidence: lownot addressed
KDNoYes 17/0/0/2departs from the planconfidence: lowderived
MYesYes 59/0/0/9follows the planconfidence: lownot addressed
SDNoYes 64/0/0/9departs from the planconfidence: mediumderived

Committee proposal

The Riksdag rejects the motions 2022/23:315 by Markus Wiechel (SD) demands 2 and 6, 2022/23:318 by Markus Wiechel (SD), 2022/23:2171 by Elin Söderberg et al. (MP) demand 10, and 2022/23:2277 by Märta Stenevi et al. (MP) demands 45 and 73.

Original (Swedish)

Riksdagen avslår motionerna 2022/23:315 av Markus Wiechel (SD) yrkandena 2 och 6, 2022/23:318 av Markus Wiechel (SD), 2022/23:2171 av Elin Söderberg m.fl. (MP) yrkande 10 och 2022/23:2277 av Märta Stenevi m.fl. (MP) yrkandena 45 och 73.

Riksdag decision: The Riksdag said no to approximately 60 proposals in motions submitted during the general motion period 2022. The reason is partly work that is already underway in the matters that the motions address. The proposals concerned, for example, the organization of public health work and disease prevention measures, infection control, and vaccinations.

Counter-proposals

Plan vs actual vote

Every party, in chamber order: what its own plan pointed to, how it voted, and the reasoning behind both. Highlighted rows are where the two differ — but a vote that follows the plan is a result too, so the reasoning is there for every party.

VVänsterpartietNoNofollows the plannot addressed

The plan regards men's violence against women as a structural societal problem whose insight must characterize various areas of social life and lead to concrete measures, and it sees women's safety work as a societal responsibility that needs development at the municipal level.

Plan documents: party programme · 2022 manifesto

Reasoning and quotes

The plan regards men's violence against women as a structural societal problem whose insight must characterize various areas of social life and lead to concrete measures, and it sees women's safety work as a societal responsibility that needs development at the municipal level. That codifying public health responsibility and making men's violence against women its own target area follows from that. The plan does not explicitly address a public health law, so the conclusion is derived.

Original (Swedish)

Planen betraktar mäns våld mot kvinnor som ett strukturellt samhällsproblem vars insikt måste prägla samhällslivets olika områden och leda till konkreta åtgärder, och den ser kvinnofridsarbetet som ett samhällsansvar som behöver utvecklas på kommunal nivå. Att lagfästa folkhälsoansvaret och göra mäns våld mot kvinnor till ett eget målområde följer av det. Planen tar inte uttryckligen upp en folkhälsolag, så slutsatsen är härledd.

  • structural societal problemdecisive»Mäns våld mot kvinnor är ett strukturellt samhällsproblem.« (party programme ↗)“Men's violence against women is a structural societal problem.”
  • societal responsibility for women's safety»Det är ett samhällsansvar att stoppa mäns våld mot kvinnor, inte en möjlighet för privata bolag att göra vinst.« (2022 manifesto ↗)“It is a societal responsibility to stop men's violence against women, not an opportunity for private companies to make profit.”
  • clearer municipal responsibility»Kommunernas kvinnofridsarbete behöver utvecklas« (party programme ↗)“Municipalities' women's safety work needs development”
  • knowledge-based women's safety work»Kvinnofridsarbetet måste bygga på kunskap om hur våldet drabbar« (party programme ↗)“Women's safety work must be built on knowledge of how violence affects”
SSocialdemokraternaNoYesdeparts from the planderived

The plan demands action to stop male violence against women and is based on a feminist analysis of gender power relations; making violence its own target area in public health policy follows from that.

Plan documents: 2022 manifesto · party programme

Reasoning and quotes

The plan demands action to stop male violence against women and is based on a feminist analysis of gender power relations; making violence its own target area in public health policy follows from that. The plan furthermore requires equal access to healthcare and care across the country, which argues for clearer division of responsibility between state, region and municipality. A public health law as such is not addressed.

Original (Swedish)

Planen kräver krafttag för att stoppa mäns våld mot kvinnor och vilar på en feministisk analys av könsmaktsordningen; att göra våldet till ett eget målområde i folkhälsopolitiken följer av det. Planen kräver dessutom likvärdig tillgång till vård och omsorg i hela landet, vilket talar för en tydligare ansvarsfördelning mellan stat, region och kommun. En folkhälsolag som sådan behandlas inte.

  • action against male violencedecisive»Krafttag för att stoppa hedersrelaterat våld, sexualbrott och mäns våld mot kvinnor.« (2022 manifesto ↗)“Action to stop honour-related violence, sexual crimes and male violence against women.”
  • feminist basic view»Med denna grundsyn är socialdemokratin ett feministiskt parti.« (party programme ↗)“With this basic view, social democracy is a feminist party.”
  • equal welfare across the country»Alla invånare i hela landet ska ha likvärdig tillgång till skola, vård och omsorg. Det förutsätter en kommunal skatteutjämning så att inte olika skattekraft och skillnader i befolkningens sammansättning leder till skillnader i välfärd mellan olika kommuner.« (party programme ↗)“All residents across the country shall have equal access to school, healthcare and care. This requires municipal tax equalization so that different tax capacity and differences in population composition do not lead to differences in welfare between different municipalities.”

The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.

MPMiljöpartietNoNofollows the planderived

The plan wants to see a national public health programme and support municipalities and regions in their health-promotion work, with public health as a long-term investment as important as healthcare.

Plan documents: party programme · 2022 manifesto

Reasoning and quotes

The plan wants to see a national public health programme and support municipalities and regions in their health-promotion work, with public health as a long-term investment as important as healthcare. It also requires equivalent efforts against violence throughout the country and connects welfare to a good environment. A public health law that clarifies responsibility and adds men's violence against women as a target area is therefore in line with the plan.

Original (Swedish)

Planen vill se ett nationellt folkhälsoprogram och stödja kommuner och regioner i deras hälsofrämjande arbete, med folkhälsa som en långsiktig satsning som är lika viktig som sjukvården. Den kräver också likvärdiga insatser mot våld i hela landet och kopplar välfärd till en god miljö. En folkhälsolag som klargör ansvaret och lägger till mäns våld mot kvinnor som målområde ligger därmed i linje med planen.

  • national public health programmedecisive»därför se ett nationellt folkhälsoprogram och stödja« (party programme ↗)“therefore see a national public health programme and support”
  • long-term public health investment»Vi menar att en långsiktig satsning på folkhälsa« (party programme ↗)“We believe that a long-term investment in public health”
  • equivalent violence prevention work throughout the country»stärka arbetet mot hedersrelaterat våld och förtryck så att likvärdig hjälp ges i hela landet.« (2022 manifesto ↗)“strengthen work against honour-related violence and oppression so that equivalent help is provided throughout the country.”
  • the environment as a public health issue»en bra miljö med tillgång till ren luft och rent« (party programme ↗)“a good environment with access to clean air and clean”
CCenterpartietNoYesdeparts from the planderived

The election manifesto requires that preventive measures against male violence against women permeate the entire society and that all municipalities have action plans against such violence, which is close to the demand for a new target area in public health policy.

Plan documents: 2022 manifesto · party programme

Reasoning and quotes

The election manifesto requires that preventive measures against male violence against women permeate the entire society and that all municipalities have action plans against such violence, which is close to the demand for a new target area in public health policy. The party programme makes the public health perspective something that should permeate the entire society. At the same time, the plan's demand for decentralization pulls in the opposite direction when responsibility is to be regulated in law.

Original (Swedish)

Valmanifestet kräver att förebyggande åtgärder mot mäns våld mot kvinnor ska genomsyra hela samhället och att alla kommuner ska ha handlingsplaner mot sådant våld, vilket ligger nära kravet på ett nytt målområde i folkhälsopolitiken. Partiprogrammet gör folkhälsoperspektivet till något som ska genomsyra hela samhället. Samtidigt drar planens krav på decentralisering åt motsatt håll när ansvaret ska regleras i lag.

  • violence prevention throughout societydecisive»Förebyggande åtgärder mot mäns våld mot kvinnor ska genomsyra hela samhället och män som slår ska inte komma undan.« (2022 manifesto ↗)“Preventive measures against male violence against women must permeate the entire society and men who hit shall not escape.”
  • municipal action plans required»Alla kommuner ska ha handlingsplaner för att förebygga mäns våld mot kvinnor och alla skolor ska ha handlingsplaner mot hedersförtryck.« (2022 manifesto ↗)“All municipalities must have action plans to prevent male violence against women and all schools must have action plans against honour-based oppression.”
  • public health permeates society»Folkhälsoperspektivet måste genomsyra hela samhället för att ge resultat.« (party programme ↗)“The public health perspective must permeate the entire society to produce results.”
  • decentralization of decisions»Decentralisera mera. Människor ska få bestämma mer själva, och politiska beslut ska fattas nära dem som berörs.« (2022 manifesto ↗)“Decentralize more. People shall get to decide more themselves, and political decisions shall be made close to those affected.”

flags: målkonflikt: ny statlig reglering mot decentralisering

The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.

LLiberalernaNoYesdeparts from the plannot addressed

The election manifesto makes it a goal that men's violence against women shall cease and the party programme requires that all forms of violence in relationships and gender-related violence are prevented, which supports the requirement that violence becomes its own target area in public health policy.

Plan documents: 2022 manifesto · party programme

Reasoning and quotes

The election manifesto makes it a goal that men's violence against women shall cease and the party programme requires that all forms of violence in relationships and gender-related violence are prevented, which supports the requirement that violence becomes its own target area in public health policy. The party programme also wants to see increased national coordination and governance in care and health services, which argues for more clearly regulated responsibility between state, region and municipality. The plan does not, however, mention a public health law, so the conclusion is derived.

Original (Swedish)

Valmanifestet gör det till ett mål att mäns våld mot kvinnor ska upphöra och partiprogrammet kräver att alla former av våld i relationer och könsrelaterat våld förebyggs, vilket bär kravet på att våldet blir ett eget målområde i folkhälsopolitiken. Partiprogrammet vill också se en utökad nationell samordning och styrning i vård och omsorg, vilket talar för tydligare reglerat ansvar mellan stat, region och kommun. Planen nämner däremot ingen folkhälsolag, så slutsatsen är härledd.

  • men's violence against women shall ceasedecisive»Mäns våld mot kvinnor ska upphöra.« (2022 manifesto ↗)“Men's violence against women shall cease.”
  • prevent gender-related violence»Alla former av våld i relationer och könsrelaterat våld ska förebyggas.« (party programme ↗)“All forms of violence in relationships and gender-related violence should be prevented.”
  • national coordination and governance»samordning och styrning. Det stärker likvärdigheten och valfriheten« (party programme ↗)“coordination and governance. It strengthens equality and freedom of choice”
  • public health goals can be expanded»vara ett uttalat folkhälsomål.« (party programme ↗)“be a stated public health goal.”

The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.

KDKristdemokraternaNoYesdeparts from the planderived

The plan establishes that public health work must not be confined to health care but requires joint responsibility-taking between societal actors, and the election manifesto shows that the party is prepared to legislate for clearer national responsibility for health when responsibility is fragmented.

Plan documents: party programme · 2022 manifesto

Reasoning and quotes

The plan establishes that public health work must not be confined to health care but requires joint responsibility-taking between societal actors, and the election manifesto shows that the party is prepared to legislate for clearer national responsibility for health when responsibility is fragmented. To legally regulate the division of responsibility and include violence in close relationships as a target area points in that direction. The subsidiarity principle at the same time urges caution in moving tasks from the municipal level, which makes the conclusion uncertain.

Original (Swedish)

Planen slår fast att folkhälsoarbetet inte får inskränkas till sjukvården utan kräver gemensamt ansvarstagande mellan samhällsaktörer, och valmanifestet visar att partiet är berett att lagstifta om tydligare nationellt ansvar för hälsan när ansvaret är splittrat. Att lagreglera ansvarsfördelningen och lägga in våld i nära relationer som målområde ligger i den riktningen. Subsidiaritetsprincipen manar samtidigt till försiktighet med att flytta uppgifter från kommunal nivå, vilket gör slutsatsen osäker.

  • broad public health responsibilitydecisive»utan kräver ett gemensamt ansvarstagande och samverkan mellan olika samhällsaktörer.« (party programme ↗)“but requires joint responsibility-taking and cooperation between different societal actors.”
  • clear national responsibility»Avskaffa regionernas ansvar för sjukvården. Låt staten ta över ansvaret för vården med en gemensam organisation i stället för 21 olika.« (2022 manifesto ↗)“Abolish the regions' responsibility for health care. Let the state take over responsibility for care with one shared organization instead of 21 different ones.”
  • protection from violence in close relationships»nära relation ska ges adekvat stöd och skydd.« (party programme ↗)“close relationships shall be given adequate support and protection.”
  • the subsidiarity principle»Det en gemenskap på ett ändamålsenligt sätt kan« (party programme ↗)“A community on an appropriate basis can”

The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.

MModeraternaYesYesfollows the plannot addressed

The plan does not address public health problems with new framework legislation and new target areas.

Plan documents: party programme · 2022 manifesto

Reasoning and quotes

The plan does not address public health problems with new framework legislation and new target areas. The programme adheres to decisions being made at the lowest effective level and warns against a state that extends its ambitions over all areas of society, which speaks against a public health law that regulates the responsibility of municipalities and regions. However, combating men's violence against women is the plan's own priority, but requires according to the plan stricter penalties and protection rather than a new target area.

Original (Swedish)

Planen svarar inte på folkhälsoproblem med ny ramlagstiftning och nya målområden. Programmet håller fast vid att beslut ska fattas på lägsta effektiva nivå och varnar för en stat som sträcker ut sina ambitioner över alla samhällsområden, vilket talar mot en folkhälsolag som reglerar kommunernas och regionernas ansvar. Att bekämpa mäns våld mot kvinnor är däremot planens egen prioritering, men kräver enligt planen skärpta straff och skydd snarare än ett nytt målområde.

  • decisions at lowest effective leveldecisive»Det politiska systemet ska bygga på att beslut fattas på lägsta« (party programme ↗)“The political system shall be based on decisions being made at the lowest”
  • limited state ambition»En stat som sträcker ut långtgående ambitioner över alla« (party programme ↗)“A state that extends far-reaching ambitions over all”
  • combat men's violence against women»Vi ska stoppa mäns våld mot kvinnor« (2022 manifesto ↗)“We shall stop men's violence against women”
SDSverigedemokraternaNoYesdeparts from the planderived

The plan establishes that public health work needs clear objectives and entirely new state governance to deliver real results, with a strengthened and clarified role for the Public Health Agency.

Plan documents: 2022 manifesto · party programme

Reasoning and quotes

The plan establishes that public health work needs clear objectives and entirely new state governance to deliver real results, with a strengthened and clarified role for the Public Health Agency. A public health law that clarifies responsibility between state, region, and municipality aligns with this, as does lifting violence in close relationships as its own area with an action plan. The plan's requirement for a minimum of bureaucracy speaks simultaneously against new regulation for its own sake. The plan states that current governance is insufficient, which is the committee's reason.

Original (Swedish)

Planen slår fast att folkhälsoarbetet behöver en tydlig målsättning och en helt ny statlig styrning för att ge verkliga resultat, med en förstärkt och förtydligad roll för Folkhälsomyndigheten. En folkhälsolag som klargör ansvaret mellan stat, region och kommun ligger i linje med det, liksom att våld i nära relation lyfts fram som ett eget område med handlingsplan. Planens krav på minimum av byråkrati talar samtidigt mot ny reglering för dess egen skull. Planen uttalar sig om att dagens styrning inte räcker, vilket är utskottets skäl.

  • new state public health governancedecisive»vi behöver en tydlig målsättning och en helt ny statlig styrning för att uppnå verkliga resultat« (2022 manifesto ↗)“we need clear objectives and entirely new state governance to achieve real results”
  • clear national responsibility»Sverigedemokraterna förespråkar därför en tydlig nationell pådrivande styrning där Folkhälsomyndighetens roll förstärks och förtydligas.« (2022 manifesto ↗)“Sweden Democrats therefore advocate for clear national steering where the Public Health Agency's role is strengthened and clarified.”
  • action plan against violence in close relationships»Upprätta en handlingsplan för den som utsätts för våld i nära relation« (2022 manifesto ↗)“Establish an action plan for those subjected to violence in close relationships”
  • minimum bureaucracy»strävan efter ett minimum av byråkrati« (party programme ↗)“striving for a minimum of bureaucracy”

The plan takes no explicit position on what the committee actually decided — often because the committee's reason was procedural. The stance is derived and fully cited, but it does not show the party broke a commitment.

Share and embed

Embed as a widget (iframe): previewSizeLanguage

Sources and documents

Documents under consideration

Source: The Swedish Parliament