Public health work in Sweden during the COVID-19 pandemic

Abstract Background and objectives This study examines the consequences of the COVID-19 pandemic for public health practice carried out at local and regional levels in Sweden. The work includes, for example, interventions in health care, schools and preschools, social services, and non-profit organisations. Methods By means of written questions and interviews in municipalities, regions, county administrative boards, networks, and organisations, we investigated whether public health-related interventions had decreased, increased, or changed as a result of the COVID-19 pandemic. Data were analysed by content analysis. Results The results show that a large number of interventions from a variety of local and regional actors aimed at broad target groups were cancelled or paused during the time of our survey. Eventually, many, but not all of the cancelled interventions were replaced with other options, most of which are included in the following themes: • Digital solutions and support over the phone instead of physical meetings. • Outdoor activities instead of indoor activities. • Organisational adaptations, for example, from drop-in visits to booked appointments and from open activities to scheduled visits. The interviews also revealed that public health issues had been highlighted and that existing collaboration structures were a success factor in managing the consequences of the COVID-19 pandemic. The risk of and concern for the spread of infection and compliance with the authorities’ recommendations were stated to be the main reasons why public health-related interventions had decreased, increased, or changed. Conclusions Both general public health practice and targeted interventions in health care and municipal activities have been cancelled or rescheduled according to our survey. Because many public health-related interventions have an equalising effect on health, this can be of great importance for groups that are socially, economically, or health-relatedly vulnerable.


Background and objectives:
The COVID 19 pandemic has highlighted how public health is dependent on many areas of society, and several aspects of public health can be affected. We have evaluated how the COVID-19 pandemic and the measures taken to reduce its spread have impacted public health in Sweden during 2020.

Methods:
We systematically compiled international research on the pandemic's impact on public health, we examined living conditions of groups at a particularly increased risk of ill health, and we collected and analysed Swedish data on lifestyles, health, injury, and illness during the pandemic compared to previous years.

Results:
Most people have, in one way or another, been affected by the pandemic and by societýs preventive measures. However, some groups have suffered more than others. Groups who were already at an increased risk of ill health before the pandemic have been most affected, e.g. in schools, on the labour market, and in society in general. There is a risk of increased health inequality, not only related to morbidity and mortality of COVID-19 during 2020, but also when it comes to the effects on living conditions.

Conclusions:
The consequences of the COVID-19 pandemic pose major challenges for public health, and the measures taken to limit its spread inter-relate with social and economic conditions. In Sweden, health inequalities have remained the same or increased over the years. Our study suggests that the consequences of the pandemic will reinforce health inequalities. It is too early to determine what the pandemic's full impact on public health will be. Nevertheless, health promotion and preventive measures need to be strengthened and prioritized in order to maintain good public health and reduce inequalities.

Background and objectives:
This study examines the consequences of the COVID-19 pandemic for public health practice carried out at local and regional levels in Sweden. The work includes, for example, interventions in health care, schools and preschools, social services, and non-profit organisations.

Methods:
By means of written questions and interviews in municipalities, regions, county administrative boards, networks, and organisations, we investigated whether public health-related interventions had decreased, increased, or changed as a result of the COVID-19 pandemic. Data were analysed by content analysis.
15th European Public Health Conference 2022

Results:
The results show that a large number of interventions from a variety of local and regional actors aimed at broad target groups were cancelled or paused during the time of our survey. Eventually, many, but not all of the cancelled interventions were replaced with other options, most of which are included in the following themes: Digital solutions and support over the phone instead of physical meetings.
Outdoor activities instead of indoor activities. Organisational adaptations, for example, from drop-in visits to booked appointments and from open activities to scheduled visits. The interviews also revealed that public health issues had been highlighted and that existing collaboration structures were a success factor in managing the consequences of the COVID-19 pandemic. The risk of and concern for the spread of infection and compliance with the authorities' recommendations were stated to be the main reasons why public health-related interventions had decreased, increased, or changed.

Conclusions:
Both general public health practice and targeted interventions in health care and municipal activities have been cancelled or rescheduled according to our survey. Because many public health-related interventions have an equalising effect on health, this can be of great importance for groups that are socially, economically, or health-relatedly vulnerable.
Abstract citation ID: ckac129.007 Prevention of alcohol, drugs and tobacco during the COVID-19-pandemic -consequences and inequalities in Swedish municipalities

Background and objectives:
The COVID-19 pandemic and measures to prevent the spread of the virus challenged public health practice at the local and regional level in Sweden. The objective of this study was to follow-up how local preventive ADT prevention (alcohol, drugs, and tobacco) in Sweden was affected during 2020-2021. Methods: All Swedish municipalities (N = 290) were included in surveys on how the pandemic affected local ADT prevention. Response rates ranged between 82 and 91 percent. Quantitative data were analysed with reference to socioeconomic and demographic conditions. Qualitative data were analysed thematically.

Results:
A majority of the municipalities reported a decrease in ADT prevention, especially aimed at groups such as parents, children, and young people. There was no correlation between the decrease in municipal ADT prevention and sociodemographic conditions. A majority of the municipalities reported that activities were adapted, often with a digital approach. Adaptation of ADT prevention was less common in smaller municipalities and municipalities where residents had lower levels of education and lower incomes. An increase in activities, as a consequence of measures to prevent the spread of the virus, was more common in larger municipalities and municipalities with a greater proportion of residents with higher educational backgrounds and higher incomes. Conclusions: ADT prevention carried out by municipalities in Sweden was initially deeply affected by the COVID-19 pandemic and by measures to prevent the spread of the virus. However, activities were adapted over time, mainly with a digital approach. The ability to adapt differed depending on the sociodemographic conditions of the municipalities. Follow-up studies on ADT prevention and the consequences of the digital approach during 2021 will be presented at the conference.

Background and objectives:
The COVID-19 pandemic has posed challenges for traditional public health practice. In the area of alcohol, drugs, and tobacco, local and regional actors have largely moved from physical to digital solutions to handle the barriers imposed by the pandemic. To strengthen the knowledge base in the area, this project aimed to explore how the local transition to, and management of, digital solutions within alcohol, drugs, and tobacco prevention might support the policy drive in Sweden towards equity in health.

Methods:
This was a qualitative study where 13 local coordinators from 7 municipalities participated. Data were collected through 9 individual and 2 group interviews (semi-structured). The analysis was inductive and followed a thematic analysis approach to identify, analyse, and present patterns (themes) in the data. Results: Three themes were developed illustrating how the local implementation of digital solutions in the area of alcohol, drugs, doping, and tobacco prevention might support the transition towards equity in health by 'making time and resources available for development and innovation', 'improving the ability to reach and engage with vulnerable groups', and '(re)shape initiatives to act inclusively'.

Conclusions:
As illustrated by experiences of the local coordinators, the municipalities seemed to have managed the challenges of the pandemic in a good way. To a large extent, they appeared to have adapted their work to remain operational by transitioning into digital solutions. Considering that the pandemic has been challenging in various ways, the finding of ensuring operations were running should not be underestimated. However, besides being able to largely maintain a ''status quo'' in a time when traditional modes of working were inadequate or inappropriate, the results illustrated how the municipalities have added numerous (digital) tools to their toolbox for use in the continuing drive towards good and equitable health.