This chapter addresses system-level analyses by discussing the translation of Norwegian
national health promotion policy into municipality-level actions, with a focus on implementation
conditions. In the 1990s, several nationwide health promotion programmes were initiated that aimed at
integrating health promotion work into the social welfare and health agendas of municipalities. Two of
these programmes are analysed in this chapter. The analyses combine two different perspectives: a
decision perspective that studies the project outcomes in terms of how the projects were integrated into
local government, and a process perspective that focuses on how the participants worked together and
on their experiences of working on the projects. The analyses found that projects aimed at integration
with local government administration were more successful than projects that aimed at empowering
local communities. It seems that a system-level approach is more effective than a community approach.
This finding represents a dilemma for health promotion that aims to stimulate community-setting
approaches and involve local residents. Consequences of the observed dilemma are discussed.
Keywords: Health promotion, policy, municipality practice, social welfare, Norwegian health promotion
programmes, decision perspective, process perspective, system level approach, community setting
approach, effectiveness, dilemma.
