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School of Health, Care and Social Welfare

THE IMPLEMENTATION OF AGENDA

2030 AT MUNICIPAL LEVEL

A qualitative study about officials’ experiences of implementing the

Sustainable Development Goals

JHONNY SALVATORE TALAVERA

Main Area: Public Health Sciences Level: Advanced

Credits: 15 credits

Programme: Master’s Programme in Public Health within Health and Social Welfare

Supervisor: Camilla Ramsten Examiner: Robert Larsson Seminar date: 2020-06-02 Grade date: 2020-06-30

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ABSTRACT

Background: Agenda 2030 is newly launched, thus little research has been conducted

about the implementation at the municipal level. To increase the Sustainable Development Goals (SDGs) feasibility requires understanding which elements can facilitate the policy implementation process with the goal of healthy and sustainable societies.

Aim: The aim of the study is to investigate the officials’ experiences of implementing the

Agenda 2030 at the municipal level.

Methods: A qualitative method with an inductive approach was used to address the study

aim. A purposive sampling of participants was conducted, and a semi-structured interview was used as the data collection method. In total, ten informants from ten different

municipalities participated. A manifest content analysis was conducted to analyze the collected data.

Result: The implementation strategies that were used for mobilizing the community to

achieve the Agenda 2030 could be divided into internal and external strategies. The internal strategies focused on knowledge enhancing activities and the integration of the SDGs into municipal existing steering documents. The external strategies focused on establishing partnerships and involving the local citizen in the community development.

Conclusion: The experiences of the officials indicated that health promotion approaches,

and the guiding principles can be valuable tools for municipalities to facilitate the policy implementation process related to Agenda 2030.

Keywords: Agenda 2030, community development, health promotion, implementation, municipal level, qualitative method.

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CONTENTS

1 INTRODUCTION ... 1

2 BACKGROUND - AGENDA 2030 CONNECTION TO PUBLIC HEALTH ... 2

2.1 Definition of health, public health and public health work ... 2

2.1.1 Health promotion - Ottawa Charter ... 2

2.2 Sustainable development - Agenda 2030 ... 3

2.3 Sustainability in public health programs ... 6

2.4 Sweden’s national steering to implement the SDGs ... 7

2.4.1 Institutional organizations ... 7

2.5 Municipalities work towards Agenda 2030 ... 8

2.5.1 Activities related to the SDGs ... 9

2.6 Implementation research ... 10

2.7 Community organization for Health Promotion – Bracht’s five-stage model .... 11

2.8 Problem formulation ... 13

3 AIM ... 13

4 METHODS AND MATERIALS ... 14

4.1 Study design ... 14

4.2 Participants and setting ... 14

4.3 Data collection ... 15

4.4 Analysis ... 16

4.5 Quality criterias ... 17

4.6 Ethical considerations ... 18

5 RESULTS ... 19

5.1 Internal strategies to implement Agenda 2030 ... 19

5.1.1 Internal knowledge-enhancing activities ... 19

5.1.2 Integration of SDGs into municipality steering documents ... 20

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5.2 External strategies to achieve Agenda 2030 ... 21

5.2.1 Establishing partnerships ... 21

5.2.2 Involve local citizens ... 22

6 DISCUSSION ... 23

6.1 Method discussion ... 23

6.1.1 Discussion about study design ... 23

6.1.2 Discussion about participants and setting ... 24

6.1.3 Discussion about data collection ... 24

6.1.4 Discussion about analysis ... 25

6.1.5 Ethical considerations ... 26

6.2 Result discussion ... 26

6.2.1 Stage 1: Community analysis or assessment ... 27

6.2.2 Stage 2: Design and initiation ... 27

6.2.3 Stage 3: Implementation ... 28

6.2.4 Stage 4: Program maintenance-consolidation ... 29

6.2.5 Stage 5: Dissemination and reassessment ... 29

7 CONCLUSION ... 30

7.1 Future investigations and practical implications ... 31

LIST OF REFERENCES ... 32

APPENDIX A; INFORMATION LETTER APPENDIX B; INTERVIEW GUIDE

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1 INTRODUCTION

In September 2015, an agenda for global sustainable development was adopted by the UN General Assembly. The worlds Heads of State and Governments had committed to leading the world to a sustainable future by 2030 with its 17 Sustainable Development Goals (SDGs) resulting in – Agenda 2030.

Sweden’s ambition is to be a leader in the implementation of SDGs, Agenda 2030, nationally and internationally. The global development towards a sustainable future requires a

transition in all sectoral levels. In order to achieve a sustainable future, national states, public sectors, business sector, organizations and individuals need to be part of the transition. It is an ongoing transition where municipalities and county councils are investing in a social development, the business community regard sustainability as a competitive advantage and the civil society are taking action to influence decision makers.

Agenda 2030 is an opportunity for Sweden and globally to impact and improve the public health of its citizens. Agenda 2030 is a goal-oriented action plan and the key elements for implementation are integration and collaboration. The intention of Agenda 2030 is to mobilize societal change by channeling strategies towards public health issues to ensure sustainable communities’ development. There is a need to raise the level of ambition,

therefore, it is vital to promote success factors to facilitate and stimulate the implementation of Agenda 2030. If public health programs for sustainability should be sustained over time it is necessary to better understand which factors can lead to promote long-term program sustainability.

The aim of the SDGs is closely related to one of the main principles for health promotion – a good and equitable health, which strives for its achievement by holistically targeting the determinants of health. The social development that targets multifactorial determinants of health at all society levels with a health-promoting and disease prevention approach, can affect the living condition of the individuals. A sustainable development is a prerequisite for the protection of community health, public goods, addressing risk factors and contributing to reducing health inequalities to achieve the highest state of well-being. This is a fundamental right stated by the World Health Organization constitution. Therefore, health and

development are closely interconnected.

The author has previous in a bachelor thesis, investigated how a Swedish non-governmental organization implements the SDGs internationally. From this thesis, an interest emerged in examining how Sweden strategically implements the Agenda 2030 at the municipal level. The authors ambition is to facilitate the selection and application of appropriate approaches in implementing the SDGs by highlighting key success factors. The ambition is to foster cross-disciplinary dialogue among implementers of Agenda 2030. This study’s main focus is the

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2 BACKGROUND - AGENDA 2030 CONNECTION TO PUBLIC

HEALTH

In the following sections, health, health promotion and public health will be defined.

Furthermore, Agenda 2030 connection to health promotion is explained by highlighting how municipalities through community development efforts can impact global development and thus, affect determinants that influence individuals’ living conditions.

2.1 Definition of health, public health and public health work

The most commonly used definition of health is cited from the World Health Organizations (WHO) constitution – “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (World Health Organization, 1948, p.1). Health was regarded as the absence from disease, which has further developed to be regarded as a resource of everyday life. Later definitions of health are based on a salutogenic

perspective where the highest attainable enjoyment of health is regarded as a fundamental right (World Health Organization, 1998). The public health is explained as the state of the populations’ health, which considers level and distribution of health within the population. Furthermore, the World Health Organization (1998, p.3) defines public health as “the science and art of promoting health, preventing disease, and prolonging life through the organized efforts of society”.

Elinder and Kwak (2014) argue that the characteristics of public health work are targeted and systematic efforts to promote health and reduce health inequalities. The systematic public health work is based on health promoting or disease prevention perspectives when targeting the determinants that influence health. Health promotion is achieved by impacting the determinants for health, which are the living condition where people live. Examples of determinants of health are; working conditions, social and economic circumstances,

education, gender equality, safe food, diet, clean water, sanitation, housing and health care. The population health is strongly correlated with the living condition of the individual (The Government of Sweden, 2018).

2.1.1 Health promotion - Ottawa Charter

The concept of health promotion was stipulated in Ottawa Charter, in the first International Conference on Health Promotion 1986, as a response to the growing public health movement around the world. The definition of health promotion is the enabling process to increase control over the improvement of the individual’s health (World Health Organization, 1986). The aim of health promotion is to enable a complete state of physical, social and mental well-being and in order to achieve it “individuals or groups must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment” (World Health Organization, 1986, p.1). Five action areas of priority were developed; the creation of supportive environments, public health policy building, personal skill development,

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community action strengthening and health services reorientation. In order to accomplish complete state of well-being, three strategies were constructed; (i) the control over the determinants of health by enabling the empowerment of individuals, (ii) improve life conditions by advocating development that impact health and (ii) mediating intersectoral collaboration (World Health Organization, 1986).

According to Kumar and Preetha (2012), the scientific evidence states that the public health and the individual’s social well-being are affected by determinants outside the domain of the health sector such as sociopolitical changes, economic changes and global environmental changes. Rootman (2001) argue that these determinants of health require a holistic approach to link the interaction and address the different dimensions that influence health with

multiple strategies. Rootman (2001) has also described seven guiding principles and values that emanated from the Ottawa Charter which constitutes a framework with significant values for health promoting approaches (see Table 1).

Table 1. Seven guiding principles for health promotion. Obtained from Rootman (2001).

2.2 Sustainable development - Agenda 2030

The General Assembly of the United Nations (UN) called for “a global agenda for change” to the World Commission on Environment and Development (WCED) (WCED, 1987, p. 5). From the Brundtland report 1987, also called “Our Common Future”, comes the most cited definition of the concept sustainable development; "a development sustainable to ensure that it meets the needs of the present without compromising the ability of future generations to meet their own needs " (WCED, 1987, p.15). It was stated that economic growth and social development was not possible if the ecological resources were overexploited and the environment destroyed. The sustainability concept developed into the inclusion of three pillars; social, economic and ecological (WCED, 1987). The social sustainability dimension

Principle

Application

Empowerment Enabling individuals and the local community to assume more power over personal, socio-economic, and environmental factors that affect their health

Participatory Involving all concerned at all stages of process

Holistic Fostering physical, mental, social and spiritual health

Equitable Guided by a concern for equity and social justice

Intersectoral Involving the collaboration of agencies from relevant sectors

Sustainable Bringing about changes that individuals and communities can maintain once initial funding has ended

Multi-strategy Using a variety of approaches - including policy development, organizational change, community development, legislation, advocacy, education and communication – in combination

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includes societies that respect human rights. The economic sustainability dimension involves systematic efforts to meet people’s basic needs to counter poverty. The ecological

sustainability dimension includes dealing with ecological challenges related to natural resources of the ecosystem (Prop. 2017/18: 249). Kjærgård, Land and Pedersen (2013) argue that the three pillars of sustainable development are crucial determinants that contribute to sustainable and healthy societies. Traditionally, the sustainable development movement has placed economy as the core element whereas the health promotion movement emphasis health as the core element for sustainable communities. However, sustainable development and health promotion are inextricably linked since both focused on the same political

elements and are driven by the same dynamic forces. Kjærgård et al. (2013, p. 562) argue that health promotion “is close to the concentric understanding of three dimensions of

sustainable development” (see Figure 1).

Figure 1. Illustration of the relationship between sustainable development and public health. Obtained

from Kjærgård et al. (2013).

Furthermore, Kjærgård et al. (2013) argue that from the mid-1980s health promotion and sustainable development developed in parallel. The public health was considered affected by environmental factors which means that the physical interaction of the environment is related to health impact. Health has also been regarded as a central aspect within social development and a precondition for sustainable development. The socioecological approach to impact health was borne out the indivisible links between population health and

environmental factors. In 1991, the World Health Organization developed the concept of creating supportive environments as a guiding principle to encourage nations and communities worldwide to create favorable conditions to develop a good health (World Health Organization, 1998).

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The Government of Sweden (2018) explains that the Agenda 2030 was stipulated at the UN Summit and the world’s countries had committed to lead the global development towards a sustainable future. The 17 SDGs ambition is to fight inequalities within and between

countries, to eliminate hunger and poverty, to respect the human rights, to promote equality, to empower women and girls, to build inclusive, peaceful and equitable societies and to ensure protection of the natural resources of the ecosystem (see Figure 2). The main principles of Agenda 2030 are (i) the SDGs are universal, meaning all countries are responsible for the implementation, (ii) the SDGs are integrated and indivisible, meaning one cannot achieve success at the expense of another goal and ultimately (iii) no one should be left behind, which refers to the consideration of vulnerable people and communities, (iv) participation of all sectors is required and (v) multi-stakeholder partnerships, which refers to the mobilization of knowledge, technology, expertise, resources in order to support the achievement of the SDGs in all communities (The Government of Sweden, 2018; UNSSC, 2017).

Figure 2: Agenda 2030 with the 17 Sustainable Development Goals. Obtained from the Government of

Sweden (2018).

In order to achieve the SDGs, all sectors participation in the transition for a sustainable future is required (Takian & Akbari-Sari, 2016). The SDGs cover all three dimensions of sustainable development and offers a holistic framework that considers the achievement of social justice, the exercise of environmental stewardship, the strengthening of governance and economic growth (Lanshina, Barinova, Loginova, Lavrovsky & Ponedelnik, 2019). The seven guiding principles for health promotion are closely linked to the SDGs since the overall aim of Agenda 2030 is a good and equal health for all societies. A good and equal health is also achieved by the integration of health promotion and disease prevention perspectives which are basic elements and prerequisites for sustainable development. Health promotion

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and disease prevention approaches enables targeting multifactorial determinants of health at all levels of government. The aim is to impact the living conditions of the individual to attain the highest state of well-being by reducing health inequalities, protecting the community health, addressing risk factors and delivering public goods. Seke, Petrovic, Jeremic, Vukmirovic, Kilibarda & Martic (2013) emphasize that public health and sustainable development are interconnected since both aims at improving the social, physical and

personal quality of the individual, without jeopardizing future generation’s needs. Therefore, health promotion is a vital development process for achieving a sustainable and equitable future (Fortune et al., 2018).

The Agenda 2030 goals, principles and approaches are linked with the seven guiding principles for health promotion, therefore it is possible to connect the SDGs to practical public health work since it aims to achieve the protection of human rights and natural resources, equity and the empowerment of individuals and communities. Fortune et al. (2018) explains that health promotion is a significant tool to operationalize Agenda 2030 for civil society groups, organizations, local and national governments. Frykman (2018)

emphasizes the need for a more comprehensive understanding for the implementation approaches of the SDGs in order to enhance coherence and program sustainability.

2.3 Sustainability in public health programs

Luke, Calhoun, Robichaux, Elliot and Moreland-Russell (2014) mentions that public health programs that are able to maintain activities over time are more likely to produce long-term outcomes. Public health programs include organized public health action, for example, community mobilization, surveillance, communication campaigns, policy development and evaluation. Traditionally, sustainability in the field of public health has primarily considered the maintenance of public health programs (i.e., program sustainability; Schell et al., 2013). Sustainability in relation to the SDGs is much wider and refers to holistically targeting, in an intersectoral collaboration, the social, economic and ecological determinants that impact the health of the population (The Government of Sweden, 2017).

Schell et al. (2013) argue that research has paid less attention to what happens after public health programs are implemented and what infrastructure or processes can contribute to enhance positive health outcomes. It is vital for a more comprehensive understanding of what factors can contribute to long-term program sustainability, to efficiently get the full benefit of public investment for program development. Schell et al. (2013) emphasize the need for time to reach program maturity to enable long-term health benefits. The

sustainability outcomes involve activities, benefits for clients, organizational practices, community-level partnerships and prominence of the core issue of the program. Program sustainability refers to ability to sustain programming and benefits over time. Sustainability capacity is mentioned as a vital concept to achieve maintenance over time and it’s defined as “the existence of structures and processes that allow a program to leverage resources to effectively implement and maintain evidence-based policies and activities” (Schell et al., 2013, p.2)

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Further, Schell et al. (2013) explains that money and resources can be wasted while limiting the health benefits and the achievement of public health goals. The lack of sustainability capacity can therefore lead to damaging trust between the community and the program, hence the importance of sustainability capacity in public health programs. After being funded it is estimated that 40% of public health programs do not make it many years after the end of initial funding according to Schell et al. (2013). Consequently, Schell et al. (2013) emphasize the importance of comprehending which factors that can lead to sustainability to promote improvement of implementation and measurement for future interventions.

2.4 Sweden’s national steering to implement the SDGs

Sweden’s contribution to the implementation of the Agenda 2030 is affected by the Swedish Government and the Swedish parliament. By making binding and guiding decisions at

national level it enables prerequisites for coherent implementation, from both horizontal and vertical approaches, at all levels in the public sector. To achieve successful implementation of the SDGs, it requires commitment, knowledge and government control. The implementation process needs to combine multiple strategies in order to provide routine preparations and decision-making processes that allows a coherent perspective for integrating Agenda 2030 into existing functions (The Finance Department, 2017). The Swedish parliament adopted the first national strategy for sustainable development, a Politic for Global Development (PGD). PGD is a central tool for implementing Agenda 2030 nationally and internationally (The Government of Sweden, 2017). Galli, Đurović, Hanscom and Knežević (2018) emphasize the importance of translating the SDGs into national specific goals, targets and policies that considers and priorities the national context, conditions and capabilities to enable a long-term vision of national development.

2.4.1 Institutional organizations

According to the Finance Department (2017), the Swedish government responsibility to implement Agenda 2030 is collectively shared among ministers and their respective

government area of responsibility. A consultation group involves the State Secretary from the Ministry of Finance, the Ministry of Environment, The Ministry of Foreign Affairs and the Ministry of Industry, which works directly under the government to facilitate the

implementations of the SDGs. The Swedish parliament affects the opportunities to

implement the SDGs since the parliament’s decision in the Finance Committee and Foreign Affairs Committee deals primarily with issues regarding the SDGs on a general level.

Furthermore, a national delegation was appointed by the government with the aim to stimulate and support the implementation of the Agenda 2030, both nationally and

internationally. The national delegation mission is to anchor the SDGs and to create dialogue and intersectoral partnerships between authorities, municipalities, county councils, civil society, business and research communities. Various government agencies within a county

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are most commonly governed by laws and ordinances, regulatory letters, authorities’ instructions, evaluation, and particular government decisions (Finance Department, 2017), The Swedish government has given the State Office the mission to evaluate and analyze how the implementation of Agenda 2030 affects the work of the county councils, municipalities and authorities. The State Offices mission is to analyze and follow up how the three

dimensions of sustainability are integrated into the core business of these institutions. The State Offices mission is also to analyze the conditions that enables the integration of Agenda 2030 into existing activities, to analyze and follow up to what extend collaborations and partnerships has enabled the strengthening of the government’s national action plan to implement the SDGs, to analyze and follow up to what extend the governments PGD is used as a tool to implement the SDGs and to make proposals that efficiently enhance the

implementation of Agenda 2030 (State Office, 2019).

2.5 Municipalities work towards Agenda 2030

The Government of Sweden (2018) argue that the county councils and municipalities are the institutions closest to the citizens and therefore their contribution for Agenda 2030 is vital since they are responsible for the ecological, physical and social infrastructure that influence the citizens’ living habits. EU law, global commitments, national goals and national

legislation are put into practice at a local and regional level. The municipal self-government allow adaptation within the local context, need and condition. Agenda 2030 is voluntarily implemented by county council and municipalities, and the municipal self-government enables to define and prioritize the implementation based of local challenges and context. Swedish Association of Local Authorities and Regions (SALAR), together with Swedish UN Association are implementing an education and communication project called Glokala Sweden. The aim of the project is to enhance engagement and knowledge about the Agenda 2030 for all municipalities and regions. SALAR together with the Council for the Promotion of Municipal Analysis has compiled key measurement indicators within the database Kolada that enable municipalities and regions to evaluate their contribution for achieving the SDGs (SALAR, 2020).

It was enacted in the government constitution that the general public needs to promote sustainable development that ensures a good environment for present and future

generations, the right to housing, work and education, to promote security, social care and good condition to health (The Government of Sweden, 2018). The county councils and municipalities are also responsible for other public services at local and regional level that affect the opportunity for equity in health, living conditions, the health of the population and global sustainable development. The social functions of these institutions are to some extent mandatory and regulated by law, others are voluntary (The Finance Department, 2017). Gustafsson and Ivner (2018) argue the importance of dealing with the SDGs locally and argue the significant role the municipalities play when central authorities fail. Gustafsson and Ivner (2018) emphasize why the integrations of the SDGs into existing strategies are vital in order to avoid marginalization of Agenda 2030 and risk a parallel non-effective process.

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A report from the Nordic Council of Ministers (Nordregio) presented an analysis that identified the experiences and efforts made by Nordic municipalities towards the Agenda 2030 (Nordregio, 2019). Two approaches were identified to implement the SDGs within their public sector; a holistic approach and a targeted approach. The holistic approach includes the integration of the SDGs at all administrative levels and organizational tasks, meaning the adaptation of management systems, connecting local plan, strategies, programs, core steering documents, quality of life programs to the SDGs and the applications of Agenda 2030 as a guidance tool in municipal mergers. The targeted approach involves specific projects and policies related to SDGs. It emerged in the report from Nordregio (2019), that some municipalities had linked Agenda 2030 to their environmental policy, others had used the SDGs for their city development plan. It also emerged that some municipalities had started information campaigns to raise awareness and other projects such as municipality public health program activities to make citizens to ambassadors of sustainability and linking other types of development plans to the SDGs.

The report from Nordregio (2019) highlights seven successful factors for the implementation of the Agenda 2030; (i) the integrations of Agenda 2030 into core steering documents, process and plans, (ii) the involvement of every local authority department, (iii) the involvement of local citizens, (iv), the application of Agenda 2030 for sustainable housing and urban planning, (v) the support of sustainable organizations and businesses, (vi) the encouragement and participation of young people and (vii) the establishment of

partnerships. Although the report has investigated the experiences of several Nordic municipalities, it is also emphasized in the report of Nordregio (2019), the lack of research about municipalities experiences of the activities, plans and implementation of the Agenda 2030.

2.5.1 Activities related to the SDGs

The State Office (2019) identifies six different activities implemented by municipalities related to Agenda 2030. These are; (i) internal dissemination to enhance knowledge about Agenda 2030, (ii) mapping organizational task to integrate Agenda 2030, (iii) appointing responsible functions, (iv) external dissemination to enhance knowledge about Agenda 2030, (v) revisions of governance documents and (vi) network participation to collaborate and form new partnerships.

It is emphasized by the State Office (2019), that an important aspect that facilitates the implementation of the SDGs, is to what extent the officials comprehend how the goals are relatable to municipalities core tasks. The State Office (2019) reported in the survey made by SALAR, that barely 60 percent of the municipalities that used Agenda 2030 organized internal dissemination to enhance knowledge about the SDGs. The internal dissemination varied among municipalities, some had regular knowledge enhancing efforts, others had organized only one internal lecture or workshop. Further, the State Office (2019) explains that the differences in conditions between municipalities affects the prerequisites for implementing the Agenda 2030. Each municipality differs in economic conditions,

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(2019), the survey made by SALAR indicates a 30 percent increase of the applications of Agenda 2030 into municipalities’ cores business compared to the survey made in 2017. However, there are still municipalities and regions who have made a political decision but have not begun to work with the SDGs.

2.6 Implementation research

In order to deal with public health threats, previous research emphasize the requirement of research-based knowledge. Policy implementation research was borne out the need to assess the effectiveness of public policy, to explain, understand and address certain problems associated with the translation of intention into desired outcomes. Policy implementation research seeks to examine “how governments put policies into effect” (Nilsen, Ståhl, Roback & Cairney, 2013, p.2). Policy implementation research is relevant to this current study since it aims to investigate why political intention seldom results in desired outcomes and to examine which elements affects the process and the result of the political will. Valaitis et al. (2016) further explains that there is a need to fill the gap in existing public health policy

implementation research since the efficacy of the health policy implementation is impacted by multiple level influences. According to Bennett et al. (2020) there is also a need for more research in identifying appropriate conceptual frameworks for implementing the SDGs among policymakers in order to achieve the SDGs. Brown and Malekpour (2019) emphasize that the SDGs need to be integrated throughout the organizational strategic management process. The lack of an integrated approach risks leading the SDGs to become an isolated project without being able to deliver a consistent impact.

Previous research according to Ramaswamy, Mosnier, Reed, Powell and Schenck (2019)

states that the SDGs is an unprecedented agenda for improving health and well-being but also emphasizes that several public health programs do not reach their full potential because of emerging trends such as globalization, climate change and demographic transitions. In order to provide more evidence-based practice (EBP), implementation science reflects a slightly different perspective on implementation born out of the need to address challenges of using research findings in professional practices to ensure successful implementation into common and routine practice (Aarons, Hurlburt & Horwitz, 2011). Nilsen (2015, p.2) defines implementation science as “the scientific study of methods to promote the systematic uptake of research findings and other EBPs into routine practice to improve the quality and

effectiveness of health services”. Dintrans, Bossert, Sherry and Kruk (2019) argues implementation science is a useful framework that enables to identify current gaps in implementation strategies by highlighting elements for successful implementation and thereby increasing the chances of desired outcomes. Elinder and Kwak (2014) summarize the empirical implementations research into two categories; (i) the investigation of facilitators and barriers of implementing interventions and (ii) research about evaluations of the effectiveness of strategies in professional practice. This present study focusses on the first category of implementation research.

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Previous research in the public health field, claims that a wider recognition has been seen in investigating which implementation strategies facilitate the adoption of interventions and health promotion programs in practice settings (Ramaswamy et al., 2019). Strategy is seen as the process directing and allocating resources to achieve execution, also called strategic management. Strategic management within organizations and decision-making processes is an approach to address complexities that comes with multifaceted systems and multisectoral collaborations (Brown & Malekpour, 2019). Durlak and DuPre (2008) emphasizes that transferring interventions into practice settings is a long-term and complicated process which involves dealing with the complexity of program diffusion.

Previous research about the implementation of the Agenda 2030 at municipal level in Sweden, state the that there is a gap between policy and implementation, whereas the

implementation of the SDGs has a risk of becoming “…an indicator-based reporting exercise” (Gustafsson & Ivner, 2018, p.305). Even though the municipality plays a significant role for the implementation of Agenda 2030, there is little research about the implementation of the SDGs from local governments, due to the fact they are newly launched (Gustafsson & Ivner, 2018). Fortune et al. (2018) explains that in order to accelerate the implementation of Agenda 2030, it is significant that the sustainable development and health promotion movement shares their priorities and exchanges relevant experience and knowledge. The achievement of the SDGs can be obtained by enhancing the ability to learn from documented evidence and practical examples in order to maximize the full potential of the public health.

2.7 Community organization for Health Promotion – Bracht’s five-stage

model

Bracht, Kingsbury and Rissel (1990) has developed a five-stage model which is a planning and implementation model for organizing health promotion. Bracht’s five-stage model is relevant in this study because it aims at the development and community mobilization of local public health work, with a focus on empowerment and participation. This is relevant for the implementation of Agenda 2030 at municipal level since local governments are health actors that advocates intersectoral participation and community empowerment in the transition for a sustainable development.

Bracht’s five-stage model is based on research in several disciplines, field experiences, components of strategic planning and organizational development, principles of community change and community empowerment theory. The overall aim of Bracht’s five-stage model is the mobilization of the local community to facilitate community empowerment in order to achieve social and health improvement. The community mobilization is possible through professional organizers or laymen, by establishing networks of government that enables the implementation of health program objectives. Bracht et al. (1990, p.86) defines community organization as “a planned process to activate a community to use its own social structures and any available resources to accomplish community goals that are decided on primarily by community representatives and that are generally consistent with local values”.

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Community development is achieved by conceptualizing strategies for community

organization practice. Bracht et al. (1990) emphasize the requirement of citizen ownership and community participation when planning strategies for locality development. Analysis and needs assessment are vital when planning for community change. Community

development involves the process of activating a community by shedding light and

identifying an existing problem or condition of priority within the community. The process of community activation also involves organizing change by the establishing of structures for implementation and maintenance of program solutions.

The five stages of the model involve; (1) community analysis, (2) design-initiation, (3) implementation, (4) maintenance-consolidation and (5) dissemination-reassessment (see figure 3). The community analysis requires assessing the community capacity by assessing community needs, resources, social structures and potential barriers to evaluate community readiness. Design and initiation involve establishing structures and identifying key

individuals and groups for the development of a collaborative relationship between the public sector and private groups. The implementation stage requires a sequential work plan that operationalize programs and activities and determine their priority. Program maintenance requires dealing with problems that occurred during the implementation process and incorporating key elements into community structures and ensuring community ownership. Incorporation requires a communitywide acceptance. Finally, the dissemination stage requires updating the community analysis, assessing the efficacy of the programs and summarizing results for future development of new interventions (Bracht et al., 1990).

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2.8 Problem formulation

Due to the fact that the Agenda 2030 is newly launched, little research has been conducted about how the SDGs are implemented at the municipal level to increase the feasibility. Previous research highlights that Agenda 2030 must be localized, the gap that is identified is between policy and implementation of the SDGs. It is stated that Agenda 2030 has a risk of becoming an indicator-based reporting exercise. Agenda 2030 is a public health policy that provides a guided framework that impacts the multifactorial determinants of health at all levels of government to ensure the highest state of well-being for individuals. Previous research emphasizes that public health and sustainable development are interconnected, since both fields strive to improve the social, physical and personal quality of individuals without jeopardizing future generation’s needs. It is of significance to analyze and

understand how local governments can improve and maintain the implementation of the SDGs to promote equity, reduce inequalities and ensure a sustainable development. Therefore, there is a need to attain more comprehensive approaches about the

implementation of the SDGs at the municipal level. A qualitative method in implementation research provides opportunities to investigate how and why certain implementation

strategies succeed or fail. Furthermore, this study focuses on two aspects; (i) identifying strategies that are used for implementing Agenda 2030 and (ii) identifying the challenges and possibilities for implementation.

3 AIM

The aim of the study is to investigate the officials’ experiences of implementing Agenda 2030 at the municipal level.

Research questions:

à What are the strategies for implementing the sustainable development goals (SDGs) within the municipality?

à Which are the officials’ experiences about possibilities and challenges for implementing Agenda 2030 at the municipal level?

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4 METHODS AND MATERIALS

In this section the study design, participants and setting, data collection method, analysis method, quality criteria assurance and ethical considerations will thoroughly be described.

4.1 Study design

Since the aim of the study is to investigate officials’ experiences about the implementation of Agenda 2030 in their municipality, a qualitative research method with an inductive approach was considered most appropriate. This study aims at gaining in-depth knowledge and new insights about the implementation process of the SDGs at municipal level. The ambition is also to shed light at challenges and possibilities in order to provide a knowledge compilation to address issues and facilitate the policy implementation process.

Therefore, a qualitative method was considered relevant to the current study since it provides an opportunity to study the phenomena in the setting where they are found. Aspers and Corte (2019) explains that knowledge is formed through the subjective experience of individuals and gathered by an up-closed investigation where the participants experience the study issue. This study commences by broadly describing the significance of implementation research in relation to the SDGs. Further, narrowing down to the specific through the collection of data to describe which key factors need to be considered in order to facilitate the policy

implementation process of the Agenda 2030. An inductive approach means organizing the collected data from a bottom up methodology, through building categories, patterns and themes to present more abstract units of data (Creswell & Creswell, 2018). Kvale and Brinkmann (2009) argues that knowledge is formed by the interaction between the interviewee and researcher in qualitative research, therefore, interviews was chosen as the data collection method in the study.

4.2 Participants and setting

A purposive sampling method was selected to recruit participants to the study. Bryman (2008) explains that a purposive sample involves a thought-out strategic technique to answer the aim of the study by choosing study participants that have relevant knowledge and

experiences related to the research problem. The participants in the study are officials working in Swedish municipalities. The inclusion criteria were (i) officials that are currently working at municipal level and (ii) experience in planning, coordinating and implementing the SDGs within the municipality.

The author found an example compilation made by SALAR, who had listed 121 municipality initiatives regarding the implementation of SDGs, together with contact information to the municipality or directly to the responsible official. An information letter was sent to 20 municipalities that stated that they had begun to work with the Agenda 2030 (see Appendix

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A). The selection of municipalities was based on a variation in population size, commuting patterns and proximity to larger urban areas. The purpose was to attain variation in relation to differences in economic conditions, population composition, geography and political governance in order to gain different perspectives about the implementation of the SDGs. The first ten municipalities that gave their consent to participate were included in the study. The municipalities that participated are classified by SALAR (2016) as (i) large cities and municipalities near large cities, (ii) sized towns and municipalities near medium-sized towns and (iii) smaller towns, urban areas and rural municipalities. The information letter that was sent included information about the aim of the study, ethical considerations and an interview schedule. The information letter gave the participants the opportunity to read about their rights and to give their consent to participate.

In total, ten interviewees from ten different municipalities in Sweden participated in the study. Three males and seven females participated. The official positions were; quality coordinator, environmental strategist, community building manager, municipal strategist, unit manager for sustainability and the development department, developer with a focus on public health and equality, public health strategist, planning manager at the city management office in the area of public health.

4.3 Data collection

Semi-structured interviews were conducted to collect data in the study. Semi-structured interviews are not a regular conversation, nor is it a closed questionnaire, it is a conversation that allows to ask suggested questions based on themes (Kvale & Brinkmann, 2009). Semi-structured interviews provide the opportunity for interviewees to speak freely with no constraint by instruments and scales (Creswell & Poth, 2018). An interview guide was constructed to structure the interviews (see Appendix B). An interview guide is explained by Bryman (2008) as the setup of suggested questions. The questions in the interview guide were based on the Quality Implementation Framework (QIF; Meyers, Durlak and

Wanderman, 2012).

The interview question was categorized into four themes from the four phases in the QIF; (1) initial consideration regarding the host setting, (2) creating a structure for implementation, (3) ongoing structure once implementation begins and (4) improving future application. Semi-structured interviews allow flexibility during the interview process, which also allows the interviewer to be flexible regarding the order of the questions, to ask follow-up questions and to ask questions that are not in the interview guide if it is connected to the research questions (Creswell & Creswell, 2018).

A pilot interview was conducted with a development leader within a regional development administration due to her experience and knowledge. After conducting a pilot interview, a few sentence structures and concepts were modified to enhance comprehension of the question by adjusting terminology to the context. Two questions were erased after the modifications from the interview guide because its similarity to other questions.

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The interviews were conducted during a three-week period. The informants were located at their homes and other at their office. All contact was through e-mail and all interviews were conducted by Skype, Microsoft Teams, Zoom or phone calls. Due to the Covid-19 pandemic, digital interviews were an advantage since it enabled to conduct the interviews while

following World Health Organization (2020) recommendation of social distancing. Verbal information about the ethical considerations were given before each interview. The

interviews lasted from 23 to 44 minutes and the median length of the interviews was 31 minutes. Each interview was recorded with the application Voice memos. Thereafter, the data were transcribed verbatim and each interview was coded with an interview number.

4.4 Analysis

A manifest content analysis method was chosen to systematic and objectively analyze and describe the collected data. Elo and Kyngäs (2008) argues that, in order to enhance understanding of data, a content analysis in qualitative research enables to examine

theoretical issues and to gain new insights that obtains a sense of the world. The purpose is to provide practical guidance to action. A manifest content analysis focuses on the explicit content and describes the obvious visible components in the text. Graneheim and Lundman (2004) emphasize that reality is interpreted in several different ways, which means that a text can have multiple meanings. Trustworthiness in qualitative content analysis is dependent on the degree of accuracy of the interpretation of the text’s meanings. An inductive approach was selected to analyze the collected data, which means that an inductive content analysis reasoning commences by describing particular examples and then constructs the general knowledge to increase understanding about the phenomena (Elo & Kyngäs, 2008).

All of the interviews were verbatim transcribed, and each interview was coded with a number, for example, P1. The process of manifest content analysis is described by Graneheim and Lundman (2004) as the selection of meaning units, the construction of condensed meaning units, codes, sub categories and main categories. The manifest content analysis matrix was constructed, and meaning units was selected from the transcriptions. The meaning units are quotations that were considered relevant for the research questions. The purpose was to begin from the specific and thereafter construct the general. The meaning units were further condensed into a reduced statement, while preserving the core meaning. The condensed meaning units were thereafter openly coded into codes. Graneheim and Lundman (2004) explains that coding the condensed meaning units allows the data to be analyzed in a different way, since one word has to capture the relation to the context. After the open coding, several categories were created and then grouped under higher order headings by choosing codes that were similar or dissimilar to each other. The purpose was to reduce the number of categories and collapse categories that were similar or dissimilar. Nine

subcategories were constructed, which gives insights of the content of the main categories (see Table 2). The reduction of categories resulted in two main categories, (i) internal strategies to implement the Agenda 2030 and (ii) external strategies to achieve Agenda 2030. The main categories should answer the research questions according to Bryman (2008).

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Table 2. Illustration of grouping subcategories into main categories in the content analysis.

Subcategories Main categories

Integration of SDGs Internal strategies to implement Agenda 2030

Target approach

Internal knowledge- enhancing activities Lack of coherence

Political support

Involve local citizen External strategies to achieve Agenda 2030

Establish partnerships Support functions Knowledge exchange

Furthermore, after the constructions of categories in the manifest content analysis, each interviewee was contacted by e-mail. The e-mail consisted of the quotations with the highlighted statements and potential categories. Each interviewee was asked to judge the accuracy of the interpretation. Eight out ten confirmed that the categories represented their experience. Two interviewees asked for a few clarifications, and after being modified, the categories were approved. According to Creswell and Poth (2018), to establish credibility, seeking participants’ feedback is the most significant technique.

4.5 Quality criteria’s

In order to ensure quality in qualitative research according to Bryman (2008), it requires considering concepts such as credibility, dependability, transferability and confirmability. During the whole study process, continuous quality assurances were made. To enrich a variety of perspectives regarding the implementation of the Agenda 2030 at municipal level, a purposive sample was selected with a background variation of work positions, gender and regions. Graneheim and Lundman (2004) argues that a central aspect to attain credibility is the selection of participants that enable gaining in-depth perspectives about the study aim. Furthermore, according to Creswell and Poth (2018) a validation process involves assessing the accuracy of the research findings. The validation process combines closeness to the participants narratives, thick description and extensive field time. According to Creswell and Poth (2018), the application of at least two validation strategies is recommended. The two main strategies that were considered in this study were; (i) seeking participant feedback and (ii) thick description. Seeking participants feedback involved taking back the interpretation of the analysis to the interviewees by allowing them to judge the accuracy of the findings.

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Allowing the interviewees to determine the accuracy is the most crucial technique according to Creswell and Poth (2018) to establish credibility. Thick description requires generating detailed information about the selection of and participants characteristics, setting, data collection and analysis process. Thick description enables readers to attain detailed information and make assumptions about transferability. Transferability in qualitative

research refers to whether the findings can be transferred to another group, context or setting (Creswell & Poth, 2018; Graneheim & Lundman, 2004). Dependability can be assessed by a thick description about of the whole study process which allows readers to critically make decision about the quality of the methodology and its application, in order to examine to what extend the study findings are dependable (Bryman, 2008).

Another quality assurance that was conducted was the pilot interview together with a development leader from a regional development administration department due to her experience and knowledge. After the pilot interview was conducted, several questions were modified to enhance the comprehension of the interview questions which according to Kvale and Brinkmann (2009) can improve the quality of the interview. Bryman (2008) emphasizes the need for the interviewees to not interpret the questions differently in order to attain trustworthiness. Bryman (2008) argues that confirmability refers to the reassurance that the study is not influenced by personal values and interest. The collected data were verbatim transcribed in order to not influence the data by personal values and interest.

4.6 Ethical considerations

The four guiding principles; the consent requirement, the confidentiality requirement the information requirement and the utilization requirement, are essential when conducting research according to the Swedish Research Council (2002). Ethical consideration was considered by respecting the values, needs, rights and desires of the interviewees. Since the research question investigates the experiences of the official’s workplace, the interview question can be perceived as an invasion in one’s life because sensitive information can be revealed and put their institution highly visible. To address this challenge while respecting the interviewees values, needs, rights and desires, the author articulated in the information letter and verbally, their right to terminate their voluntary participation when they desired and that their confidentiality will be considered by protecting sensitive data from

unauthorized people and by presenting the results with an interview code to ensure that no study participants can be identified. The confidentiality requirement has been taken into account during the whole investigation process. The consent requirement was considered by the written and verbal agreement of the interview and the utilization requirement was considered by the information in the information letter and verbally that the collected data are only being used for study purposes. The information requirement has been considered by articulating in the information letter and verbally, about all the participants rights and ethical consideration during the whole investigation process.

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5 RESULTS

The result section will describe the categories that were identified in the manifest content analysis (see Appendix C). To answer the research questions, two main categories were constructed; (i) internal strategies to implement Agenda 2030 and (ii) external strategies to achieve Agenda 2030. The nine subcategories will further provide in-depth insights into the content of the main categories. Only the strategies that were identified are included in the result section as subcategories. The challenges and possibilities are integrated into each of the subcategory sections.

5.1 Internal strategies to implement Agenda 2030

Several municipalities officials explained the importance of providing internal enhancing activities within their municipality. The first step of implementing Agenda 2030 is to

understand what it is, the broadness of the SDGs, the role of local governments and how the SDGs can be integrated into their core existing municipality goals.

5.1.1 Internal knowledge-enhancing activities

It emerged that one of the most common activities related to the Agenda 2030 is internal knowledge-enhancing activities. The aim of internal knowledge-enhancing activities was to improve managers and official’s knowledge about the SDGs and analyze how Agenda 2030 is compatible with their core organizational goals. Several officials explained that enhancing their knowledge about Agenda 2030 was essential to provide guidance to integrate all other municipality goals from other steering documents with the SDGs.

“We have had this working group [...] We started by talking about what Agenda 2030 is and what it contained, there were about 15 people in the group, and just like with the heads of administration, the first meeting to present Agenda 2030, it was also what it really is and what it contains.” – P5

It was further explained that the political knowledge and engagement was vital for keeping the interest alive of implementing the Agenda 2030. By working with the political knowledge of the SDGs it provides prerequisites for prioritizing funding into the policy implementation process and to work with SDGs over the entire mandate period. A challenge that arose was political disagreement among the different political parties that rule the municipality, which could be problematic when all parties have to agree on a decision on how to prioritize Agenda 2030. Furthermore, political disagreement was explained as a challenge that could obstruct working long-term with implementing the SDGs.

“We have seven parties that rule together, they have to agree on the decisions and then it can be difficult to push certain questions. It is also very much about working with political knowledge on the issue (Agenda 2030) [...] working long term to work over an entire term of office…” – P3

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5.1.2 Integration of SDGs into municipality steering documents

Another common strategy among the municipalities was the integration of the Agenda 2030 into their own municipality development goals by revising their steering documents and making them compatible with the SDGs. After conducting a needs assessment, the SDGs were prioritized and localized. Several officials explained that they made current state analysis to analyze how the implementation affects their municipality tasks. By aligning the SDGs with steering documents, local goals and local plans, it enables an integrated approach to holistically work with the sustainability dimensions of Agenda 2030.

“When we work with, for example, public health and equality, we look at what global goals [...] which of these 17 goals fall below public health goals and are compatible” -P7

One of the purposes of mapping compatibility of SDGs with municipality core goals, plans and visions is to avoid working parallel with the same goals. All municipalities have been working with sustainability before the statue of the Agenda 2030, hence much of the overall aim of the SDGs is already being implemented. An integrated approach enables avoiding working parallel since several goals overlap with each other, it creates coherence and allows to develop strategies to work intersectoral because of the broadness of Agenda 2030.

“The municipality is a broad business [...] it takes time to get started, so it is

important to get the agenda together with the development goals that exist to get the same process, so that you do not work in parallel with different things but focus together the work and improve effectiveness.” – P2

It was further explained that several municipalities had challenges in avoiding goal conflicts. As mentioned, many SDGs overlap with existing municipalities development goals and many officials explained it as confusing and overwhelming with a lot of issues to consider. The challenge that several officials experienced was concerns about losing construct that are vital to the sustainable development of community due to the lack of coherence of new constructs that needs to be consider when working with the SDGs. The lack of coherence hampered the integration of Agenda 2030 into their municipality’s development goals. Lack of coherence also created confusion among

“And then we have these environmental goals, and the public health goals that are at national level [...] there is a lot to hang up on” – P5

One municipality dealt with goal conflict challenge by letting an external investigator examine the municipality development goals, plans and visions to investigate if there were any goals conflicts. The purpose was to examine if the municipality’s development goals and SDGs opposed or reinforced each other. The investigators’ report enhanced the

municipalities internal knowledge about how to work in a more integrated way and at the same time avoid goals conflicts.

“Looked at the extent to which we work with the agenda in an integrated way [...] overall programs, plans and visions to see if they reinforce each other, or if there are conflicts of objectives. She has done a GAP analysis [...] if they reinforce each

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other, if they enable each other, if there are no connections at all, if they limit or oppose each other in their strategies” – P10

5.1.3 Target approach

Another internal strategy for implementing Agenda 2030 locally was a target approach. One official explained that their municipality is planning programs and projects targeting specific SDGs. The target approach refers to specifically constructing programs, activities and

projects that contributes to achievement of the SDGs which also are relevant to their community development goals. Only one municipality stated explicitly that their internal strategy that contributes to the achievement of the SDGs is based on a target approach. The usage of Kolada measurement indicators was further explained as a facilitator to measure the municipalities contribution to the Agenda 2030.

“We will pursue these development goals; we will develop certain activities that are developed in project form [...] at Kolada, there are recommendations on how to measure to contribute to the agenda of the 2030 goals, some of the indicators we have included that we follow up on our common goals.” – P2

5.2 External strategies to achieve Agenda 2030

External approaches were another central strategy among municipalities to contribute to the achievement of Agenda 2030. The municipalities are advocating all sectors involvement in contributing to achievement of the SDGs by participating in networks, establishing

partnerships and involving local citizens to take action towards a sustainable future.

5.2.1 Establishing partnerships

It emerged that one of the main external strategies to implement Agenda 2030 is the

establishing of partnership. The officials explained that participating in networks and forums was perceived as giving more legitimacy to Agenda 2030. By establishing partnerships, it allowed officials to learn from other municipalities and stakeholders about their expertise to mobilize resources, pitfalls and successful projects. The establishing of partnerships was further explained as a prerequisite to improve innovations and to complement different expertise with the exchange of knowledge.

“Global Sweden, where the idea is to build networks with other municipalities and share interesting projects [...] at the service person level we participate in different networks [...] where you discuss sustainability projects, what you do or what you have done.” – P1

The participation in forums and networks is described as constructing platforms to improve sustainable practices with the aim to improve actions and impacts. The exchange of

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knowledge and enhancing competencies was further explained as a prerequisite to accelerate the effectiveness of achieving the Agenda 2030.

“Each administration has looked at knowledge initiatives based on how we

implement 2030. We have been to external conferences and for example the Forum for Gender Equality [...] where the entire conference was about gender equality from Agenda 2030 perspective.” – P7

A challenge that emerged is the differences in conditions such as; population compositions, geography, political governance and economical prerequisites was a challenge for smaller municipalities for implementing the SDGs. These municipalities emphasized the need to be creative with the construction of cost-effective solutions.

“It's a little difficult for a small municipality [...] is a small municipality with small resources both in terms of personal resources and financial [...] much is related to the economy of course. There is a lot you could do if you had money. That is probably the big obstacle, and then it’s up to our politicians to prioritize where to put the money” – P3

Furthermore, another challenge that emerged was the ability to sustain partnerships over time. Each actor has their own internal dynamics and its own bureaucracy and its vital to emphasize all sectors responsibility to extend all partnerships that contributes to long-term prosperity.

“We see challenges especially in this collaboration, how to build collaboration that is sustainable in the long term” – P1

5.2.2 Involve local citizens

A common strategy that was identified was the involvement of local citizens in the sustainable development work. It emerged that one significant aspect was to create participation and engagement of the local citizen to contribute to the guiding principle of “leaving no one behind”. The citizens were involved in different ways. The municipality’s external information efforts aimed at enhancing the citizens’ knowledge by involving them in a collaborative relationship and creating local legitimacy for Agenda 2030. One municipality conducted an information campaign to teach children about the sustainability values and using thereafter, the video as a tool for spreading the municipality’s sustainability vision with the rest of its citizens.

“An information campaign, where we engaged elementary school [...] for a week they got to work based on the global goals [...] that movie is published on the municipality's website, it came out also as a commercial in SF cinemas” – P1 The involvement of the civil society is significant in the transition towards a sustainable future, hence the ability to engage the local citizens becomes an important aspect to ensure their participation. It emerged that one municipality involved their local citizen by having citizen dialogues out in the community. The citizen dialogue involved citizens’ opinion about which SDGs should be prioritized by the global community, their national government and

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their municipality. The dialogue with the citizens worked also as an awareness-raising activity to engage civil society and to build collaborative relationships.

“We have had quite a lot of citizen dialogues [...] out in the community with different groups and there they actually got to prioritize what Agenda 2030 goals they think the municipality should work with [...] people in the city had the opportunity to prioritize three priority goals for Sweden, the world, and the municipality.” – P9 It was explained that establishing partnerships was essential because associations and civil society for instance, are those who will have the most cost-effective approaches for achieving the SDGs. For example, local citizens can put demands on products and companies that contribute to global sustainable development.

“I think that you have to work with partnerships, with associations, civil society, at a lower cost, they will achieve more of what municipalities themselves can do. There, you need to collaborate very much.” – P1

6 DISCUSSION

The discussion section critically discusses the methodology and study findings in relation to scientific literature.

6.1 Method discussion

The method section will discuss the choice of study design, the participants and setting, data collection, analysis and ethical considerations in this study. The quality criteria that will be discussed are; credibility, transferability, dependability and confirmability which describes the central aspects of trustworthiness.

6.1.1 Discussion about study design

Since identifying facilitators and barriers is a central task of implementation research, the qualitative method becomes a valuable instrument because it helps answering questions such as, how and why certain implementation strategies fail or succeed (Hamilton & Finley, 2020). The aim of the study was to investigate the officials’ experience of implementing the Agenda 2030 within their municipality, hence a qualitative method was considered most appropriate. According to Hamilton and Finley (2020), a qualitative method in

implementation research operates as a critical approach to where implementation occurs to discover and document the context. A qualitative method in implementation research also enables to discover and document the policy implementation process, to examine the effectiveness of implementation strategies and the relationship between concrete and

Figure

Table 1. Seven guiding principles for health promotion. Obtained from Rootman (2001).
Figure 1. Illustration of the relationship between sustainable development and public health
Figure 2: Agenda 2030 with the 17 Sustainable Development Goals. Obtained from the Government of  Sweden (2018)
Figure 3. Illustration of community organization stages. Obtained from Bracht et al. (1990)
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