Determinants of an integrated public health approach: The implementation process of Greenland’s second public health program

Greenland struggles with a high prevalence of smoking, alcohol and drug abuse. Combined with dietary changes, these factors drive most death and disability in Greenland. In response to the increasing need for preventive initiatives, the comprehensive public health program Inuuneritta was implemented in 2007. Evidence-based evaluations of comprehensive public health programs represent a major knowledge gap. Furthermore, most research describing integrated policy approaches are set within organisational, not governmental, settings. This paper aims to augment the empirical evidence on the implementation of integrated health promotion programs within a governmental setting. In this study, the constraining and facilitating determinants of the implementation processes within and across levels and sectors were examined. Qualitative methods with a transdisciplinary approach were applied. Enabling determinants influencing the implementation process related to: 1) adopters’ high motivation, 2) Inuuneritta’s topic areas being compatible with adopters’ perceptions of health issues in Greenland, 3) an operation-based schedule assisted work efforts, 4) health consultants had relevant educational backgrounds, 5) community health workers
(CHWs) made use of the local knowledge available to them, 6) existing local prevention committees supported CHWs, 7) initiation of the central prevention committee. In contrast, constraining determinants included: 1) ambiguous aims,
2) CHWs lacking tools and guidance, 3) CHWs’ low education level, 4) high turnovers, 5) separated budgets and work environment, 6) inconsistent central prevention committee. Inuuneritta II has provided a substantial framework for an integrated health policy approach. However, its integrated approach does not harmonise with the government’s inflexible organisational structure resulting in insufficient implementation.