Prioritising Public Health Services in Danish Municipalities: A Political Balancing Act

Prioritisation in public health is complex, as decision-makers must allocate limited resources across diverse health concerns, risk factors, and target groups. In Denmark, municipalities play a central role under the Danish Health Act §119, which mandates health promotion and preventive services. However, municipalities face challenges in balancing competing needs without clear guidance. This qualitative study explores how municipalities navigate public health prioritisation, through in-depth interviews with 21 health directors and managers from 15 municipalities, selected for demographic, socio-economic, and geographical diversity. Data were analysed using systematic text condensation (STC). The findings highlight the following six themes which are central to understanding how municipalities prioritise within health promotion and prevention: (1) Economic considerations: Prioritising short-term, patient-focused services under budget constraints, (2) Public health data: Prioritising services based on locally identified health challenges, (3) Legal frameworks: Focusing on mandated services amid ambiguous legislation, (4) Evidence and evaluation: Selecting interventions with perceived effectiveness, (5) Political context: Aligning health priorities with agendas and ideological acceptability, and (6) Demographic and geographic conditions: Adapting services to local realities. We find that municipalities adopt a pragmatic, consensus-driven approach, but prioritisation processes vary, leading to disparities in service provision. Using Kingdon's Multiple Streams Framework, we discuss how municipalities frame health issues, select policy solutions, and navigate political contexts. The study highlights the need for clearer national frameworks to promote equitable public health access.