Implementation of public health tasks by Polish municipalities in 2019-2024: a cross-sectional study

Public authorities, including local government units, play a fundamental role in shaping public health (PH) policy. To date, the activities of self-government communities in the domain of PH have not been the subject of scholarly research. The study aims to characterise the activity of Polish municipalities in implementing PH tasks during the period 2019-2024.

The cross-sectional survey was conducted via Computer-Assisted Web Interview using a proprietary questionnaire prepared with input from experts in PH. All municipalities in Poland were invited to participate (N = 2,479). Statistical analysis was conducted using IBM SPSS Statistics 29, which included frequency analysis, Mann-Whitney U tests, Kruskal-Wallis tests, and cross-tabulations with a chi-square test of independence. Verification was conducted to determine whether the type of municipality, the province in which it is located, the number of employees in the municipal office responsible for PH issues, the operation of healthcare entities within the municipality, and the existence of a Municipal Development Strategy influence the implementation of PH tasks.

The analysis included responses from 601 municipalities, with 69.9% having performed PH tasks between 2019 and 2024. Rural municipalities perform PH tasks less frequently (χ ² = 17.20; p < 0.001), including prevention programmes, compared to urban municipalities. Municipalities that conducted PH tasks have statistically significantly more employees (Z = -6.80; p < 0.01) and hospitals (χ ² = 10.18; p = 0.001). Moreover, the presence of a Municipal Development Strategy during the analysed years was also significantly linked to the implementation of these tasks (χ ² = 10.16; p = 0.006). However, no statistically significant correlations were found when comparing different provinces.

Adequate measures should be implemented to support the development of health policies in smaller local authorities. Factors that warrant particular attention are the number of employees involved in PH tasks, the number of potential task implementers, and the existence of a Municipality Development Strategy.