The Swedish Agency for Public Management
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Evaluation of the Swedish Government's alcohol, drugs, doping and tobacco policy strategy (2015:9)

The Swedish Agency for Public Management (Statskontoret) was commissioned by  the Swedish Government to evaluate the Government's overall alcohol, drugs, doping and tobacco policy strategy (known as the ADDT strategy). The strategy was initiated in 2011 and continues until the end of 2015.

The ANDT strategy's design is appropriate

Statskontoret's overall conclusion is that the strategy's design has largely been appropriate to achieving the Government's goal of addressing the problems associated with the use and misuse of alcohol, narcotics, doping products and tobacco. Nevertheless, Statskontoret still believe there is a need to develop certain aspects of the strategy, provided that work in the field of ADDT will continue to have a similar focus after 2015.

The goal structure provides good support …

Statskontoret's assessment is that the ADDT strategy has contributed to providing a solid foundation for the Government's ADDT policy. The goals are easy to communicate and the goal structure is familiar to those working on ANDT issues at different levels in the community. Accordingly, no significant changes should be made to the current goal formulations or goal structure.

… but needs to be adjusted

The prioritised goals focus on processes, structures and results at the population level. Prioritised goals focusing on processes and structures have a more direct link to the measures that are implemented in the ADDT strategy than results goals as the measures focus on improving processes such as collaboration and the use of methods. Statskontoret therefore believes that all the prioritised goals should be formulated as process or structural goals. This would make the link between the goals and the measures clear and make the goal structure more consistent. 

Certain prioritised goals express the current status instead of the direction desired, for example the goals concerning tackling offending and health promotion in schools. In order for the goals to exert more control over the work and make it easier to monitor the strategy, Statskontoret believes that the Government should consider formulating all prioritised goals in a way that expresses the direction desired.

Over the course of the current strategy period, there have been tobacco policy goals that have overlapped with goals in the ANDT strategy. Ahead of a potential future strategy period, the Government should also ensure that there are no parallel goal structures within the field of ADDT.

The measurements from indicators for goal fulfilment exceed the strategy's scope of impact

The Government's aims for the indicators in the ADDT strategy have mainly been that they make it possible to monitor the ADDT strategy and that they be limited in number. The current proposals for indicators to be used for monitoring the prioritised goals are extensive and are in danger of becoming costly if they are implemented in full. Several indicators measure variables that the measures in the strategy have no impact on. Statskontoret believes the Public Health Agency of Sweden should therefore differentiate between the indicators for the prioritised goals that look at the results of measures and the indicators which look at factors that the measures are not able to affect. The focus should subsequently be on the former. This can contribute to a reduction in the number of indicators.

Double monitoring systems for ADDT inefficient

The Public Health Agency of Sweden is currently responsible for two databases supplying indicators that will be linked to the ADDT goals. There are both gaps and overlaps between these systems, which can create unnecessary additional work and a lack of clarity for external stakeholders. Statskontoret believes that the Public Health Agency of Sweden should review the need to have two databases for monitoring developments in the field of ADDT.­­

Indicators need to be broken down at the regional and local levels

The municipalities are an important target group for the ADDT strategy, but have limited use for the ADDT indicators. The majority of indicators measure development at the national level, but not the regional or local level. Statskontoret believes that the Public Health Agency of Sweden should speed up its effort to make the indicators usable at the regional and municipal levels.

The gender equality perspective needs to be made clear

The Government rarely justifies the ADDT measures on the basis of a gender equality perspective, nor does it demand that ADDT-funded measures contain a gender equality perspective. However, there are clear differences between women and men in terms of the consumption and harmful effects of ADDT; although the gender differences with respect to alcohol have decreased in the last 20 years. In many cases, men are a more vulnerable group in terms of misuse, accidents and deaths. Statskontoret believes that the Government should make it clear which measures are expected to have a gender equality perspective or may have an impact on gender equality.

The Public Health Agency of Sweden should be given a clearer responsibility in the field of ADDT

The Public Health Agency of Sweden has nationwide responsibility for public health matters. This covers such issues as those concerning alcohol, drugs, doping and tobacco. Statskontoret's evaluation indicates that the ADDT strategy has contributed to providing a foundation for the Government's ADDT policy and that the Government's measures largely contribute to the ADDT policy goals being achieved. Work on the current strategy has therefore transitioned into a more administrative phase.

Consequently, Statskontoret believes that the Government should consider providing the Public Health Agency of Sweden with more extensive responsibilities in a future ADDT strategy. Aside from its current responsibility for monitoring, the Agency should be given the task of assessing the need for government agencies' annual situation reports and drawing up proposals for an alternative to these for the Government. In addition, the Agency should be responsible for anchoring the strategy among stakeholders in the field of ADDT. Furthermore, the Government should give the Public Health Agency of Sweden the task of improving the support it provides to the county administrative boards' coordination offices for ADDT matters via its appropriation directions or instructions.

The Public Health Agency of Sweden offers support to the regional ADDT coordinators at the county administrative boards. What this support is to entail is, however, unclear. According to Statskontoret, the Government's management of the Public Health Agency of Sweden with respect to support to the county administrative boards' coordination offices is unclear. The task of supporting the county administrative boards is mentioned neither in the Public Health Agency of Sweden's instructions nor its appropriation directions.­ However, this task is addressed in the Government's programme of ADDT policy measures.

The Government should assess new ways to disseminate information about the strategy

Over the course of this strategy period, the Government has published an annual programme of measures in order to set out the current ADDT policy measures. However, the opportunity to use the programme has been limited by the fact that publication takes place late in the year. In addition, many measures extend over several years, which reduces the need for reporting to be done annually. The data, in the form of annual situation reports provided by government agencies to the Government, also involves additional work for these agencies. Accordingly, Statskontoret believes that the Government should assess ways to compile and disseminate information about its ADDT policy measures other than a printed annual publication.

Measures in the ADDT strategy can contribute to achieving the goals in the long-term

Statskontoret's assessment is that the Government's ADDT measures contribute to achieving the goals of the ADDT strategy in the majority of cases. The aims of these measures are linked well to the goals, their results are consistent with their aims, they are usually based on evidence and experience, the funds that have been allocated have largely been used and the majority of the measures are long-term.

Many measures are focused on building up knowledge and, to some degree, disseminating knowledge, which are two of central government's key roles in the field of ADDT. This type of measures has a limited chance of having an impact on the goals during the strategy period as any effects are also dependent on the new knowledge being processed through dissemination, implementation and administration.