Local and regional approaches to demographic change in the Nordic countries
Ingrid H G Johnsen & Liisa Perjo
NORDREGIO WORKING PAPER 2014:3
Local and regional approaches to demographic change in the Nordic countries
Local and regional approaches to demographic change in the Nordic countries
Ingrid H G Johnsen & Liisa Perjo Local and regional approaches to demographic change in the Nordic countries
Nordregio Working Paper 2014:3
ISBN 978-91-87295-20-1 ISSN 1403-2511
© Nordregio 2014
Nordregio P.O. Box 1658 SE-111 86 Stockholm, Sweden [email protected] www.nordregio.se www.norden.org
Editors: Ingrid H G Johnsen & Liisa Perjo Cover photo: Magnus Fröderberg / norden.org
Nordic co-operation Nordic co-operation is one of the world’s most extensive forms of regional collaboration, involving Denmark, Finland, Iceland, Norway, Sweden, and the Faroe Islands, Greenland, and Åland. Nordic co-operation has fi rm traditions in politics, the economy, and culture. It plays an important role in European and inter- national collaboration, and aims at creating a strong Nordic community in a strong Europe. Nordic co-operation seeks to safeguard Nordic and regional interests and principles in the global community. Common Nordic values help the region solidify its position as one of the world’s most innovative and competitive.
The Nordic Council is a forum for co-operation between the Nordic parliaments and governments. The Council consists of 87 parliamentarians from the Nordic countries. The Nordic Council takes policy initiatives and monitors Nordic co-operation. Founded in 1952.
The Nordic Council of Ministers is a forum of co-operation between the Nordic governments. The Nordic Council of Ministers implements Nordic co-operation. The prime ministers have the overall responsibility. Its activities are co-ordinated by the Nordic ministers for co-operation, the Nordic Committee for co-operation and portfolio ministers. Founded in 1971.
Nordregio – Nordic Centre for Spatial Development conducts strategic research in the fi elds of planning and regional policy. Nordregio is active in research and dissemina- tion and provides policy relevant knowledge, particularly with a Nordic and European comparative perspective. Nordregio was established in 1997 by the Nordic Council of Ministers, and is built on over 40 years of collaboration.
Stockholm, Sweden, 2014 Contents
1. Introduction ...... 9 Examples of local and regional approaches to demographic change ...... 13 2.1 In-migration...... 13 2.1.1 The in-migration project in Nordland ...... 13 2.1.2 The “Närpes model” for integrating immigrants ...... 17 2.2 Promotion of social mobility and inclusion ...... 21 2.2.1 Young people as a resource for sustainable regional development in Kalmar County ...... 21 2.3 Access to services...... 24 2.3.1 Cross-border health care in Tornedalen ...... 24 2.3.2 Distance Health Care in Sydjylland, Denmark ...... 27 2.3.3 Improving educational opportunities in Northwest Iceland ...... 29 2.4 Improving regional attractiveness ...... 31 2.4.1 The regional attractiveness of Sør-Trøndelag ...... 31 2.4.2 Facing demographic challenges in Hedmark-Dalarna ...... 34 2.4.3 The “We Choose the Faroe Islands” campaign ...... 37 2.4.4 Cold Hawaii in Nordjylland, Denmark ...... 39 3. What can be learned from these examples? ...... 43 4. Directions for future research ...... 45 References ...... 47
1. Introduction
Th e Nordic countries are currently undergoing dramatic Th e examples address the following main themes. demographic changes that aff ect almost all policy areas at the municipal, regional, and national levels. As an exam- In-migration, geographic mobility and matching la- ple, the ageing population increases demand for health bour demand with supply (the In-migration project in and elderly care and at the same time decreases labour Nordland, Norway and the “Närpes model” for integrat- supply, which may cause a labour shortage and weaken ing immigrants in Finland) the tax base. Th ese complex and interrelated issues re- Promotion of social mobility and inclusion (young quire action in many areas. In the Nordic countries, many people as a resource for sustainable regional development demographic changes infl uence the policy areas that con- in Kalmar County, Sweden) cern municipal and regional authorities, and in some Access to services (cross-border health care in cases, the areas for which they are responsible. Th e room Tornedalen, Finland/Sweden; distance health care in for manoeuvre of local and regional authorities is both Sydjylland, Denmark; access to education, in Northwest limited and supported by the national policy framework, Iceland) and in many cases, they can develop solutions to address Regional attractiveness (regional attractiveness in Sør- challenges and to utilise opportunities for demographic Trøndelag, Norway; facing demographic challenges in change within their territory. Hedmark-Dalarna, Norway/Sweden; We choose the Far- Th e “Innovative Local and Regional Approaches to De- oe Islands campaign in the Faroe Islands; Cold Hawaii in mographic Change” project commissioned by the Nordic Nordjylland, Denmark) Working Group for Demography and Welfare has stud- ied selected local and regional examples of measures to Th e examples of these themes cover a variety of demo- address demographic change. Th e project and this report graphic challenges and policy areas. Th e two examples as its outcome build on the Nordic Demographic Hand- on in-migration in particular address the mismatch be- book (Nordregio 2012) and complement it by highlight- tween labour demand and supply that can result from ing a variety of local and regional examples of measures out-migration or population ageing, among other caus- to manage a variety of demographic changes. Th e 2012 es. Th e examples related to social mobility and inclusion handbook provides local and regional authorities with focus on the ways in which inclusion and involvement of tools to identify demographic challenges and a list of ex- population groups can infl uence trends; for example, by amples of ways in which challenges have been addressed mitigating out-migration or ensuring the availability of by other regional and local authorities in the Nordic labour. Th e examples related to access to services focus countries. As a continuation of the Nordic Demographic on aspects such as the logistical and resource-related dif- Handbook, this project examines some examples of meet- fi culties of service provision in areas that are sparsely ing demographic challenges in greater depth and hope- populated or that have an ageing population and/or a fully provides inspiration and explains lessons learned on scarcity of resources in health care services. One of the how those challenges can be met. examples of the theme of “access to services” also high- Th is report presents a variety of local and regional lights the role of provision of education as a way to miti- examples of diff erent ways to adapt to the demographic gate out-migration. change and to mitigate unwanted demographic develop- Some examples that have a more general approach to ment, from project-oriented initiatives to more strategic regional attractiveness are included to show how mu- approaches, including both top-down and bottom-up ini- nicipalities and regions characterised by out-migration tiatives. Many of the examples in this report cover several work with holistic approaches to attract new inhabitants, themes related to demographic change, both directly and tourists and businesses. Developing the specifi c assets of indirectly. Th ese examples are chosen based on discus- a region to attract business and residents can be one way sions with national experts in the Nordic Working Group to counteract out-migration and the challenges posed by on Demography and Welfare as well as on desk study and an ageing population. interviews.
NORDREGIO WORKING PAPER 2014:3 9 Heading
Northwest NR_0746 Iceland
©
N
Tornedalen f Finland & NLS ordregio
Faroe Islands Nordland
o
r administrative boundar r administrative
km 1000
500
0
ies
Sør- Trøndelag Närpes
Hedmark-Dalarna
Case study areas
Municipality: Närpes (FI) Regions: Kalmar (SE) Nordjylland (DK) Nordjylland Nordland (NO) Kalmar Northwest Iceland (IS) Sør-Trøndelag (NO) Sydjylland (DK)
Cross-border regions: Hedmark-Dalarna (NO, SE) Sydjylland Tornedalen (FI, NO, SE) National boundary Self-governing nation: Regional boundary Faroe Islands (FO) 0 100 200 Municipal boundary § km
10 NORDREGIO WORKING PAPER 2014:3 Th e examples are primarily intended to serve as inspi- amount of demographic vulnerabilities of each case ration for regional and local authorities but could also study areas based on the demographic vulnerability inspire national policy-making and provide new in- map. Th e indicators that are used to show the complex- sights into the characteristics of successful ways of ity of demographic challenges in the map are the per- both addressing demographic challenges and building centage shares of diff erent age groups of the total popu- on the opportunities off ered by changing demographic lation (0-14 years, 15-24 years, 25-54 years, 55-64 years, structures. Even though all of the examples presented 65 years and over), the total number of females per 100 are bound to specifi c historical and institutional back- males, the total number of females in age group 15-64 grounds, they can promote exchange of experience and years per 100 males in age group 15-64, the total num- provide general lessons concerning potential success ber of live births per 1000 inhabitants, the total number factors in responses to demographic change across of deaths per 1000 inhabitants, and net-migration. Nordic regions and municipalities. Th e vulnerability map as well as the other maps can To provide a better understanding of the context of be found in the handbook that is available at http:// each example, a short description of the demographic www.nordregio.se/en/Publications/Publications-2012/ challenges of the municipality or region is provided Att-mota-demografi ska-forandringar/. More detailed in the introduction to each initiative. Th e background information about the technical notes concerning the information is based on the maps in the Nordic De- maps and indicators can also be downloaded. mographic Handbook. Th e maps provide one way of Th is report fi rst presents all the examples separately studying the demographic vulnerabilities of Nordic and then discusses them in combination in the fi nal municipalities and off er information such as the num- conclusions. All the examples are presented in a shorter ber of diff erent types of demographic vulnerabilities of form on Nordregio’s web site, where they are also locat- a specifi c municipality, such as low birth rate. ed on a map showing their geographic locations within Connected to each of the examples, we present the the Nordic Region.
Map 1. Geographic locations of the case study areas of the examples. Map design: Linus Rispling.
NORDREGIO WORKING PAPER 2014:3 11 12 NORDREGIO WORKING PAPER 2014:3 2. Examples of local and regional approaches to demographic change
2.1 In-migration 2.1.1 The in-migration project in Nordland Regional Development (KRD). Th e idea of the in-mi- Th e in-migration project (“Tilfl ytningsprosjektet”) in- gration project was to attract immigrants to meet cur- tended to attract new citizens to the county and has rent and future needs for skilled labour, especially in focused specifi cally on work, housing, integration, and health care, engineering, and fi sheries/aquaculture. language education for the people moving to the coun- Th e project also aimed to make Nordland more visible ty. It was implemented by the Nordland County Coun- as an attractive place for employment, business crea- cil in co-operation with the Norwegian Labour and tion, research, and entrepreneurship from an interna- Welfare Service (NAV), the Confederation of Norwe- tional perspective.2 Th e project was initially named gian Enterprises (NHO), the Norwegian Association of “Migration–Recruitment–Integration, Exploring Po- Local and Regional Authorities (KS), and the Centre of tential for New Settlement and Integration of Immi- Competence for Rural Development (KDU), and it re- grants and other Newcomers in Selected Communities ceived funding from the Ministry of Regional Develop- in Nordland”.3 ment and Local Authorities. Th e purpose of the project was to explore opportu- Nordland County is situated in Northern Norway. nities to attract immigrant labour, and for immigrants Th e county consists of 44 (mainly small) municipali- to become important resources in eff orts to revitalise ties, and the county administration is situated in the and develop small communities in the county. Th e main city of Bodø, which has approximately 44,000 long-term goal was to increase permanent settlement inhabitants. Th ere are vast diff erences between the in Nordland, and fi ve main priorities to achieve this municipalities and in the extent of their demographic were outlined: 1) Obtain an overview of the industries challenges. Th e smaller municipalities are vulnerable and agencies that will have trouble with future recruit- on at least seven of 10 indicators of demographic vul- ment; 2) Facilitate the marketing of selected munici- nerability listed in the Demographic Handbook.1 palities; 3) Facilitate the quality assurance of workers with vocational training from other countries; 4) Fa- Initiation cilitate settlement of migrant workers and other new- In response to the lack of skilled labour in many of the comers in the county, and include measures to identify smaller municipalities in Nordland, the county council opportunities for partners to fi nd work, as well as to in 2009 initiated a two-year project funded by the for- provide Norwegian language training and integration; mer Norwegian Ministry of Local Government and and 5) Initiate projects in one or more municipalities.4
2) Nordland Fylkeskommune (2013)
3) Tilfl ytting- rekruttering- integrering, utforsking av potensialet for ny bosetting og integrering av innvandrere og andre grupper tilfl yttere i ut- valgte småsamfunn i Nordland
1) Nordregio (2012): Map 1 4) Nordland Fylkeskommune (2013)
NORDREGIO WORKING PAPER 2014:3 13 ment Services and the Norwegian Labour and Wel- fare Administration (NAV EURES), the Directorate of Integration and Diversity (IMDi), the University of Nordland, and the county council’s own personnel or- ganisation. It became apparent that there was a need for clear goals for this pillar, and among the measures that the county council considered important to pri- oritise was a recruitment project with a focus on inter- nationalisation and international migration. Th rough collaboration with the Norwegian Embassy in Manila, the Philippines, the county council was able to obtain knowledge about the process of recruiting labour from abroad. Many of the municipalities have also worked with NAV EURES to advertise jobs abroad and with staffi ng agencies to recruit temporary staff for the lo- cal government. However, most migrant workers are recruited through the personal social networks of im- migrants already living in Norway. Language skills are a prerequisite for participation in society and the work-place. Th e aim of the second pillar, language, was to develop language training for the large groups of immigrants who are not eligible for the existing language training off ered by the public au- thorities, such as immigrants from the European Eco- Photo: Magnus Fröderberg/norden.org nomic Area (EEA) or the European Free Trade Asso- ciation (EFTA) countries One of the municipalities in Nordland, Hamarøy, decided to off er courses in Nor- Implementation wegian to all migrant workers. Participants pay only Nordland County Council chose to approach the a small fee (around 1500 NOK) for an 80-hour course project by dividing the work into four pillars: recruit- held on evenings and some weekends. Th e munici- ment, language, housing, and integration.5 Th e munic- pality also facilitates other initiatives, for instance by ipalities to be targeted in the project were chosen. One lending meeting rooms to a private company that off er employee in each targeted municipality was given re- courses in Norwegian for its employees. For migrant sponsibility for the preparation and administration of workers employed in the public sector, the municipal- each of the four pillars. In addition, a co-ordinator was ity off ers free language courses immediately aft er their responsible for organising seminars and meetings as arrival in Norway. well as co-ordinating the pillars and the work of the Th e third pillar, housing, involves many actors: the county council, municipalities, and participating or- Norwegian State Housing Bank (which is responsible ganisations/institutions. for the implementation of housing policy), municipali- Regarding the fi rst pillar, the recruitment of foreign ties, intermunicipal co-operation bodies, companies in workers was identifi ed as an important topic. It was de- relevant industries, educational institutions, and local cided to direct eff orts towards the recruitment of per- health care institutions. Because housing is primarily a sonnel from abroad, instead of targeting those who had municipal responsibility, the Nordland County Coun- already arrived in Norway. It quickly became appar- cil has limited infl uence over this issue. However, it of- ent that there was insuffi cient expertise on this subject ten collaborates with key players such as the Housing in Nordland. Th erefore, the county council arranged Bank and in a sense has taken on a role of promoter meetings with relevant partners, including Bodø mu- and co-ordinator in relation to local authorities and nicipality, Nordland Regional Council, Health North, others. Th e idea has been to include the construction of Nordland Hospital, the Norwegian Association of housing as an important part of development projects Local and Regional Authorities (KS), the Norwegian in the municipalities. Public Roads Administration, the European Employ- For the fourth pillar, integration, the aim was to improve the integration of immigrants by engaging 5) Nordland Fylkeskommune (2013) voluntary organisations and NGOs. Organised leisure
14 NORDREGIO WORKING PAPER 2014:3 activities are an integral part of Norwegian culture; eral. Th rough the project it became apparent that em- however, immigrants and children of immigrants are ployers in Nordland, particularly in the public sector, oft en under- represented in such activities. Th e reasons had to a limited extent developed strategies for recruit- for this are many but could be related to a lack of fi nan- ing from abroad and that certain employers seemed cial means and/or to cultural barriers and diff erences. sceptical of recruiting personnel from abroad because Th e focus was to create a model for integration of im- of cultural barriers. At the end of the project, there was migrants that could be transferred to other municipali- a study tour to the Philippines, which gave the partici- ties. Th ere has been a specifi c focus on children, youth, pants some insight into what was needed when recruit- and their parents. As part of this pillar, the intermunic- ing health care personnel from this specifi c country. ipal co-operation body allocated NOK 250,000 to sup- However, the absence of other stakeholders in the pro- port voluntary organisations in applying integration ject, such as health care facilities and universities and schemes to their activities. One example of the ways in colleges, and integration-related activities has made it which municipalities encourage integration is found in challenging to achieve any clear results from the eff orts the municipality of Andøy, which has made an action to integrate the immigrant labour force. plan for inclusion in the municipality. Among other Regarding the language pillar, geographic distance aspects, the action plan focuses on sports, and one ini- and the large number of municipalities in Nordland tiative on this theme has been the establishment of a were major challenges in off ering suitable language cafe run by the Lions service club that introduces new courses for immigrants. Th e immigrants are a diverse immigrants to the local community. group in terms of occupations and backgrounds, and thus have diff erent needs. Although many can pay Main challenges for tuition, many cannot—at least not for a long time, One of the main challenges has been the regulations which is a further challenge. regarding recruitment of labour from outside the Euro- With regard to integration, the above-mentioned pean Economic Area (EEA). It can be diffi cult to obtain strategy employed by Andøy has the potential for the required visa, and for health care professionals, transfer to other municipalities. At the same time, mu- there are special regulations regarding the validation of nicipalities in Nordland diff er greatly, and there is still degrees obtained outside the EEA, and Norway in gen- a need for concrete results from other municipalities.
Photo: Magnus Fröderberg / norden.org
NORDREGIO WORKING PAPER 2014:3 15 Many municipalities are small and vulnerable in terms been and will remain an important and active partner of resources for integration. in the work of strengthening the planning and con- Th e fi nal challenge relates to the opportunities for struction of homes in Nordland. municipalities to share their experience, as there are Finally, with regard to further integration, there has few venues where this actually occurs. Th ere has gener- been an eff ort to develop an educational programme ally been a need for more extensive sharing of infor- as well as to increase the knowledge and competence mation and expertise, and for increasing co-operation of municipal actors concerning these issues. Several between municipalities. Th e municipalities themselves municipalities have participated in a collaborative pro- have also taken little initiative in this regard, and one gramme to increase awareness, to build networks and has therefore tried to establish a system for knowledge to share knowledge and experience. sharing through the “Local Community Development Nordland County Council has decided to extend the in Municipalities” (LUK) programme, which is embed- project from 2014 to 2018. Th e new four-year project ded in the national regional development policy. One will include more participants and requires greater ef- of the aims of LUK is to assist the municipalities in forts while continuing the work undertaken in the fi rst the planning, mobilisation, co-operation, and imple- programme period. As part of this initiative, the KUN mentation of local development projects. Th rough the centre for gender equality was granted NOK 890,000 LUK programme, there has been an eff ort to develop a from the “Bolyst” national initiative and NOK 800,000 system for disseminating and sharing experience and from Nordland County Council to initiate the “Immi- knowledge.6 grants as a resource in Nordland” project.9 Th e idea is to develop a model of the ways in which local authorities Outcomes and continuity can structure the inclusion of immigrants, strength- Th e main priorities of the in-migration project have ening their ability to develop their own resources and been achieved with varying degrees of success. With to participate in Norwegian society. Th is work is be- regard to recruitment of foreign labour, the project has ing conducted in collaboration with the Vesterålen revealed an overall low level of competence and aware- Regional Council and the municipalities of Lødingen, ness in enterprises and municipalities concerning this Hadsel, Bø, Øksnes, Sortland, and Andøy. issue and the opportunities that recruiting from abroad off ers. As recruitment from abroad is demanding for Lessons learned and transferability individual companies, there is a need to develop exper- Th e project has managed to increase signifi cantly the tise, common systems, and co-operation to facilitate focus on the challenges associated with recruitment the recruitment processes. from abroad. It highlights the complexity of the issue, With regard to the adaptation of language courses, which also concerns language, housing and leisure, as there is still much to do, although some municipalities well as attitudes and knowledge. A key driver of project have found good solutions to off er to immigrants. Th is implementation has been the development of a com- work must be given priority in the future, as it is neces- prehensive and long-term strategy for recruitment and sary for language courses to be available to immigrants integration. throughout the whole county for them to integrate Many of the municipalities that need to recruit for- more easily into local communities.7 eign labour are small and therefore benefi t from in- With regard to the housing issue, the experience and termunicipal co-operation and partnerships with the conclusions from the project will contribute to pro- county council to establish networks and to enhance posed housing policy programme initiatives directed expertise in the recruitment of foreign labour. By by the county council. Resource allocation and prac- combining eff orts, collaboration can facilitate activi- tical organisation of the activities related to housing ties such as organising language courses or well-being need to be discussed further, but it has been proposed measures. However, one challenge is to encourage that the planning department of the county council municipalities to share their experience; thus, there should work in co-operation with municipalities be- should be a focus on creating arenas in which the mu- cause construction of housing is restricted by priorities nicipalities can meet, as the municipalities themselves in planning at the local level.8 Th e Housing Bank has take little initiative with regard to information sharing. Municipalities should also co-operate with local busi- nesses in recruitment processes to ensure correspond- 6) Nordland Fylkeskommune (2013)
7) Nordland Fylkeskommune (2013)
8) Nordland Fylkeskommune (2013) 9) Innvandrere en ressurs i Nordland
16 NORDREGIO WORKING PAPER 2014:3 ence between labour demand and supply. cross-sectoral co-operation). Th ose factors have been Much remains to be done, particularly in the area of studied in an extensive report by Mattila and Björklund language training and the development of a compre- (2013). Th is short presentation of Närpes’ approach to hensive recruitment plan for the municipalities. Th ere labour market-based immigration is based largely on is, however, an increased awareness that a response to that report as well as on discussions with a representa- this issue requires co-operation between public and tive from the municipality. private bodies as well as diff erent administrative levels According to Mattila and Björklund, the Närpes model (i.e., the municipal and county levels). contains several aspects: the existing positive attitudes Th ree main points may be highlighted with regard towards labour force immigration, various activities by to the transferability of the project. First, this exam- the municipality, the active role of employers, and a ple shows that one way for municipalities to succeed in relatively large proportion of immigrants in Närpes. the recruitment of foreign labour is to establish a com- Cross-sectoral co-operation and development of diff er- prehensive and long-term strategy for recruitment and ent aspects of integration (e.g., employment and hous- integration that includes issues such as housing, infor- ing) in a holistic manner has been essential as well. mation, co-operation, language training, and job sat- However, labour demand has been key to the success of isfaction.10 Second, the success of this comprehensive Närpes in integrating immigrants. Immigrants who strategy has depended on broad political participation have come to Närpes have already been employed in to place the issues on the agenda. For instance, the in- the municipality, which has made it easier for them to migration project has been politically well embedded integrate into the local community.11 in Nordland County. Migration, recruitment, and inte- Th e demographic profi le of Närpes is typical of many gration were also the themes of the regional planning municipalities in the Nordic countries. Th ere is a lack seminars during 2012, as well as conferences hosted by of people of working age, and fewer women than men, the regional councils that contributed to placing these but a positive infl ow of international migration. In to- issues on the political agenda. Finally, because single tal, there are approximately 9,000 inhabitants in the municipalities oft en do not have the resources to initi- municipality. Map 1 in Part one of the Demographic ate collaboration with other municipalities, the county Handbook (2012) shows a set of indicators of demo- administration can have an active role in creating fo- graphic vulnerability and indicates that Närpes is vul- rums for knowledge sharing and stimulating collabo- nerable on nine of the 10 indicators. Th ere is a surplus ration. Intermunicipal collaboration is an important of men and the replacement ratio in Närpes is <0.8, means of fi nding new and collaborative solutions to which means that there is a shortage of people aged be- tackle the challenges related to in-migration and inte- tween 15 and 64 years; i.e. those active in the labour gration. force. A large proportion of the working-age population 2.1.2 The “Närpes model” for integrating immi- left Närpes during the 1960s and 1970s to work in grants Sweden. Th is development led to a situation whereby Th e Närpes model refers to the ways in which the small an entire generation is “missing” (the children of those Swedish-speaking municipality of Närpes in Western who emigrated in the 1960s and 1970s). Th e shortage of Finland has been working to integrate immigrants. Th e labour caused by the challenging demographic struc- example of the “Närpes model” concerns the demo- ture has been mitigated by international migration to graphic issue of mismatch between labour demand and Närpes during the past two decades. At the moment, supply. In this case, immigration from abroad is uti- approximately 10% of the population have foreign citi- lised successfully as a way to meet labour demand. zenship (which is a high proportion compared with Th e term “model” is used relatively loosely to describe other parts of Finland). Today, 35 diff erent nationali- an approach consisting of a variety of elements (such as ties are represented among the inhabitants of Närpes municipality.12
11) Mattila & Björklund (2013); Ivars (2013)
10) Proba (2014) 12) Nordregio (2012); Statistics Finland (2013)
NORDREGIO WORKING PAPER 2014:3 17 Photo: Magnus Fröderberg/norden.org
Initiation Närpes was the fi rst municipality outside the largest networks of the existing immigrants could be used to city regions of Finland to decide to accept quota refu- recruit more immigrant labour. Th is caused a so-called gees in the late 1980s. From the beginning, the inhabit- “snowball eff ect”, whereby the presence of many im- ants of Närpes were comprehensively and widely in- migrants in Närpes attracted more immigrants to the formed on the subject of immigration and integration. municipality. Th e municipal organisation supported Education and information were also directed to em- immigration in ways such as providing the structures ployers regarding opportunities to recruit foreign la- needed.14 bour. Information and communication measures to infl uence the attitudes of the inhabitants and employ- Implementation ers have been central in creating a good environment It has been emphasised that there has been no clear or for integration. explicit strategy in Närpes to attract immigrant labour. Societal structures for integrating immigrants were Rather, it has mainly happened to satisfy the needs of developed in the 1980s and 1990s, when Närpes took employers. Th e greenhouse and metal industries espe- in small numbers of immigrants. Th e small scale of cially have had a need for labour that has been ad- immigration to Närpes facilitated the development dressed through migration. Mattila and Björklund of well-functioning systems for integration, such as note that employers have actively recruited from ways to manage day care for the children of immigrant abroad, while the municipality has had an important families and ways to organise language courses and to role in providing the societal structures needed for the disseminate information. Th ese established structures integration of the labour force.15 facilitated an increase in immigration in the 2000s.13 Th e role of co-operation in developing approaches In the early 2000s, employers considered using la- to the integration of immigrants in Närpes is a key bour-market-based immigration to meet their labour aspect of the Närpes model proposed by Mattila and demand because they were unable to recruit the nec- Björklund (2013). Partly because of the small size of essary labour from the local market. As there already the community, it has been possible to create eff ective were immigrants in Närpes, the international social
14) Mattila & Björklund (2013); Nordregio (2012)
13) Mattila & Björklund (2013); Nordregio (2012) 15) Mattila & Björklund (2013)
18 NORDREGIO WORKING PAPER 2014:3 cross-sectoral co-operation between municipal au- tions will provide step-by-step information on settling thorities, and between authorities, employers and the in Finland as well as information about authorities that third sector (non-profi t organisations). In the Närpes provide assistance on a variety of issues.20 model, co-operation has also been central to the simul- taneous development of parts of the integration struc- Main challenges ture (employment, housing, language education, and Mattila and Björklund (2013) mention diffi culties in social infrastructure). Th is has been another key to the fi nding suitable housing and the problems related to model’s success.16 residence permits for non-EU citizens as the main In addition to the structures provided by the mu- challenges for immigration and integration in Närpes. nicipality, support measures from employers have been Increased demand for housing has increased housing central. Both Mattila and Björklund and the inter- prices, which has complicated the housing market situ- viewees note that local business owners independently ation. However, as the ageing population of Närpes launched campaigns to recruit people from other coun- move from the countryside towards central areas, im- tries actively and succeeded in attracting a large num- migrants have been able to buy and renovate old houses ber of people, especially from South East Asia, Poland, in rural areas. Th is has revitalised village communities. and the Balkan states. Employers have also supported Furthermore, residence permits granted to non-EU their employees in ways such as organising language citizens are oft en for short periods and are renewed courses during working hours and helping with hous- only when employment contracts are renewed. Th e ing arrangements. Th e small size of the community bureaucracy related to residence permits has caused and the small size of the employer companies have also insecurity among immigrant families. Th ere is a mini- facilitated the establishment of personal relationships mum income limit for people with resident permits, between employers and employees.17 and there is a risk that a residence permit may not be Specifi c information and communication measures renewed in case of unemployment.21 have continuously been targeted at both existing in- Even though co-operation and co-ordination be- habitants and immigrants. New information channels tween actors has mainly functioned well in Närpes, have been found to reach immigrants who speak a vari- there have been some challenges in terms of com- ety of languages.18 Th e municipality has also invested munication and exchange of information between in immigrant children and their education. Aft er a employers and the municipality. Th e employers may fi rst year in special language classes, the children are not always have the time to inform the municipality integrated into the same classes as the Finnish children whenever they recruit immigrant labour, or how many in order to promote integration. Th ere is an education employees are moving to Närpes and whether they are programme for teachers in multicultural education, bringing children. Th is has in some cases made it chal- and kindergarten staff members receive continuous lenging for the municipality to plan service provision. education on multicultural issues.19 Th e municipality has also lacked an organisation re- Th e municipality has been active in various pro- sponsible for integration issues with a good overview jects, oft en partly fi nanced by the EU. At the moment, of the various aspects of integration. However, Närpes the municipality co-operates with four other munici- is currently co-operating in a project (“Delaktig i Fin- palities in the region (as a member of the so-called K5 land”) with the other K5 municipalities to create the municipalities) in a state-funded project. Th e goal of kind of organisation that is needed and to employ a the project is to develop a new model for education shared immigration co-ordinator. By working together, on issues related to integration that is to be rolled out these small municipalities with their limited resources throughout Finland. Th e project also develops a shared can provide services and improve their work in ways integration programme for the fi ve municipalities in that would not be possible individually.22 addition to a virtual learning environment on societal issues and language for immigrants. In another pro- ject, Närpes, together with other municipalities, plans to establish a “welcome offi ce” that among other func-
16) Mattila & Björklund (2013)
17) Mattila & Björklund (2013); Ivars (2013) 20) Ivars (2013)
18) Mattila & Björklund (2013); Nordregio (2012) 21) Mattila & Björklund (2013)
19) Ivars (2012) 22) Ivars (2013)
NORDREGIO WORKING PAPER 2014:3 19 Photo: Magnus Fröderberg/norden.org
Main outcomes and continuity Lessons learned and transferability Attracting a good number of immigrants and their Th e Närpes example shows the importance of the pub- successful integration into the labour market and the lic sector’s co-operating with other actors and involv- local community can be considered to be the main out- ing both employers and employees in its work. Cross- come of the various activities of municipal actors, em- sectoral co-operation and a bottom-up approach have ployers and the third sector in Närpes. been central to this model. Without collaboration be- Th is success is found to be dependent on many fac- tween public and private actors, and the municipal au- tors. Mattila and Björklund emphasise that the con- thorities considering employers’ and employees’ needs, tinuity of various projects and initiatives promoting Närpes would not have been so successful in establish- integration has been good. Projects on integration in ing a well-functioning integration framework. Närpes have built on the success of the earlier projects. Närpes has several strengths that have contributed Th is has created a “positive circle”, where successes in to its success in the integration of immigrant labour. some aspects feed into successes in others.23 As noted, its small size has facilitated co-operation and Mattila and Björklund also note that the upcoming close and personal contact between actors (e.g., be- municipal reform, merging several small municipali- tween immigrant employees and small employers, and ties into larger entities, is seen as a possible challenge between employers and authorities, as well as between for the future implementation of the Närpes model. Th e authorities and immigrants). Th e study by Mattila and model is to some extent dependent on the small size of Björklund further emphasises that being a Swedish- the municipality and the fl exibility that this provides. speaking municipality has also been an advantage, as In the case of municipal mergers, the local authorities Swedish can in many cases be easier than Finnish for are afraid that service provision may be centralised and immigrants to learn. Mattila and Björklund also stress that the eff ective local integration services of Närpes that Närpes has a tradition of immigration, and many may be closed down.24 inhabitants have their own experiences of immigra- tion among family members. Th is has contributed to a generally positive attitude towards international labour mobility.25 Th e existing high demand for labour has also been 23) Mattila and Björklund (2013)
24) Mattila & Björklund (2013) 25) Mattila & Björklund (2013); Nordregio (2012)
20 NORDREGIO WORKING PAPER 2014:3 crucial for the success of the Närpes model in integrat- the ways in which child and youth issues should be in- ing labour immigrants. However, even though immi- cluded in policy making.27 Th e Regional Development gration has mitigated the demographic challenges in Strategy 2012–2020 prioritises youth issues, and the the municipality, current immigration is not suffi cient regional council has taken several individual initiatives to respond to the ageing of the current population. concerning young people as a resource for sustainable Mattila and Björklund emphasise that the long-term regional development.28 future success of the municipality depends on the suc- Challenges related to out-migration of youth are cess of local businesses, on whether immigration con- common demographic issues that the Regional Coun- tinues and on whether the municipality succeeds in cil in Kalmar County intends to address. Th e initiatives keeping the young people in Närpes. Education and of the council are to encourage young people to stay in promotion of entrepreneurship are mentioned as good the region to balance the population development. ways to achieve this goal. All of the municipalities in the county face demo- It is diffi cult for municipal actors in Närpes to see graphic challenges caused by the large proportion of the main reasons for their success, because the devel- elderly people and the shortage of children and young opment of the methods and measures has happened people. Th e municipality of Kalmar is vulnerable in over a long period of time. Maintaining the continuity only two of the demographic vulnerability indicators, of integration-related projects and the ability to keep but all the other municipalities in the county are vul- the issue on the agenda in policy-making and adminis- nerable in six to 10 indicators. Th e county also has three tration has been crucial. EU-funded projects have also municipalities that are vulnerable in all the indicators. been very important, and many eff ective methods have Th is clearly shows that the county in general faces se- been developed in those projects. vere demographic challenges. Th e challenges related to Närpes has been able to benefi t from its small size, the ageing population and the low proportion of the which could inspire other small municipalities. In younger population seem to be the most pressing chal- Närpes, the small size of the municipality and the lim- lenges facing Kalmar County in general.29 ited resources that this entails have not been seen as negative but rather as encouragement for increased Initiation co-ordination, communication and co-operation be- Th e Regional Council of Kalmar County is a politically tween actors within the municipality and with the steered regional authority owned by all the municipali- neighbouring municipalities. As noted above, Närpes ties in the county and the county council. It shares re- has also taken a step forward and co-operates actively gional development responsibilities with the county with four other municipalities in the region (the other council and the county administrative board. It was K5 municipalities). Co-operation and combining re- established in 1997 as a pilot authority when Sweden sources is a good way for small municipalities with trialled the transfer of regional development tasks of limited resources and population to develop and pro- the county administrative boards and county councils vide services that they could not off er on their own. to regional councils. It became a permanent authority Co-operation also contributes to the exchange of expe- in 2002. rience and mutual learning between the participating From its initiation, youth issues have been priori- municipalities.26 tised by the regional council. Th is is partly because some of the municipalities in the county had previ- 2.2 Promotion of social mobility ously worked on these issues and partly because some active employees in the new authority had previously and inclusion worked in municipalities that had prioritised youth is- sues and had brought relevant experience to the region- 30 2.2.1 Young people as a resource for sustainable al council. Th e regional council has thus actively en- regional development in Kalmar County gaged municipalities in work with youth as a resource Th e Regional Council in Kalmar County has made for regional development. At fi rst, the proportion of “youth as a resource for sustainable regional develop- active municipalities was smaller, but the exchange of ment” one of its focus areas in dealing with a negative demographic development. In 2006, it developed a pol- 27) Th e Regional Council in Kalmar County (2006) icy for a child and youth perspective where it outlined 28) Th e Regional Council in Kalmar County (2012)
29) Nordregio (2012)
26) Ivars (2013); Mattila & Björklund (2013); Nordregio (2012) 30) Ilhammar (2013)
NORDREGIO WORKING PAPER 2014:3 21 Photo: Magnus Fröderberg/norden.org experience between municipalities has continuously infl uence on their everyday lives in the county (by increased the number of municipalities actively pursu- means of bodies such as youth councils) and if they feel ing the theme.31 that they belong in the region. At the regional council, Co-operation and knowledge sharing between mu- youth policy is implemented by the department of pop- nicipalities have been central in the process of engag- ulation and welfare, which is also responsible for the ing municipalities, encouraging them to include youth in-migration of labour, refugees, equality, and health themes in their daily operations and raising their care.33 awareness of the potential of youth for regional devel- Youth work is prioritised in the Regional Develop- opment. Some municipalities have already had long ment Strategy of Kalmar County, which includes youth traditions of work on various youth issues, and the re- policy goals that will be followed up in 2015. Th e cur- gional council has been active in spreading knowledge rent main priority areas in youth policy are engagement of good examples from those municipalities to encour- and participation (e.g., youth councils and infl uence in age other municipalities to participate. By now, the schools), and employment and safety (e.g., decreasing regional council has engaged most of the municipali- drug and alcohol use and safety on public transport). ties in the county to work on youth issues, although in Th e regional council also prioritises equality issues.34 practice, there are variations in the degree to which the Th e Regional Development Strategy also includes a municipalities actively participate and incorporate this list of recommendations for municipalities and other into their daily work.32 actors. For example, the strategy recommends that mu- nicipalities should establish structures for regional and Implementation local youth politics and invest in youth involvement Th e regional council considers that the likelihood of at all levels and in a variety of administrative sectors young people staying in the county or returning in fu- within their municipal organisations. Th e strategy also ture will increase if they realise that they can have an encourages the public, private, and third sector to fa-
31) Ilhammar (2013) 33) Th e Regional Council in Kalmar County (2013)
32) Ilhammar (2013) 34) Th e Regional Council in Kalmar County (2012)
22 NORDREGIO WORKING PAPER 2014:3 cilitate and promote the involvement of young people changing needs and more agile than a public authority in the labour market.”35 such as the regional council. Th e priority areas in youth policy are chosen based As noted above, the regional council has been suc- on an analysis of the situation of youth in the county. cessful in persuading almost all the municipalities in Th e analysis is based on a survey that is conducted in the county to participate in activities to strengthen the almost all municipalities and co-ordinated by the re- position of youth in the county. However, it has not gional council, while the analysis is conducted by Lin- been particularly active in engaging non-public actors naeus University. Th e theoretically grounded research outside Kumulus, and organisations such as enterpris- reports and analyses from the university provide good es have not taken part in its activities. In the future, the support and recommendations for policy-making at regional council intends to engage more companies as the regional and local levels. Most of the municipali- it devotes increased attention to youth unemployment ties in Kalmar County engage with youth issues in and labour market issues.38 their local areas and use the survey as a tool to moni- tor the opinions and experiences of youth at the local Main challenges level. However, the extent to which the municipalities Although the division of tasks between the regional can incorporate the survey and analysis results varies council and Kumulus has been clear, it has been chal- in practice. Monitoring and analysing the situation of lenging to communicate the various roles to the mu- young people in the county is one of the two main cur- nicipalities. Because both the regional council and the rent projects related to youth that the regional council NGO are fi nanced by membership fees from the mu- is co-ordinating.36 nicipalities, some municipalities consider that they Th e other main project focuses on strengthening must pay twice for the same services. Moreover, some young people’s opportunities for personal development municipalities have delegated responsibility for youth through national and international experience as well issues to their own employees and therefore have diffi - as on developing the competence, quality, and methods culty in seeing the added value of working on these is- of municipal youth work. sues at the county level and supporting two organisa- During 2013, the regional council has been working tions in addition to the cost of local activities. Th e with municipalities to develop project ideas targeting regional council considers that the current structure youth unemployment. In the autumn of 2013, it also functions well, but there still appears to be some chal- received funding for a pre-study in a project on youth lenges in including many administrative levels and di- employment in which young people would receive in- verse types of actors.39 ternships in health care. Th e regional council is also Th e regional council would also like to improve its building a system of “student co-workers” whereby lo- dialogue with the National Board of Youth Aff airs and cal students are given opportunities to work part-time co-ordination between the regional and national lev- in local enterprises.37 els. Th e board could provide more support, and the Th e regional council has an important co-ordinat- regional council wishes the board to be more active in ing role at the county level, and it co-operates mainly disseminating information and knowledge in regions with municipalities and an NGO (“Kumulus”) that was and municipalities.40 fi rst established as part of the regional council to work with youth issues but now functions as an independ- Main outcomes and continuity ent organisation. Th e activities of the NGO are funded No evaluations are available on whether the work in by the membership fees of municipalities. Work tasks engaging youth and related initiatives— for example, are divided between the regional council and the NGO. increasing young people’s infl uence, participation, and Th e regional council works on a strategic level, while safety—has aff ected the youth population of the region the NGO works on practical youth-related projects. or whether it has contributed to balanced population Th e two organisations have co-operated well, and the development in the manner that the regional council regional council fi nds it useful to co-operate with a seeks. smaller, dynamic organisation that is more adaptive to However, according to the regional council, its pro- motion of youth aff airs in policy-making has at least
35) Th e Regional Council in Kalmar County (2012) 38) Ilhammar (2013) 36) Th e Regional Council in Kalmar County (2012); Th e Regional Coun- cil in Kalmar County (2013); Ilhammar (2013) 39) Ilhammar (2013)
37) Ilhammar (2013) 40) Ilhammar (2013)
NORDREGIO WORKING PAPER 2014:3 23 resulted in more municipalities placing these issues on some challenges because it complicates the governance their agendas. Th e regional council works actively to system and makes it more diffi cult for some stake- initiate and establish dialogue with municipal authori- holders to understand. Nonetheless, for the regional ties and politicians to increase awareness of youth is- council, establishing an NGO that later became an in- sues. It seems that the regional prioritisation of youth dividual organisation has been a good way of having aff airs has contributed to the issues being considered at a smaller and more agile organisation for practical im- the local level and prioritised in many municipalities.41 plementation, while the regional council can focus on Many of the municipalities have draft ed action plans the strategic level. and have youth councils. Some have also recruited an employee to work in the area of youth aff airs or at least to be responsible for this area. According to the region- 2.3 Access to services al council, many of the municipalities have understood 2.3.1 Cross-border health care in Tornedalen the importance of working across sectors and between Tornedalen is situated on the Finnish–Swedish border administrative levels. Th is may improve work on youth and has a long tradition of mobility across the national as a resource for regional development.42 borders. Many inhabitants live in Finland and work in Sweden or vice-versa. Co-operation on cross-border Lessons learned and transferability health care was initiated in the region in the 1970s and Th e strategic work and implementation of youth policy has been further developed in the 2010s; for example, at the regional level in Kalmar County can be consid- in INTERREG projects. ered to be an illustration of the ways in which munici- Th is example of meeting demographic challenges palities can pursue policy goals established at the re- is related to provision of access to services, especially gional level. Th e regional council works across sectors health care, in sparsely populated regions. Cross-bor- and remains in continuous dialogue with municipal der health care has enabled the inhabitants of the cross- employees and politicians. It also promotes the ex- border region of Tornedalen to receive acute health change of experience and mutual learning between care from the closest health care service provider, even municipalities, which has improved co-operation be- if it is located on the other side of the border. Th is is tween them. useful for the inhabitants of this remote region, as well According to an external evaluation, the municipal- as for the health care providers. ities fi nd the co-ordinating work of the regional coun- Th e work on cross-border health care has made cil useful in supporting their local policy-making and health care less dependent on the place of work or implementation concerning youth as a resource for the residence of the patient and thus meets the challenges development of the county.43 of sparse population, remoteness, an ageing popula- Th e youth policy of the Regional Council in Kalmar tion, and scarcity of resources for health care services. County is a good example of a policy process where Health care centres and hospitals in both countries analysis of the current situation is the basis for formu- have been the main actors developing cross-border lating policy. Th e extensive surveys and analyses by a health care in the region.44 local university provide a good knowledge base for re- Th e Tornedalen region has approximately 60,000 in- gional policy-making. Most municipalities participate habitants; 40,000 live on the Finnish side and 20,000 in the process and conduct the surveys in their munic- on the Swedish side of the border. Except for Tornio ipalities, where they can also support local policy by in Finland, all the municipalities in the Tornedalen giving the municipalities a view of the situation. region face severe demographic challenges. Most of Th e work on youth issues in Kalmar County has the municipalities are vulnerable on all 10 of the de- spread to other actors (the regional council, Kumulus, mographic vulnerability indicators identifi ed in the and municipalities), which may improve the effi cien- Demographic Handbook. Haparanda in Sweden is cy of the work because diff erent actors have diff erent vulnerable on nine of the indicators and Tornio on fi ve strengths and roles in the system. However, the pres- indicators. All the municipalities except Tornio have a ence of many actors with a range of administrative negative labour force replacement ratio and a surplus of roles at a variety of levels has been shown to present males in the population (a replacement ratio lower than 0.8 and fewer than 92 women per 100 men).45
41) Ilhammar 2013
42) Ilhammar (2013) 44) Eero (2011); Eero (2013)
43) Th e Regional Council in Kalmar County (2013); Ilhammar (2013) 45) Nordregio (2012)
24 NORDREGIO WORKING PAPER 2014:3 Initiation of the INTERREG IV A Nord “Gränslös vård” project.50 Development of cross-border health care in the region was initiated in the 1970s. Physicians on the Swedish Main challenges side of the border were overloaded with emergency du- Th e action space for the partners on each side of the ties, which had a negative eff ect on their work. Because border is restricted by border obstacles. Th e main ob- there was another health care centre on the Finnish stacles to further development of cross-border health side, a decision was made to attempt to initiate co-op- care in the region have been related to legislation and eration to divide responsibilities and resources across diff erences in regulations between Finland and Swe- borders. A shortage of resources and the challenges of den.51 providing health care in such a sparsely populated and In particular, in the management of patient journals remote region were the main reasons for initiating co- and confi dentiality, diff erences in regulations impede operation.46 further development of co-operation, as it is not pos- For this purpose, the health care centres negotiat- sible to access patient journals across borders. Th e ex- ed with respective national ministries responsible for ample of a large EU project in which the Tornedalen health care issues. Initially the ministries were scepti- region has participated illustrates how the main obsta- cal about ideas such as shared emergency services, but cles and challenges in the development of cross-border the health care centres were granted a year-long test health care are oft en related to large legislative changes. period. Aft er the fi rst year of testing, they were given Th e so-called epSOS project, for example, included a permanent permission to share emergency duties be- measure to test e-prescriptions. However, the testing tween the two health care centres.47 period needed to be rescheduled, as legislative changes From the beginning, it was decided to avoid bu- were demanded on the Finnish side even to commence reaucracy to improve co-operation. Contracts between testing these new methods.52 actors across the border were made simple and non- bureaucratic. It was decided that there would be no ex- Main outcomes and continuity change of money because this was thought to facilitate Th ere are no available evaluations of the actual conse- bureaucratic co-operation. Th is co-operation was con- quences of cross-border health care co-operation for sidered to be a win–win situation for all partners, and aspects such as accessibility or the travelling distances therefore, no monetary transactions were needed.48 of the inhabitants, or for the effi ciency of health care in the sparsely populated areas. Implementation One of the most tangible results of the work on Th e co-operation on health care has always been based cross-border health care was an agreement that was es- on a local need for co-operation. Working methods tablished in 2011 for co-operation in acute health care have evolved over time in co-operation between the ac- across the national borders of Sweden, Finland, and tors. Initiatives to establish co-operation between ac- Norway. According to the agreement, ambulances and tors have been undertaken locally based on need and helicopters can be used across borders. Th e agreement interest. For example, there has been co-operation be- has been in force since 2012 and covers insurance and tween dental health care centres in acute dental care.49 costs for patients from all of the regions of the three Th e co-operation has in principle been eff ective, and countries.53 over the years, many practical solutions were estab- Th e future of cross-border health care in Tornedalen lished to facilitate cross-border health care. However, is uncertain at the moment. According to the project not all of the practices always functioned well in all leader of the Gränslös vård project, both Finland and emerging situations. Th erefore, an INTERREG project Sweden may be moving towards changes in the or- was implemented in the period 2008–2011 to assess the ganisational structures that may result in increased quality of existing methods and to develop new ones. centralisation. Th e trend towards increased centralisa- Th e Norrbotten County Council was the lead partner tion could extend travel times to health care services for the patients. It is emphasised by the project leader that when health care services are moved farther from
46) Eero (2011); Eero (2013) 50) Eero (2011); Eero (2013)
47) Eero (2013) 51) Eero (2011); Eero (2013)
48) Eero (2011); Eero (2013) 52) Eero (2011); Eero (2013).
49) Eero (2011); Eero (2013) 53) Eero (2011); Eero (2013)
NORDREGIO WORKING PAPER 2014:3 25 Photo: Johannes Jansson/norden.org the border areas, cross-border health care issues may areas with demographic challenges. It is notable that not be so easily prioritised by the personnel because the there has been no explicit strategy behind these eff orts, border issues do not aff ect their everyday practices. As and that the ways of working together have grown or- an example, the transfer of the ambulance services on ganically over time in an informal manner. Tornedalen the Finnish side of the border from Rovaniemi south to provides an example for other regions of development Oulu is considered to have a negative infl uence on the that has been driven by employees and actors in a spe- possibilities for ambulance co-operation.54 cifi c sector rather than in a top-down manner by au- It remains unclear how the new directive on cross- thorities working at the strategic level. border health care and patient mobility will infl uence It has been central that co-operation has been based health care in Tornedalen. Th e directive allows citizens on active employees at health care centres who are to seek specialist health care services across borders committed to the issue. In the case of the Tornedalen and does not limit cross-border health care to acute region, this bottom-up approach has been eff ective, cases, as was previously the case. Th e experience and and cross-border health care is an organic part of the skills that the actors in Tornedalen have already ac- daily activities of the health care centres. Th e health quired in their earlier work on cross-border health care care centres consider their co-operation to be a win– may make it easier for them to adapt to some of the win situation. requirements of the directive.55 However, such informal working methods may have a downside if the activities are not co-ordinated, and Lessons learned and transferability their quality may not always be assured if they evolve Th e measures to develop and organise health care without careful planning and control, and grow in an across borders in Tornedalen have from the beginning informal way. In Tornedalen, this problem was recog- been based on actual need for co-operation and shar- nised, and an INTERREG project was started to pro- ing resources to provide services in sparsely populated vide quality assurance for the working methods. In more informal development, it remains important to recognise the need for co-ordination and quality assur- 54) Eero (2013) ance. 55) Eero (2011); Eero (2013)
26 NORDREGIO WORKING PAPER 2014:3 2.3.2 Distance Health Care in Sydjylland, Den- tives from the Hospital of Sydjylland.60 At the political mark level, there was a mandate to improve the quality of Of the population in Denmark, 0.2 per cent—more wound management, and the former health boards of than 10,000 Danes—are in contact with the health care Sydjylland County decided to initiate a wound healing system because of chronic wounds. Wound patients are programme for the whole of Jutland. It was eventually mainly elderly, and Sydjylland in the region of south- decided that the telemedicine concept could support ern Denmark is to a large extent characterised by an both the policy objectives and the objectives set by the increasing elderly population. Moreover, according to project group. In 2006, telemedicine was introduced the Demographic Handbook, parts of Sydjylland56 (es- and off ered to the home care personnel (wound care pecially the municipality of Tønder) show a high de- nurses) in the then 22 municipalities in the region of gree of demographic vulnerability.57 South Denmark. In Denmark, the responsibility for running the health service is decentralised, and most tasks are the Implementation responsibility of regional authorities. Th e region of Th e technological arrangement available through tele- southern Denmark currently has four hospital units medicine means that patients can be diagnosed, moni- running a total of 18 hospitals. Over the past fi ve years, tored, and treated in their own homes. Th e use of tele- the Region of Southern Denmark has increasingly fo- medicine normally requires only one visit to the clinic cused on eHealth and telemedicine—both in research to make the fi nal diagnosis, while routine checks are projects and in implementation. All hospitals in the abolished, thus saving travel time for patients and re- region have implemented telemedicine services, and sources for taking these patients to the hospital or doc- the region is very active in several national and inter- tor. Th e technology and the division of labour further national eHealth projects.58 increases the likelihood that patients who need special- ist treatment receive it fast because the wound journal Initiation is easily accessible electronically. An electronic journal Telemedical wound care is a multidisciplinary and in- contains all information and images that represent the tersectoral collaboration, where telemedicine contrib- health professional’s assessment of the patients with utes to closer co-operation between the municipality the (greatest) need for specialist treatment. Because and hospital treatment and care of patients and people data transfer is simple and fast, and the data are col- with chronic wounds. lected in one place, work is reduced and resources are Telemedicine solutions are increasingly common freed for other purposes. in the health sector. In Sydjylland, the Telemedical Th e project has involved a wide range of actors, such wound care project (“Sår i Syd”), a cross-sectoral co- as social and health care assistants, nurses, wound care operation between Sønderjylland Hospital and Had- nurses across sectors, doctors across sectors, prosthe- erslev, Sønderborg, and Aabenraa municipalities, has tists, podiatrists, and external experts. A steering com- led to an increase in the use of telemedicine techniques mittee for Sår i Syd, with representatives from hospitals in wound management over recent years.59 In the Sår and municipalities, is responsible for the main activi- i Syd project, patients are given the option of home ties of the project, and this committee meets approxi- treatment. Th e project is an interdisciplinary and in- mately every two months. Matters such as major pro- tersectoral collaboration between four municipalities ject decisions and fi nancial issues are vested in the local in Sydjylland as well as the Region of Southern Den- co-ordination forum led by Sydjylland Hospital. mark, where treatment of wound patients is supported Sår i Syd assumes that the actors involved (such as by telemedicine. social and health care assistants) have suffi cient knowl- In January 2005, a project group, which was initially edge and can use the technical equipment to support led by Aabenraa Hospital, was established. Th e group patient care, such as mobile phones, cameras, and digi- consisted of home health care representatives from tal pens. It is the individual hospital’s responsibility to the four municipalities of Sydjylland, and representa- teach actors how to operate the various pieces of tech- nical equipment. Th e hospital off ers ongoing training for 1–2 hours, while in the municipalities, local wound 56) Sydjylland is a NUTS 3 region that is part of the larger NUTS 2 re- gion of Southern Denmark. care nurses are responsible for the training of staff . Th e wound care nurses also meet regularly to discuss pro- 57) Nordregio (2012): Map 1
58) Region Syddanmark (2009)
59) Region Syddanmark (2009) 60) Region Syddanmark (2009)
NORDREGIO WORKING PAPER 2014:3 27 Photo: Johannes Jansson/norden.org fessional issues and developments related to the pro- Main challenges ject. Participation in Sår i Syd is therefore an oppor- At a technical level, there has been a need to simplify tunity for ongoing skill development and introduction the forms of communication between patients and ad- to techniques that could be used in other telemedicine ministrative systems across hospitals and municipali- projects. ties. Th e project has also lacked involvement by general Th e implementation and operation of Sår i Syd would practitioners. Previously, it was a problem that only a not be possible without the establishment and opera- single hospital doctor and a handful of staff were in- tion of a wound database as well as technical equip- volved in the project. Th is made it vulnerable to staff ment. Th ere are also costs associated with training problems such as illness, absenteeism or job changes. medical professionals to manage the system. Sydjylland Another challenge has been a lack of equal fi nan- Hospital spent DKK 388,000 to develop the wound da- cial distribution between the region, the hospital, and tabase. Th e yearly cost of the project is estimated to be the municipalities, and in the future, this could be approximately DKK 56,000, which is paid by regional improved by creating a billing system that more ac- authorities. Finally, the cost of procurement of neces- curately regulates and distributes the municipalities’ sary equipment amounts to a total of DKK 15,200 (ex- payment for hospital services related to telemedicine. It cluding consumption).61 Th ese expenses are paid by the has also been a challenge to simplify the integration of users—local authorities and the hospitals. Th e organi- information from the wound database, municipal care sation of the project provides a functionally diff erenti- systems and hospital patient systems. Clear manage- ated division of labour, meaning that some parts of the ment and integration of technical solutions and equip- patient pathway are handled by the municipal health ment for storing data are thus essential for the success- professionals, while other parts require the involve- ful implementation and operation of such a project. ment of specialists at the central hospital.
61) Region Syddanmark (2009)
28 NORDREGIO WORKING PAPER 2014:3 Outcomes and continuity and the strong consensus and leadership of the project Th ere are signifi cant benefi ts associated with telemedi- have also been crucial for its success. At the operational cine, especially for the patient. In addition to the time level, support from local management in hospitals and savings, there are economic gains, because the number municipalities to make telemedicine in wound man- of visits both to a general practitioner (regional and agement a priority focus area has been crucial. Simi- municipal savings) and the hospital (municipal sav- larly, at the local level, support from academic institu- ings) is minimised. Th e patient is diagnosed faster and tions has allowed continuous and/or further thus can start treatment of the underlying cause more development of the treatment approach. Th e hospitals quickly. At the same time, there is a reduction in the have ensured that a suffi cient number of staff members number of outpatient contacts, implying a reduction in manage the telemedicine equipment and are part of the waiting time and fi nancial savings for both municipal- project. On a practical level, agreements with suppliers ity and region in each patient’s treatment. Th e telemed- to create a wound database, to procure the necessary icine collaboration also facilitates a division of labour equipment and to devote time and resources to areas between the parties,62 with the technology ensuring such as training and skills development have been cru- fast communication between health professionals and cial for the implementation of the project. providing a better basis for monitoring patients. While a loss of patients in the outpatient clinic rep- 2.3.3 Improving educational opportunities in resents a loss of income for the hospital, it is estimated Northwest Iceland that total activity remains largely unchanged, with Th e region of Northwest Iceland is suff ering from a other patient groups gaining quicker access to hospi- sharp decrease in population, with young women in tal services instead. Th e interdisciplinary co-opera- particular leaving the region. In terms of demographic tion between hospitals and municipalities in relation vulnerability, the situation is not as alarming as in to wound treatment has been strengthened; however, many other regions, but most municipalities are vul- extending this participation to general practitioners nerable according to several of the demographic vul- could benefi t the project. Economically, there are sav- nerability indicators.64 In total, the region has 7,200 ings for municipalities in the form of fewer outpatient inhabitants in seven municipalities. Th e average educa- visits and hospitalisations, and for the region in terms tion level in the region is low, which is an issue that of fewer consultations with the general practitioner infl uences demographic development. and fewer travel expenses. As one of the primary ways to meet these challenges, In 2007, it was decided that the project should con- the region has actively worked to improve the educa- tinue. Th is entails continued co-operation between the tional opportunities in the area to make it possible for municipalities and the regional authorities. Th e condi- young people to stay in the region and for companies to tions for the collaboration have been implemented in have access to a competent labour force. the municipal health agreements (“Sundhedsaft aler”)63 that regions and municipalities are required to develop Initiation at least once during every administrative term. In these Th e Union of Local Authorities in Northwest Iceland agreements, the mutual obligations and expectations of has had an important role in identifying challenges as the project are listed to ensure continued co-operation well as activating various actors to address the demo- and management. Th is not only ensures support at the graphic challenges. Th e broadening of educational op- political level but also ensures that the challenges (eco- portunities is based on an analysis showing that young nomic, organisational, and technological) that occur people leave the region early, in many cases before the on a regular basis are addressed in the local co-ordi- age of 18, because of the lack of educational opportuni- nation forums. ties.65 Th e union and the municipalities in the region con- Lessons learned and transferability tinuously survey the youth in the region to respond to Th e project is rooted in co-operation across adminis- their interests and to provide the kinds of educational trative levels. A main driver of this co-operation has programmes that suit the interests of the students and been the active commitment of employees at health the needs and labour demand of the companies.66 care centres. Th e formalised co-operation structures
64) Nordregio (2012)
62) Region Syddanmark (2009) 65) Andrésdóttir (2014)
63) Sundhedsstyrelsen (2014) 66) Andrésdóttir (2014).
NORDREGIO WORKING PAPER 2014:3 29 Photo: Magnus Fröderberg/norden.org
Implementation Th e Union of Local Authorities, municipalities, fi rms munity life more dynamic.68 and the local college have in practice worked together Based on an analysis of the interests of the young to establish educational programmes focusing on crea- people in the region and the needs of the local in- tive industries and other topics. At the same time, op- dustries, there has been an aim to provide education portunities for distance studies have been developed as related to the creative and other industries identifi ed a way to mitigate demographic change.67 as a growing or key sector in the region. Educational Opportunities for distance studies at various lev- programmes in fi lming and hair dressing have already els have been found to be especially important for the been established. In the fall of 2014, a new educational development of the region and the smallest villages. programme focusing on innovation, technology, de- In the most remote villages, young people oft en need sign, and art will commence. Among other purposes, to move out of their parental home at an early age to educational programmes focusing on creative areas are attend secondary education, but distance education considered to be one way of enticing young women to makes it possible for them to stay at home longer. Th e stay in the region instead of moving away to obtain their distance learning opportunities have been organised by degrees. Before the initiation of the creative industries the local college and supported fi nancially by the mu- programme, college students had been predominantly nicipalities and the Union of Local Authorities, which male because of the educational programmes off ered, allocates state-level support for regional development but this programme has contributed to improving the projects. It has been found that this approach makes a gender balance.69 diff erence in the small villages because the young peo- Companies are actively involved in establishing and ple stay there two years longer and contribute to the implementing educational programmes at various lev- local communities in many ways, making local com- els and in a number of subjects. Th is is a way to im-
68) Andrésdóttir (2014).
67) Andrésdóttir (2014). 69) Andrésdóttir (2014).
30 NORDREGIO WORKING PAPER 2014:3 prove the employment prospects of the students aft er forming the educational programmes and surveying graduation and to improve matching between labour the wishes of youth is an important part of the work, demand and supply. Th is work is particularly impor- which may contribute to the future potential of using tant in the creative professions, and the aim of com- educational programmes to meet demographic chal- pany involvement is to make them understand how lenges. employees with creative skills can provide new ideas Th ere are no evaluations or assessments available for innovation and development. In this way, creative on the outcomes of the activities, but the numbers of educational programmes not only encourage young enrolments in the local college show a shift towards a people to remain in the region but also develop the lo- more balanced gender structure among students. cal business environment.70 Lack of funding has been a major challenge in de- 2.4 Improving regional attractive- veloping educational opportunities as a way to develop the north-west region. Th e region had already been ness granted funding under the EU IPA (Instrument for 2.4.1 The regional attractiveness of Sør-Trønde- Pre-Accession Assistance) programme, but because lag the Icelandic EU negotiations were put on hold, it was Many of the municipalities in Sør-Trøndelag, like most not possible to access the funding. For the application, of the coastal municipalities in Norway, experienced a a large two-year project had already been planned, decrease in population during the last decades, al- focusing especially on keeping young women in the though this trend has recently been off set by an in- region by providing better educational opportunities crease in population mainly due to an in-migration and off ering, among other measures, personal coun- surplus of international migrants72. Th is decrease has selling and courses for young women to support them been linked to a decline in employment in the tradi- in seeking further education and strengthening their tional coastal industries (e.g., fi shing, fi sh processing, skills. Th e local authorities, fi rms and other actors to- and shipbuilding). gether have been able to fund activities that were part According to the indicators in the Demographic of the planned project (including the establishment of Handbook, the coastal municipalities of Sør-Trøndelag the creative educational programme), but the Union are less vulnerable to demographic decline than many of Local Authorities still seeks funding opportunities of the inland municipalities. However, the municipali- to implement all parts of the project without the EU ties of Hitra, Åfj ord, Roan, and Åsen are all vulnerable 71 funding. on seven to 10 of these indicators. In addition, several of the municipalities (e.g., Hitra, Frøya, Agdenes, Ør- Lessons learned and transferability land, Rissa, Åfj ord, and Osen), have a surplus of men Co-operation between the local authorities, the Union in the population (fewer than 92 women per 100 men), of Local Authorities, the educational facilities, and even though they have a positive replacement ratio in companies has been crucial in addressing the demo- the labour market.73 One major challenge in the region graphic challenges by broadening the educational op- will be a generational shift in the public sector in the tions in the region. Th e co-operation of these actors is coming years, when there will be a substantial demand partly co-ordinated by the Union of Local Authorities, for civil servants,74 and there is currently a shortage of which has an important role in facilitating collabora- suitable competencies in the region. tion as well as providing background knowledge and analysis. Initiation Th e analyses of the demographic situation have con- As a response to the challenges facing Sør-Trøndelag, tributed to an increased awareness of the demographic such as out-migration, lack of access to technological challenges, which in turn has created a common under- expertise in the private sector, and insuffi cient person- standing in the region on the actions required. Analy- nel to work in the health care services and public sis is therefore an important building block in promot- schools75, Kysten er Klar (“Th e Coast is Clear”) was es- ing co-operation and ensuring broad implementation of measures. In Northwest Iceland, involving young people, public authorities, schools, and companies in 72) Roto et al. (2014)
73) Nordregio (2012), map 2
70) Andrésdóttir (2014). 74) Hanssen (2014)
71) Andrésdóttir (2014). 75) Sør-Trøndelag Fylkeskommune (2012)
NORDREGIO WORKING PAPER 2014:3 31 Photo: Karin Beate Nøsterud/norden.org tablished in 2007. Th e ambition was to make the region thority and four representatives from local businesses. the most attractive coastal region in Europe, based on Kysten er Klar is funded by the participating munici- its resources, advantages, and qualities. Overall, the palities and the county council. Th e 11 municipali- goal of the programme was to contribute to user-driv- ties pay an annual membership fee of NOK 200,000, en projects that have practical applicability for the Sør- and the county council contributes NOK 200,000. In Trøndelag coastal area. addition, the project receives funding from thematic Th e programme was initiated by Sør-Trøndelag subprojects administered by the Norwegian Ministry County Council, which is a regional political body of Local Government and Modernisation and Innova- with a directly elected County Council consisting of tion Norway. Th e participating municipalities and lo- 37 elected offi cials.76 Initially, the independent research cal businesses also contribute extra funding to projects organisation SINTEF was appointed to manage the of special relevance to them.77 Th e project can thus be programme, and eight of 11 municipalities joined it. regarded as a partnership that involves a broad range However, it was feared that the programme would be of institutions and groups, such as municipal depart- too research oriented, and in 2009, a new programme ments and employees, local businesses, local cham- manager was appointed, and all 11 municipalities bers of commerce and tourism, and upper secondary (Hemne, Snillfj ord, Agdenes, Frøya, Hitra, Ørland, schools. Moreover, it makes use of services from R&D Bjugn, Rissa, Åfj ord, Roan, and Osen) joined it. institutions such as SINTEF, the Norwegian University Kysten er Klar has a steering group consisting of of Science and Technology (NTNU), Sør-Trøndelag all 11 municipal mayors and fi ve politicians from the University College, BI Norwegian Business School, and county council. In addition, there is a programme man- Nord-Trøndelag University College. ager and a programme board who are responsible for implementation. Th e programme board consists of two Implementation administrative representatives from the municipalities, Initially Kysten er Klar analysed the industrial and one administrative representative from the county au- economic situation for the coastal region. Th e analysis
76) 75 Sør-Trøndelag Fylkeskommune (2012) 77) Zaucha & Świątek (2013)
32 NORDREGIO WORKING PAPER 2014:3 led to the choice of three thematic priorities: 1) im- Main challenges provement of quality of life and regional reputation, 2) Th e main challenge has been to build trust among the development of knowledge and competence, and 3) municipalities and enterprises, because both groups land use planning. Th e fi rst two thematic priorities es- have a history and tradition of internal competition. pecially are related to demography and welfare issues, Th e main success is actually the degree of trust that has as increasing the attractiveness of the region may help already been built during the fi rst 4–5 years of Kysten to counteract out-migration and to attract skilled peo- er Klar, which has convinced both private and public ple as well as businesses to the region. partners of the benefi ts of regional co-operation. Under the fi rst thematic priority, improved qual- Th e municipalities also compete on certain issues, ity of life and regional reputation, Kysten er Klar has such as the construction of roads, which has previ- implemented a variety of subprojects aimed at hous- ously been problematic because various parts of the ing, tourism, industrial areas and harbours, inclusion coast have had diff erent and competing priorities for of foreign workers, and work-force recruitment.78 For projects. Th erefore, one strategy to avoid confl icts aris- instance, one subproject focuses on comprehensive re- ing is to stay away from “dangerous” matters such as cruitment to ensure the future growth of districts in transport and road building, which automatically trig- Sør-Trøndelag. In 2012 Kysten er Klar received NOK ger competition between transport corridors and other 4 million from the Ministry of Local Government parties.79 Instead, the initiative has focused on “safe is- and Regional Development to initiate a development sues” that create less tension, at least at the beginning project called “Bolyst”. Th e goal was to develop a tool- of the programme period, in order to build trust and kit with specifi c measures directed at various target consensus among the participating municipalities. groups—such as high school and college/university Th ere has also been some tension between the mu- students, and local people who have moved out of the nicipalities and the county council. Th is may be at- region—to attract people with relevant education and tributable to a general scepticism towards the county background to meet the labour demand. Th e measures authorities and not the programme in particular. were targeted at the local, intermunicipal, and regional levels to create attractive communities. Outcomes and continuity One of the problems in the region has been access Kysten er Klar has had signifi cant activity related to to qualifi ed labour. Th is is linked to the fact that the various projects associated with the focus areas. Th e decline in the traditional industries has been off set by extensive number of collaborative projects has also new growth in other industries such as farming, ship been made possible through co-fi nancing from other technology, services, and construction. More specifi - sources. In addition, support from Kysten er Klar has cally wind farming and tourism are new growth areas triggered additional co-fi nancing from sources such as that provide increased job opportunities in the region. the private sector. Attracting qualifi ed people can also be seen as an im- From a structural point of view, Kysten er Klar can portant way to attract business to the region, and sev- be considered to be one of several networks that con- eral projects have been initiated to retain and attract nect municipalities. Th e initiative provides networks young people. One example is the “Coast Trainee” pro- and information channels to actors such as the county gramme, which focuses on attracting young graduates administration, private sector companies, and mu- to the regional labour market. Another example is the nicipalities. While the existence of multiple network “Decentralised College Education” initiative, conduct- structures can create confusion about responsibility ed in collaboration with the University College of Sør- and authority, the positive aspect is that such a network Trøndelag, with the goal of strengthening the presence overall provides greater resources in terms of knowl- of university colleges and nursing education in the pe- edge and thus the possibility of infl uencing external ripheral regions. Th is project is a response to the future actors. Th e idea is that by combining eff orts, the whole needs of employees in the health care sectors. region will have a greater ability to achieve goals such All these projects have been initiated through col- as attracting business and labour to the region. How- laboration between the municipalities, the universities ever, in a mid-term evaluation of the programme,80 it and colleges, and the private sector in the region. was clear that there was a lack of collaboration between Kysten er Klar and similar networks and that this is
79) Hanssen (2014)
78) Zaucha & Świątek (2013) 80) Hanssen (2014).
NORDREGIO WORKING PAPER 2014:3 33 one aspect that could be improved in the future. because of high out-migration, ageing populations, and low fertility. Based on the maps in Nordregio’s Lessons learned and transferability Handbook on Demographic Challenges in the Nordic Th e mid-term evaluation81 concluded that the pro- Countries (2012), the project chose 11 municipalities gramme has been successful and that the external co- that were vulnerable in more than fi ve demographic funding of projects demonstrated that external stake- vulnerability indicators to participate. holders perceived the programme as useful. Th e programme has been well organised with a small cen- Initiation tral management team of county council staff , while Although the counties of Hedmark and Dalarna are the activities of the programme have been decentral- separated by a mountain range, the regional authorities ised to the municipalities.82 Th is has led to broad par- have close relations and have previously collaborated ticipation and autonomy for the actors in the various on various projects, in particular through the Border projects. Committee of Hedmark and Dalarna, which is a cross- Th e opportunities for improvement that have been border co-operation body. In addition, the counties of indicated are a need to create a more active and dynam- Hedmark and Dalarna share similar demographic ic programme with increased effi ciency and more focus challenges, which encouraged them to start working on the local authorities and actors willing to commit together on the issues. 83 to it. Th is would also lead to increased consensus and Before initiating the project on demographic chal- ability to conduct the proposed initiatives. Th ere has lenges, the Border Committee contacted the selected been some vagueness around the programme’s focus municipalities. Th e municipalities expressed their in- and relationships with other collaborative networks. A terest in participating in the project, and the themes stronger connection to such networks may strengthen were then chosen based on the main challenges in the the programme through the exchange of experience chosen municipalities. However, aft er the project was and knowledge. established, it was a challenge for the Border Commit- In relation to the transferability of the lessons tee to ensure true commitment and engagement of all learned, four points can be emphasised. First, there is municipalities in the project. It was particularly diffi - a need for a clear focus and concentration of eff ort, fo- cult to make municipalities far from the border areas cusing on a set of prioritised initiatives rather than a see the added value of cross-border co-operation on broad range of activities. Second, success stories should demographic issues. When these diffi culties were iden- be highlighted and used to promote the programme tifi ed, the project plans were changed slightly, and time externally. Th ird, target areas should be communicat- and resources were allocated to establish good contacts ed in a clear manner to create enthusiasm for the pro- with all the municipalities.84 gramme. Fourth, the organisation requires suffi cient Th e Border Committee found it to be important to competencies to ensure the successful management of ensure that good personal contacts were established the programme. with all municipalities and that the project was prop- erly anchored in the municipal administrations. Th ere- 2.4.2 Facing demographic challenges in Hed- fore, it was considered to be necessary to pay personal mark-Dalarna visits to all the municipalities, which enabled the com- Th e “Demographic Challenges in Hedmark and Da- mittee to hear about their needs and expectations and larna” project was implemented in 2013, and it focused to include them in the project activities. Th ese steps of on the regional attractiveness of the border counties of the initial phase of the project proved to be essential in Hedmark in Norway and Dalarna in Sweden. Th e the later stages of implementation.85 theme of the project was to make the region a more at- tractive place to live, visit and do business. Th e project Implementation was initiated by the Border Committee of Hedmark Th e strategy of the project was to address the demo- and Dalarna and funded by the Nordic Council of graphic challenges in the region by increasing cross- Ministers’ Nordic Demographic Programme. On both sides of the border, there are several mu- nicipalities with particularly challenging situations 83) Th e Border Committee of Hedmark and Dalarna (2013) 84) Th e Border Committee of Hedmark and Dalarna (2013); Sahlander & Vaagen (2014) 81) Hanssen (2014). 85) Th e Border Committee of Hedmark and Dalarna (2013); Sahlander 82) Hanssen (2014). (2013); Sahlander & Vaagen (2014)
34 NORDREGIO WORKING PAPER 2014:3 Photo: Johannes Jansson/norden.org border co-operation across the Swedish–Norwegian seminars, the “Attractiveness Model” developed by the border. Th e goal was to facilitate the work of the mu- Norwegian Telemark Research Institute was presented nicipalities on the demographic challenges by creating, and received extensive attention from the participating collecting, and spreading information and knowledge, representatives of municipalities. Many were interested and by creating a platform for exchange of experience.86 in applying the model in their own municipalities. Th e In addition to the fi rst stage of engagement with mu- model has not previously been applied in Sweden, al- nicipalities, the main activities planned were organis- though there has been national-level interest in inves- ing seminars (“demographic laboratories”) to spread tigating it. Th e municipalities of the county of Dalarna knowledge and to build networks, collecting informa- in Sweden may become pioneers of the model, which is tion, and conducting a study to map the work of the considered to be advantageous for the county.88 municipalities on demographic issues and to provide From the seminars, it became clear to the Border a consequence analysis and cross-border comparisons. Committee that the municipalities were interested Because there were challenges in public procurement in obtaining more information on addressing demo- to initiate a mapping study within the allotted time graphic challenges and that there was a need to con- frame, the seminars were eventually the main element tinue such activities aft er the project.89 of the project.87 Although the planned activity of mapping the mu- Th e aim of the fi rst seminar was for the project par- nicipalities’ work on demography and conducting a ticipants to introduce themselves to each other, while consequence analysis was not followed through, data the following seminars focused on the themes of at- were gathered during the seminars to obtain an over- tractiveness and competence. Th e seminars contrib- view of the demographic situation. Th is resulted in uted to the sharing of knowledge, building networks a report produced by Hedmark University College between the participants and drawing inspiration from other municipalities. For instance, in one of the 88) Th e Border Committee of Hedmark and Dalarna (2013); Sahlander & Vaagen (2014) 86) Th e Border Committee of Hedmark and Dalarna (2013) 89) Th e Border Committee of Hedmark and Dalarna (2013); Sahlander 87) Th e Border Committee of Hedmark and Dalarna (2013) & Vaagen (2014)
NORDREGIO WORKING PAPER 2014:3 35 Photo: Magnus Fröderberg/norden.org describing the project and examining demographic change. Nevertheless, it was found that although many development in general. Th e report includes a list of municipalities may have no opportunity to follow the possible future activities for continuing the work on good practices presented in the good practice brochure demographic challenges. In addition, the project pro- developed for the project, collecting and highlighting duced a good practice brochure presenting case exam- good practice examples was a good way of strengthen- ples from the 11 municipalities describing their work ing the identities and pride of the small municipalities on demographic issues. Th e Border Committee has whose work was included.91 been active in disseminating information on the pro- ject and on demographic issues in external seminars.90 Outcomes and continuity Increased visibility and raised awareness of demo- Main challenges graphic issues were the most signifi cant outcomes of It was a challenge for the project that properly engaging the project. Aft er the initial diffi culties, the project was municipalities in project activities was more time-con- successful in engaging municipalities in considering suming than expected. However, aft er the challenge demographic issues. It has been noted that there has was identifi ed, it was decided to readjust the timetable, been local and regional interest in utilising the “Attrac- to send representatives to visit the municipalities per- tiveness Model” presented at a seminar. Th is shows sonally and to organise an initial seminar. that regional and municipal authorities are interested Financial constraints were identifi ed as a challenge, in addressing the demographic issues and that the pro- and it was noted that it is not suffi cient to have access ject has given them access to particular tools that they to good practice examples if the municipalities lack can use in their work.92 the fi nancial resources to implement them in their Demographic issues did not feature strongly on the own organisations. Th ere is a need for funding op- earlier agenda in Hedmark and Dalarna, and this pro- portunities from the national level for municipalities to work on the specifi c consequences of demographic 91) Th e Border Committee of Hedmark and Dalarna (2013); Sahlander & Vaagen (2014)
90) Th e Border Committee of Hedmark and Dalarna (2013) 92) Sahlander & Vaagen (2014)
36 NORDREGIO WORKING PAPER 2014:3 ject drew more attention to these issues. Aft er the pro- proach, it is possible to place new issues on the agenda ject, a cross-sectoral working group on demography and to build awareness and networks by thoroughly was established at the regional level in Hedmark. In engaging actors at all levels. Creating a better under- Dalarna, demography became a more integrated focus standing of the demographic challenges of the counties area in the work of the regional authority County Ad- contributed to overall increased interest in working on ministrative Board of Dalarna. It was also decided that those issues. Continuity is also crucial, and in this case, the Border Committee would continue working on de- the activities of the project contributed to the develop- mography in 2014 and 2015.93 ment of new ideas and initiatives to implement aft er the When the project ended in December 2013, the Bor- project, based on the connections and new information der Committee already had many ideas for possible created. topics of new projects. Th e work of the earlier project, and particularly the contacts established between the 2.4.3 The “We Choose the Faroe Islands” cam- Border Committee and municipalities as well as be- paign tween municipalities across the border, may be essen- Th e “We Choose the Faroe Islands” campaign focuses tial in the success of future projects. Th e plan is for a on changing the rhetoric concerning the living and new project with particular focus on matters of specifi c working conditions in the Faroe Islands and presenting interest to the municipalities, and it should be linked the positive aspects of life in the islands. Th e overall directly to the municipalities’ own strategies and ac- aim is to showcase the opportunities that the Faroe Is- tion plans.94 lands can off er and in particular to attract highly edu- cated young people from the Faroe Islands who have Lessons learned and transferability studied abroad to return to the islands. One of the most important lessons learned was the im- Th e population of the Faroe Islands has been stag- portance of establishing good connections with all ac- nating for several years, and the more remote parts of tors to create real commitment. Th is was found to be the island group especially suff er from demographic essential for the success of the project, even though the vulnerability related to various aspects. A particular implementation phase was found to be more time-con- challenge in the Faroe Islands is that a large proportion suming than expected. It is essential to allocate suffi - of the young population moves abroad for their studies cient time to ensure the engagement of actors and and do not return aft er fi nishing their education. Th is thereby the success of the initiatives. is an issue that the “We choose the Faroe Islands” cam- Engaging with municipal actors is particularly im- paign wants to address.96 portant but also challenging in cross-border projects. One of the lessons learned in the process was that the Initiation added value of participating in such a project should be Th e overall initiative to address the demographic de- impressed upon the municipalities. Th is is important velopment was undertaken by the Faroese Government for engaging them, and also because small municipali- in 2013, but the campaign as such was initiated by the ties in particular may have very limited resources for Faroese municipalities and industry in the same year. projects or initiatives that require extra work. Half of the campaign costs are covered by the mu- During the seminars with the municipalities, the is- nicipalities in the Faroe Islands and half by compa- sue of attractiveness was identifi ed as a common area nies. Th e Association of Municipalities, as well as the of interest to all types of municipalities regardless of umbrella organisation of industries, is responsible for size, geographic location or other characteristics. Be- the overall co-ordination of the project. Th eir aim is cause they have limited resources, it was essential to to spread knowledge of the campaign and to make it a fi nd a common theme of real interest to the municipal- national Faroese project including a wide range of ac- ities that could be incorporated into, and benefi t, their tors.97 daily work.95 A common theme of interest can also fa- cilitate their engagement, co-operation, and transfer of Implementation knowledge and experience. Th e campaign is mainly implemented via the Internet Th is project shows that even with a project-based ap- on the campaign website, as well as social media. Peo- ple who have moved back to the Faroe Islands have
93) Sahlander & Vaagen (2014)
94) Sahlander & Vaagen (2014) 96) Christiansen (2014)
95) Sahlander & Vaagen (2014) 97) Christiansen (2014)
NORDREGIO WORKING PAPER 2014:3 37 Photo: Nikolaj Bock/norden.org made a commitment to tell their stories concerning life lation development, but it is not possible to assess the in the islands on the website. An Instagram account is role of the campaign in that, as other issues such as also used, where one person per week documents his/ economic development may be more important.99 her life on the Faroe Islands. Th e social media accounts Co-operation between the municipalities and the of the campaign are widely followed and have become private sector has been considered to be eff ective in popular. this project. Th e co-ordinators of the Association of Sceptical attitudes have been the main challenge Municipalities and the industry association have been faced by the campaign. Some actors fi nd that the cam- able to mobilise their members to become involved. paign attempts to glorify the life on the Faroe Islands Th e use of social media, among other things by sharing while emphasising the positive aspects as well as the the stories of expatriates who have moved back to the career and social welfare opportunities. Some industry Faroe Islands, has also been an important aspect, and actors have also been sceptical about the focus on at- as expected, it has proven to be a good way to reach out tracting highly educated people to the islands because to those who have left the Faroe Islands. they consider that there is no need for such workers.98 As noted above, the main challenges have been re- lated to sceptical attitudes. A lesson learned could be Lessons learned and transferability to work more actively on engaging various actors and Th ere are no evaluations available of the eff ects of the to make sure that there are common goals in order to campaign because it is a relatively new project. How- avoid challenges related to attitudes. Moreover, it may ever, the project co-ordinator notes that there has been be benefi cial to provide more information and to com- an overall shift in the rhetoric and general image of the municate the goals of the project even more clearly, Faroe Islands. Th ere has also been some positive popu- and to explain the role of the target group of highly
98) Christiansen (2014) 99) Christiansen (2014)
38 NORDREGIO WORKING PAPER 2014:3 educated young émigrés in the Faroese labour market. club launched a public protest against the port expan- sion project. And in August 2005, they established the 2.4.4 Cold Hawaii in Nordjylland, Denmark “Save Middles” association to promote the positive im- Th e peripheral areas that stretch from Skagen down pact of surfi ng, especially in Th isted municipality but along the west coast to Sydjylland across the archipela- also in the rest of Denmark and Europe. Th e idea of go to Lolland-Falster and Bornholm have long been this was to emphasise the contribution of surfi ng to the characterised by declining population, an increasing local economy. With funding from the three nearby number of senior citizens, rising unemployment and municipalities, the association was granted one year to relocation of public jobs. In Th isted municipality, fi nd a solution. which is located in the region of Nordjylland, one of the biggest challenges has been a strong decline in the Implementation population over recent years; from 2006 to 2011, the Together with Hanstholm’s mayor at the time, Save population fell by 2.2% (from 45,910 citizens to Middles drew up a master plan for surfi ng in Th y,103 an 44,908100). In addition, the population is older as a re- area that covers Th isted municipality. Th e fi rst step sult of the out-migration of the younger population. was to create a web site to inform surfers around the Th is is partly because of the region’s lack of education- world about the campaign. Similarly, it was possible to al opportunities, which is also refl ected in the fact that donate money to the association via the web site for the the proportion of the population with higher educa- preparation of an alternative proposal that would not tional qualifi cations is one of the lowest in the coun- harm the surf spots. Th e idea of a web site as the central try.101 platform for communication and articulation may Th isted municipality is vulnerable on nine of the 10 have been inspired by similar projects elsewhere in the indicators in the Demographic Handbook.102 One rea- world, where surfers have organised to oppose projects son for this is that many of the villages in Th isted mu- that would destroy surf spots.104 nicipality have traditionally been dependent on fi sh- In less than two months, the association managed ing, manufacturing, and farming, and have therefore to recruit 300 members, and through crowd-funding experienced hard times because of the centralisation, collected DKK 130,000 from surfers around the world. decline, and outsourcing of jobs in these sectors. One Th e funds were used to hire NIRAS, a consulting engi- issue has therefore been how to change this trend and neering company, to propose a minimum of two alter- to attract new residents in the municipality. native plans for the Port of Hanstholm and to secure optimal business development.105 In addition, contact Initiation was made with the Danish Hydraulic Institute to doc- Cold Hawaii is not one but 29 registered surfi ng spots, ument how the area’s unique geographic characteris- all located on the west coast of Th isted Municipality, tics made it ideal for surfi ng. where many villages have long been an attractive des- In 2007, the project resulted in a long-term develop- tination for surfers. In the 1980s and 1990s, surfers ment strategy called Building the Cold Hawaii—Mas- were already coming to the small villages along the ter Plan for Th y as a Centre for Surfi ng in Northern coast to surf. However, in early 2005, the politicians in Europe. Th e strategy had three main objectives: surf- the former Hanstholm municipality (now part of the ing should be the basis of a major annual event hosted new Th isted municipality) challenged a proposed ex- in Th y, surfi ng should be part of an alternative settle- pansion of the port of Hanstholm that would threaten ment strategy, and surfi ng should become part of the the surf spots in the area. Hanstholm Harbour admin- local culture in Th y. Th e plan had a national and inter- istrators wanted to establish a new onshore area with national perspective, but it was built around the local room for aquaculture facilities, among other propos- associations and led by the NASA Surfer Organisation. als, opposite the beach on the north-east side of the Sydthy, Th isted, and Hanstholm municipalities were harbour, which was considered to be one of the best the main sponsors, together with private companies. A surf spots in the area. large variety of local organisations also supported the As a response to these plans, the surfers together development of the master plan. with the NASA (North Atlantic Surf Association) surf Th e desire to have a major annual surfi ng event led
100) Statistics Denmark (2014) 103) NASA (2007)
101) Pedersen & Ibsen (2010) 104) Pedersen & Ibsen (2010)
102) Nordregio (2012), map 1 105) Johnsen (2007)
NORDREGIO WORKING PAPER 2014:3 39 to Th y’s hosting one of the World Cup of Surfi ng com- Outcomes and continuity petitions four years later. Th is is the biggest windsurf- Th e focus on surfi ng has had a huge impact on the de- ing event in Scandinavia and is one of the major sport- velopment of the area. It has attracted more educated ing events in Th y. Th e Cold Hawaii PWA World Cup young people to settle in the area, and Klitmøller in was held for the fi rst time in the small town of Klit- particular has become a magnet for surfers through its møller—better known as the capital of Cold Hawaii— reputation of being one of the best surf spots in Cold in 2010, and this success was repeated in 2011. Th e an- Hawaii. Th e NASA Surfer Organisation now holds a nual event is the focal point of a larger eff ort to build strong position and can be said to have greatly infl u- awareness of Th y as an attractive place for tourism and enced the development of co-operation that has led to living. At the same time, it is a gathering point for the growing settlement in the community. Th isted Munici- many local actors. pality has also been active in providing excellent condi- tions for surfers. Besides its engagement in the Cold Main challenges Hawaii PWA World Cup, the municipality has part- Th e attraction of the surfers to the small villages along nered with the Realdania foundation. Together, they the coast of Th isted municipality was not an immedi- have contributed DKK 60 million. Th e money has been ate success, because the surfers’ attitudes created con- placed in the “Land of Opportunities—Th e Good Life fl icts with the local inhabitants.106 Th e late 1980s to the on the Coast” project, and one of the project’s main foci 1990s were characterised by confl icts between surfer is to make the area more suitable for surfi ng. Th e pro- tourists and locals. Th e focal point of the confl ict was ject has led to a large number of construction projects, the Ørhage surf spot in Klitmøller, which was the fi rst primarily in Klitmøller but also in Vorupør, as pro- windsurfi ng spot that was discovered in the area. Surf- posed in the master plan, to create an alternative settle- ers came in greater and greater numbers in the early ment based on surfi ng. Th is has resulted in a new dedi- 1990s and occupied much of the village with their vans cated surfi ng pavilion, a new beach promenade, and and gear. It was said that windsurfers took up too much better access to the beach. space and contributed too little to the local communi- Th e local business environment has also seen a posi- ty.107 Th e surfers spent the night in their vans and tive development, and the Cold Hawaii master plan brought all their food and drink from home. Addition- has been a strong contributor to this new identity. An ally, there were some cultural diff erences between local increase in revenue of the city’s two commercial surf fi shermen and surfers, when the local fi shermen felt schools of several hundred per cent within the past that the surfers had invaded their “space”. four years testifi es that tourism in the area is changing, Th e fi rst step to a proper dialogue between the surfer and an increasing number of tourists are coming to the tourists and the local inhabitants around these issues area because of the surfi ng facilities and activities such occurred when surfers began to settle in the village and as surfi ng lessons.110 Other companies have also chosen to become an integrated part of the local community.108 to locate in the area because of surfi ng opportunities In addition to some of the surfers’ moving to Klitmøller, and to contribute to local economic development. One several local residents began to surf, which meant that such example is Starfi sh, an offi ce space where people it was easier for locals and surfers to communicate. can come and rent space on a daily, weekly, or monthly Th rough the establishment of the NASA surfi ng asso- basis and thus become part of the community. Th e of- ciation, a more formal institution was established that fi ce houses professionals such as graphic designers and could communicate on behalf of the surfers with the project managers. community about confl icts. Th is was a very important Today, Klitmøller is the only town in Th isted Mu- step in institutionalising surfi ng, and the surf club nicipality that has a positive population development, could provide services such as advising surf tourists on and the demographic statistics present an unusually respecting the local community. Th is helped to change positive picture of a fringe area in modern Denmark: the attitudes towards surfi ng greatly.109 an increasing number of people are moving to the re- gion, both from Denmark and from other countries. Th ese people are oft en families with small children, and many are highly educated professionals. Th e vil-
106) Pedersen & Ibsen (2010) lage has almost become a small surf colony, and surfers have created an exciting environment and given new 107) Pedersen & Ibsen (2010)
108) Pedersen & Ibsen (2010)
109) Pedersen & Ibsen (2010) 110) Pedersen & Ibsen (2010)
40 NORDREGIO WORKING PAPER 2014:3 Photo: Karin Beate Nøsterud/norden.org life to the village. Th e population has grown by about and a niche branding strategy, Th isted—and Klitmøller 20 per cent from the late 1990s to 2013, when it peaked in particular—has managed to attract positive atten- at 833 inhabitants.111 Approximately 160 of Klitmøller’s tion nationally as well as internationally. Th e periph- inhabitants are new inhabitants or the off spring of mi- eral areas face huge challenges, and a way for these to grants. be competitive is to focus on distinguishing themselves from others. Locations with specifi c features may be Lessons learned and transferability able to establish themselves as niche destinations. Klit- Cold Hawaii is a good example of how to develop a ru- møller is one example where the optimal conditions of- ral area by building on one of its major strengths, lead- fer a form of surfi ng not found in many other places on ing to population and commercial growth. Cold Ha- the globe, and this has attracted the surfer community waii is now an international brand, and the story of not only locally, regionally or nationally, but also inter- how surfers from all over the world travel to this area to nationally. take advantage of the amazing surf opportunities has Th ird, continuity is important. In the case of Cold travelled around the world. Hawaii, activities based on the connections and new Four main lessons can be highlighted. First, the ini- information created during the project contributed to tiative has been led in a typical bottom-up approach the development of new ideas and initiatives to imple- whereby local enthusiasts managed to establish aware- ment aft er the initial project had ended. ness of certain issues by building functioning net- Finally, it is clear that public support for grass root works in the local community and by establishing a initiatives, such as the development of the master plan, solid association to front the campaign. Th rough this is an important precondition for the municipalities to collaboration, the surfers managed to place surfi ng on gain overall support in the community. Cold Hawaii the agenda and to build positive awareness in the com- demonstrates that it is possible to turn a confl ict into a munity. positive development by working together across sec- Second, by developing a strategy with a clear motive tors and administrative levels.
111) Statistics Denmark (2014)
NORDREGIO WORKING PAPER 2014:3 41 42 NORDREGIO WORKING PAPER 2014:3 3. What can be learned from these examples?
Demographic issues in one way or another infl uence all between municipalities. policy areas, and this report has examined examples of Th is became very clear, for example, in the demog- how local and regional authorities have approached the raphy project in the cross-border region of Hedmark challenges and opportunities of demographic change. and Dalarna, where initial diffi culties in engaging Th is fi nal chapter summarises the lessons learned from municipalities led to a change of plans in the project the examples and highlights specifi c issues to be con- implementation. It was decided to allocate more re- sidered in policy-making. sources to establishing a personal dialogue between Th e number of examples studied in this report is project leaders at the regional level and the municipali- of course limited, and the selection of examples is re- ties, which led to improved engagement of municipal stricted thematically and in terms of institutional set- actors, a more fruitful co-operation, and contacts that tings. Given these issues, the lessons learned are by no can be utilised in the future. means exhaustive but rather are a limited selection of In several of the examples studied, engaging munici- lessons from the selected examples that illustrate re- palities in initiatives and concrete activities co-ordinat- sponses to demographic change. ed by regional actors (e.g., in Hedmark and Dalarna, Kalmar County and Sør-Trøndelag) has been shown to Co-operation across policy areas be a good way of providing local authorities with sup- Th e complex issues of demographic change cannot be port in policy-making, and establishing common goals managed in only one policy area, which is obvious and a shared understanding of the needs of the region. from the selected examples in this report, illustrating Th e need to take local and regional experiences and that successful initiatives include collaboration across knowledge into consideration in national level policy policy areas. In many of the examples, it is clear that to making was also illustrated in one of the examples. address the impacts of demographic change, it is es- In Tornedalen, the local and regional actors fi nd that sential for public authorities to co-operate across sec- there is a risk that national centralisation policies may tors in their organisations and in a holistic manner to have negative eff ects on access to services in the most ensure that all policy areas share common goals. Th e remote parts of the cross-border region. Th is is because approach of the Närpes municipality in integrating im- centralisation may make it diffi cult to provide services migrants and that of the Sør-Trøndelag region in creat- across borders and thereby make travel time to services ing regional attractiveness are good examples of col- longer for the inhabitants. laboration across policy fi elds such as housing, the Co-operation between administrative levels may labour market and planning. also contribute to the exchange of experience between municipalities, and facilitates sharing of information Co-ordination and co-operation between adminis- such as good practices. Smaller municipalities joining trative levels forces and pooling resources can be a good way of ad- In addition to co-operation across policy areas and dressing demographic challenges, because a lack of re- policy integration, many of the examples illustrate the sources in an individual municipality may limit its op- need to include public authorities at various adminis- portunities to act. For example, the Regional Council trative levels. In many examples, it proved to be essen- of Kalmar County has been successful in co-ordinating tial for parties such as regional-level authorities to en- its priority area of “youth as a resource for regional de- gage in true dialogue with local actors to understand velopment” at the regional level and contributing to their concerns, to ground the project in common goals, policy-making, co-operation and exchange of experi- and thus to establish co-operation between the region- ence in the local community and between municipali- al and local levels as well as to facilitate co-operation ties. Cold Hawaii is another example of an initiative
NORDREGIO WORKING PAPER 2014:3 43 where three municipalities decided to invest in a pro- to make use of potential initiatives that stem from ject together. the civil society and are not initiated or formulated by the public authorities. Engagement of private actors Citizen engagement in the examples entails both In most cases, it is not suffi cient for public organisa- including citizens’ perspectives in policy-making and tions alone to engage in cross-sectoral activities. Rath- public authorities supporting good ideas in ways such er, collaboration with actors outside the public organi- as providing fi nancial support. sation is of key importance in addressing demographic change. Th e importance of including companies is par- Project-based approaches as a way to address de- ticularly clear for labour market issues and meeting the mographic changes challenges of competence provision. Th e examples have shown that even though strategy- In Närpes, co-operation between employers (re- based approaches can provide a holistic way to address cruiting immigrant labour force to meet their labour demographic challenges, project-based approaches can demand) and the local authorities (responsible for the also provide valuable input into policy processes at dif- integration infrastructure) has been crucial, while there ferent levels of government. Although there are obvi- have also been some challenges related to establishing ous challenges in project-based work (in terms of e.g. a dialogue between the two. In Sør-Trøndelag, there continuity), projects can achieve outcomes such as has also been broad collaboration between the public placing demographic issues on the political agenda and and private sectors in the various projects. In some of making them priorities in policy-making and imple- the examples, private sector actors were not included, mentation. Projects can also be a good way to tackle although this may have been benefi cial for the imple- specifi c challenges and to develop new working meth- mentation of the initiatives. Involvement of companies ods. However, it is important to ensure continuity in is, naturally, not always needed and it seems that it may projects as well as co-ordination between the initia- be easier for authorities to see the value of including tives. Taking these issues into consideration can pre- private actors when they address labour market issues serve the long term-eff ects of the actions, maintain directly, while the value of working with companies achievements, and avoid the loss of knowledge. may seem to be less clear with issues that have tradi- An example of a project approach to respond to tionally been managed exclusively by the public sector. long-term demographic challenges may be found in the cross-border region of Hedmark and Dalarna in Nor- Citizen engagement and support for grassroots initi- way and Sweden, where a demographic project led to atives increased awareness of demographic issues at the local Citizen engagement is important for local development and regional levels in both countries. Another example as a way to involve the local community and to encour- is Distance Health Care in Sydjylland, Denmark, where age residents to take an active part in activities. Th e a project that was initiated by a hospital was extended examples in this report demonstrate that inclusion of to become an important part of service provision in the civil society and citizens can have a substantial impact region. on individual decisions about whether to stay, to leave In some examples, project-based approaches were or even to move into the local community (e.g., the mi- used to continue established work in a less formal gration projects in Nordland and the Cold Hawaii ini- manner. For instance, the practices of organising acute tiative). cross-border health care in Tornedalen had grown In terms of the responses to demographic change, from a need to share resources and the needs of health the examples studied in this report included both top- care workers. Th rough two INTERREG projects, it was down and bottom-up initiatives as well as project- and possible to assure the quality of activities and measures strategy-based approaches. Th e bottom-up initiative of that had developed over time based on various needs Cold Hawaii demonstrates how local enthusiasts can identifi ed by health care personnel. drive development in a region by building on social In the Närpes municipality, various projects co-fi - networks in the local community as well as highlight- nanced by the EU have been used to develop working ing local uniqueness. Th is can contribute to creating methods, and the municipality is currently co-operat- a more attractive living environment that can attract ing with neighbouring municipalities on the establish- young highly-educated people to move to the area. ment of a “welcome offi ce” to provide information to Support for grass roots initiatives can function as a way immigrants and to co-ordinate the integration work in the region. 4. Directions for future research
Th is fi nal chapter briefl y discusses the issues identifi ed the “regional attractiveness model” has been widely during the course of this project that may be relevant applied, and increased interest in the concept has aris- for further studies. Th e Nordic Working Group on De- en among Swedish policymakers. Similar models or mography and Welfare will continue until the end of other work on the same theme across the Nordic region 2016, and this chapter contributes to planning its fu- could therefore provide insights and facilitate exchange ture activities. of experience concerning existing tools. Th is report has examined a broad scope of responses Another concept that has gained increased attention to demographic challenges without focusing on any among researchers and policymakers during recent specifi c thematic or “methodological” ways to address years, and one that is prioritised by the EU, is social in- demographic change at the local and regional levels. novation. Th e Guide to Social Innovation (2013) by the One possible theme for further study in the Nordic Directorate-General for Regional and Urban Policy de- context by the working group is to focus on specifi c de- fi nes social innovation as “the development and imple- mographic challenges and opportunities to gather in- mentation of new ideas (products, services and models) depth knowledge about policy areas or responses. For to meet social needs and create new social relationships example, it would be interesting to study in detail some or collaborations. It represents new responses to press- aspects of how local and regional authorities use inter- ing social demands, which aff ect the process of social national migration to address demographic change. interactions. It is aimed at improving human well-be- As the lessons learned from the examples in this re- ing. Social innovations are innovations that are social port and earlier research show, more potential is oft en in both their ends and their means.”112 found in integrated cross-sectoral solutions across pol- Many of the examples studied in this report include icy areas than in more traditional approaches focusing elements that are discussed in the social innovation on single policy areas without cross-sectoral ambitions. debate, such as the need to engage actors other than Th erefore, it would be interesting to examine holistic public authorities in the process of policy-making ways of addressing demographic changes. For example, and implementation. In many cases, however, there is the concepts of regional attractiveness and social inno- potential for greater use of various elements of social vation have been used by researchers and policymakers innovation at the local, regional, and national levels. to discuss more integrated policy-making. Operationalising the concept of social innovation may Th e lessons learned in this project suggest that re- provide policymakers and practitioners with new prac- gional attractiveness is a theme that could be further tical ways to address demographic challenges in an in- studied in the Nordic context. Th e concept of regional clusive and effi cient way. attractiveness describes integrated cross-sectoral poli- More research is needed, both in terms of the impli- cy processes to increase a region’s appeal as a place to cations of the social innovation concept in the specifi c live, to visit, and to do business. Th e need for integrated Nordic context and in terms of adapting it and pos- and holistic policy approaches, including policy areas sibly developing suitable tools for operationalising it. such as housing, service provision, and labour market, It could be useful to examine the concept of social in- was identifi ed in many of the examples and is also cen- novation more closely, as well as to examine critically tral to the concept of regional attractiveness. Applying how it suits the Nordic welfare state context and its po- the concept of regional attractiveness may be a good tential for addressing the specifi c needs of Nordic local way to address demographic change in a holistic man- and regional authorities. ner in a variety of policy areas. In Norway in particular
112) DG Regional and Urban Policy (2013)
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NORDREGIO WORKING PAPER 2014:3 47 ISSN 1403-2511 ISBN 978-91-87295-20-1
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