1. Embedding social sustainability across Malmö



With health inequalities causing social polarisation and a burden on services, city officials in Malmö, Sweden, established a commission dedicated to improving health equity and encouraging sustainable growth – socially, financially and environmentally.





Malmö City Executive Board establishes the Commission for a Socially Sustainable Malmö to tackle health inequalities.


The Commission delivers its final report to the City Executive Board in late 2012, with recommendations for improving social sustainability and reducing health inequalities. The report, Malmö’s path towards a sustainable future: health, welfare and justice, is published in 2013.


The Comprehensive Plan for Malmö is published to guide development over the next 20 years.


Annual progress reports are published.,,


Malmö’s Office for Sustainable Development is established.


Malmö is a large city in southern Sweden. It is one of the fastest-growing cities in Europe, but has substantial health inequalities. In the mid-2000s the gap in life expectancy between people with the highest and lowest levels of education was 5.4 years for men and 4.6 years for women, with the most educated experiencing the longest life expectancy. There was also a clear difference between the health of Swedish-born Malmö residents and those born abroad, partly due to unequal access to work and social services. For example, Malmö’s Iraqi population had high unemployment, were physically segregated in certain parts of the city, and had levels of obesity twice that of Swedish-born residents.

The intervention

Phase 1: The Commission for a Socially Sustainable Malmö

Inspired by the 2008 WHO Commission on the Social Determinants of Health, the Malmö City Executive Board established the Commission for a Socially Sustainable Malmö in 2010 to reduce health inequalities and help the city grow sustainably in all social, financial and ecological aspects.

The Commission’s mandate was to reduce health inequalities through areas such as preschools, workplaces and urban design. The City Executive Board also had an ambition to work towards sustainable development from all perspectives, with a greater focus on the social dimension of sustainability.

Following its decision to establish the Commission, the board engaged in an extensive consultation process to determine its structure, scope, process and priorities.

The Commission began its work in 2011. It comprised 14 academic researchers and practitioners working in Malmö, and was coordinated by a dedicated secretariat of four people, including a general secretary and a communications manager.

The Commission initially undertook a comprehensive evidence-based analysis of health, health inequalities and the social determinants of health in Malmö, which it published in 31 reports. These reports served as discussion papers to facilitate dialogue and consultation with stakeholders within and beyond Malmö. Around 2,000 people, including representatives from the private sector, interest groups, professional organisations and city residents, took part in participatory action research through 30 public and private events. The findings informed the Commission’s final recommendations.

The Commission published its final report in 2013. Its overarching recommendations were:

  • to establish a social investment policy to reduce inequalities in living conditions and make social systems more equitable
  • to change processes by creating knowledge alliances and democratised management.

The Commission also recommended 72 specific actions grouped into six domains across the wider determinants of health. The domains were:

  • everyday conditions during childhood and adolescence
  • residential environment and urban planning
  • education
  • income and work
  • health care
  • transformed processes for sustainable development through knowledge alliance and democratised management.

Phase 2: Implementing the Commission’s policy recommendations

The recommendations from the Commission for a Socially Sustainable Malmö were supported at the highest political and administrative levels. In 2014, the City Executive Board invested SEK3.5m in promoting, coordinating and monitoring the Commission’s work and established a cross-sector steering group to oversee implementation.

A working group, comprising representatives from local government departments across the city, began the implementation by developing a framework of feasible actions that individual departments could work towards and be monitored on. A small team of civil servants supported implementation through a communications strategy, sharing knowledge and good practice, and coordinating and producing annual progress reports.

The Commission’s recommendations were implemented in a number of ways – for example:

  • The planning department adopted more bottom-up approaches to engaging stakeholders in decision making. It also started using its procurement processes to strengthen social outcomes – for example, by employing local people in new renovation and building work.
  • The culture administration conducted a mapping exercise to see who was accessing culture and leisure activities, and then worked to distribute them more equally. For example, Malmö City Theatre introduced mid-week daytime performances in schools to compensate for cutbacks in arts in the school curriculum.
  • A social investment fund of SEK100m was established for city administrations to apply for policy or project funding. However, the requirements to estimate future cost savings were too complex for most applicants and did not match the annual budgeting cycle, and the fund was later abolished. Instead, the City Executive Board embarked on a programme to build capacity for economic evaluation within departments, with a view to introducing a new social investment fund in the future.


Between 2014 and 2016, the City Office undertook three annual progress reviews.,, The researchers used interviews and text analyses to assess whether specific language around social sustainability had been incorporated into local government policy documents.

The reviews suggested there had been incremental progress towards incorporating social sustainability into policies and practices across the city. For example, 50% of the actions were underway in 2015, rising to 84% in 2016. There were other examples of progress too:

  • The City Office implemented a comprehensive suite of communications activities to raise awareness of the Commission for a Socially Sustainable Malmö and its recommendations.
  • The annual city budgets demonstrated ongoing political and administrative prioritisation of social sustainability. For example, all committees across the municipality were tasked with making specific social sustainability investments.
  • The city planning administration adopted a more bottom-up approach to involving communities in urban planning decisions.
  • Efforts were underway to build teams’ knowledge, expertise and capacity for economic and social impact assessments, and policies were increasingly assessed for their social impacts.
  • The city authorities demonstrated their commitment to social sustainability through establishing the SEK100m social investment fund.
  • In 2018, the Office for Sustainable Development was established to oversee the city’s work.

In 2018, a formal evaluation of the Commission’s impacts on health inequalities and their determinants began. The findings have not yet been published, but the researchers recognise it will be challenging to attribute any observed changes in health inequalities to the Commission itself.

Lessons learned

What worked well

  • Because health inequalities and their social and economic impacts had high visibility – both socially and structurally – there was strong public and political support for action.
  • High-level political commitment has maintained social sustainability as a priority in Malmö.
  • Many individuals and communities were engaged and committed to improving social sustainability in Malmö, and demonstrated this through creating networks and pooling resources. This was crucial for driving change.

What worked less well

  • Measuring the impacts of social investments was difficult, partly because the benefits take a long time to be realised and because such complex interventions have wide-ranging effects across many sectors, which are rarely measured. For example, investment in children’s services may result in reduced input from social work, health care or criminal justice – but much further down the line.
  • Financial constraints and budget deficits hampered investment in preventative measures since funding core operations was prioritised. Further, the annual budgeting, planning and measurement cycle made it difficult to invest in more long-term approaches.
  • Some actors did not buy into the Commission’s work, including some within the municipality’s administration. This meant continual framing and re-framing of the problem and the solutions were needed to keep those in positions of power engaged.

Implications for the UK

Local authorities in Sweden are less reliant on central government for funding than those in the UK, and the higher rate of income tax frees up more public funding for investment and experimentation with policy initiatives. Nevertheless, this case study gives UK local authorities some valuable knowledge and insight when planning for and coordinating their own joined-up work across sectors.

UK councils may benefit from building knowledge and capacity for economic evaluations. Assessing the costs and savings from policy interventions is important for understanding their impact on health, enabling costs and savings to be redistributed across the system, and making the case for long-term investment in social policies.

Complex policy interventions, such as the Commission for a Socially Sustainable Malmö, are inherently difficult to evaluate. New methods for assessing the impact of policies on health and health inequalities will support central and local government and the wider public health community to measure the complex effects of interventions more accurately and comprehensively.

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