The practice of public health coordination in Sweden: roles, responsibilities, and realities.

In response to increasingly complex and cross-sectoral public health challenges, coordination has emerged as a key strategy for aligning efforts across fragmented systems. However, despite its widespread endorsement, coordination remains conceptually ambiguous and difficult to operationalise in practice. This qualitative study explores how public health coordination is enacted at the local level in Sweden, where municipalities employ public health coordinators to promote population health and reduce inequalities. Semi-structured interviews with 21 public health coordinators across diverse Swedish municipalities were conducted and through an inductive thematic analysis four key themes were developed: driving targeted efforts and holding processes together; connecting activities to policy goals through purposeful planning; creating conditions for collaboration by engaging relevant stakeholders; and building a knowledge support function through acquiring and sharing new knowledge. The findings reveal that coordination is a dynamic and adaptive function requiring strategic thinking, relational skills, and contextual sensitivity. Effective coordination depends not only on individual competencies, such as communicative, diplomatic, and administrative abilities but also on structural conditions, including political mandates, formalised goals, and sufficient time and resources. Coordinators often operate without formal authority, relying on trust and leadership support to navigate complex and shifting responsibilities. The study concludes that coordination is essential for enabling collaboration, sustaining public health efforts, and aligning activities with policy goals. It highlights the need for clearer role definitions, supportive frameworks, and further research into how coordination contributes to long-term public health outcomes across different domains and local contexts.