Promoting health by addressing living conditions in Norwegian municipalities (original) (raw)
Related papers
2018
The article by Susanne Hagen and colleagues on Health Promotion at Local Level in Norway discusses actions by municipal governments to assess and address heath inequities within their respective regions, as required under the Norwegian Public Health Act (PHA). Although the broad intent of the Norwegian government is to encourage action on social determinants of health (SDH), Hagen et al find that many of the initiatives undertaken by municipalities 'tend to cash out as single, targeted initiatives, ' and focus on individual behaviours. In this commentary, I use the concept of place-based policy and ideas from policy theory on the institutional behaviours of public policy agencies and services, to discuss reasons behind this narrowing of perspective and policy action. I argue in favour of an alternative approach involving public agencies and services supporting processes of community-led action and social change. Citation: Fisher M. Challenging institutional norms to improve local-level policy for health and health equity: Comment on " Health promotion at local level in Norway: the use of public health coordinators and health overviews to promote fair distribution among social groups.
Scandinavian journal of public health, 2015
The public health coordinator (PHC) is a municipal-government position in Norway whose role is to organise and oversee municipal policies and functions to support national public health goals. This cross-sectional study investigates conditions associated with use of PHCs by Norwegian municipalities in the period immediately before the new Public Health Act came into effect in 2012, decentralising responsibility for citizen health to the municipal level. This study provides descriptive baseline data regarding Norwegian municipalities' use of PHCs in this time - a marker for municipal engagement with inter-sectorial collaboration - before this policy was nationally mandated, and explores whether municipal characteristics such as structure, socio-economic status and extent of Health in All Policies (HiAP) implementation were associated factors. All Norway's municipalities (N=428) were included. We combined Norwegian register data with survey data. Descriptive analyses and bi- a...
2018
Background: Norway is internationally known today for its political and socioeconomic prioritization of equity. The 2012 Public Health Act (PHA) aimed to further equity in the domain of health by addressing the social gradient in health. The PHA's main policy measures were (1) delegation to the municipal level of responsibility for identifying and targeting underserved groups and (2) the imposition on municipalities of a " Health in All Policies " (HiAP) approach where local policy-making generally is considered in light of public health impact. In addition, the act recommended municipalities employ a public health coordinator (PHC) and required a development of an overview of their citizens' health to reveal underserved social segments. This study investigates the relationship between changes in municipal use of HiAP tools (PHC and health overviews) with regard to the PHA implementation and municipal prioritization of fair distribution of social and economic resources among social groups. Methods: Data from two surveys, conducted in 2011 and 2014, were merged with official register data. All Norwegian municipalities were included (N = 428). Descriptive statistics as well as bi-and multivariate logistic regression analyses were performed. Results: Thirty-eight percent of the municipalities reported they generally considered fair distribution among social groups in local policy-making, while 70% considered fair distribution in their local health promotion initiatives. Developing health overviews after the PHA's implementation was positively associated with prioritizing fair distribution in political decision-making (odds ratio [OR] = 2.54; CI: 1.12-5.76), compared to municipalities that had not developed such overviews. However, the employment of PHCs after the implementation was negatively associated with prioritizing fair distribution in local health promotion initiatives (OR = 0.22; CI: 0.05-0.90), compared to municipalities without that position. Conclusion: Development of health overviews — as requested by the PHA — may contribute to prioritization of fair distribution among social groups with regard to the social determinants of health at the local level. Implications for policy makers • The very process of developing a health overview seems to build the institutional muscle, awareness, and skills among relevant municipal personnel to address health inequalities. • Employing a public health coordinator (PHC) does not necessarily lead to greater focus on equity. • For PHCs to succeed in reducing health inequalities they need necessary information and competencies, to be employed in positions close to full-time, and possess sufficient organizational authority to coordinate municipal sectors and assist in developing and implementing policies. Implications for the public Attaining more equitable public health requires coordination of national and local policy. Our research suggests that tasking municipalities with developing local health overviews of the social determinants of health can help build both municipal awareness and competencies for addressing inequalities. A tentative unexpected finding is that merely employing a public health coordinator (PHC) can reduce the capacity to advance equity. If the PHC position is only part-time, and not empowered enough or bureaucratically integrated, or held by someone skilled at building needed cross-sectorial collaboration, equity might not be advanced.
Governing health equity in Scandinavian municipalities: The inter-sectorial challenge
Scandinavian Journal of Public Health, 2017
Aims: Local governments in the Scandinavian countries are increasingly committed to reduce health inequity through ‘health equity in all policies’ (HEiAP) governance. There exists, however, only very sporadic implementation evidence concerning municipal HEiAP governance, which is the focus of this study. Methods: Data are based on qualitative thematic network analysis of 20 interviews conducted from 2014 to 2015 with Scandinavian political and administrative practitioners. Results: We identify 24 factors located within three categories; political processes, where insufficient political commitment to health equity goals outside of the health sector and inadequate economic prioritization budget curbs implementation. Concerning evidence, there is a lack of epidemiological data, detailed evidence of health equity interventions as well as indicators relevant for monitoring implementation. Concerted administrative action relates to a lack of vertical support and alignment from the nationa...