Reducing social inequities in health in Norway: Concerted action at state and local levels?

• Published in: Health policy (Amsterdam) Vol. 113; no. 3; pp. 228 - 235
• Main Authors: Tallarek née Grimm, Marie J, Helgesen, Marit K, Fosse, Elisabeth
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 01-12-2013; Elsevier
• Subjects: Autonomy; Biological and medical sciences; Equality; Federal Government; Health; Health administration; Health care; Health impact assessment; Health Policy; Health Promotion; Health Status Disparities; Humans; Internal Medicine; Local Government; Medical sciences; Medical service; Miscellaneous; Norway; Policy Making; Priorities; Public Health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Public policy; Qualitative Research; Questionnaires; Social factors; Social inequities in health; Socioeconomic Factors; Success; Norway; Europe; Health impact assessment; Public policy; Health promotion; Social inequities in health; Socioeconomic factors; Public health; Evaluation; Socioeconomic status; Political aspect; Equity; Health hazards; Social aspect; Inequality
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2013.09.019

Abstract Norwegian national policies have been distinguished by their focus on equity, contributing to comprehensive policies to reduce the social inequities in health (SIH). The newly adopted Public health act, which aims at reducing the SIH, endorses these acknowledgements while highlighting the importance of municipalities as the key actors in public health. Municipal obligations include inter-sectoral policies for health, health impact assessments (HIA), and the development of local health overviews. Against the background of a system of local autonomy in Norway, this article illuminates whether, and how, municipal public health policies reflect national priorities. Our data are based on one qualitative study, combining document content analysis and expert interviews conducted in 2011, and one quantitative questionnaire sent to municipal chief administrative officers in 2011. Our findings indicate a divide between national and municipal public health strategies. Many municipalities focus on life-style and health-care related measures. Only few municipalities acknowledge the social determinants of health and have implemented HIA and health overviews. Arguing for the importance of concerted multi-level action to reduce the SIH, we need to better understand the gap between national and municipal approaches. We thus suggest further research to illuminate the challenges and success factors faced at local levels.