IntroductionThe Norwegian health care system is well organized within its two main sectors—primary health and long-term care on the one hand, and hospitals and specialist services on the other. However, the relation between them lacks mediating structures.Policy practiceEnhancing coordination between primary and secondary health care has been central in Norwegian health care policy in the last decade. In 2003 a committee was appointed to identify coordination problems and proposed a lot of practical and organisational recommendations. It relied on an approach challenging primary and secondary health care in shared geographical regions to take action. However, these proposals were not implemented. In 2008 a new Minister of Health and Care worked out plans under the key term “Coordination Reform”. These reform plans superseded and expanded the previous policy initiatives concerning cooperation, but represented also a shift in focus to a regulative and centralised strategy, including new health legislation, structural reforms and use of economic incentives that are now about to be implemented.DiscussionThe article analyses the perspectives and proposals of the previous and the recent reform initiatives in Norway and discusses them in relation to integrated care measures implemented in Denmark and Sweden.

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Building heavily on the Health in All Policies (HiAP) approach, Norway implemented the Public Health Act in 2012 to reduce social inequalities in health. Local public health coordinators (PHCs) at municipal levels were seen as tools to provide local intersectoral public health work. In this study, we examine factors related to intersectoral agency and if intersectoral work is understood as relevant to securing social justice in local policy outcomes. A national web-based survey in 2019 of all Norwegian PHCs (n = 428) was conducted with a response rate of 60%. Data were analysed through multiple linear regression, hierarchical regression modelling and structural equation modelling. Neither factors relating to community contexts nor individual characteristics were associated with intersectoral agency. Organisational factors, especially position size, being organised at the top level and having a job description, were significantly associated with perceptions of intersectoral agency. PHCs seeing themselves as intersectoral agents also found themselves able to affect annual budgets and policy outcomes. We conclude that municipal PHC positions can be important HiAP tools in local public health policies. However, organisational factors affect how PHCs perceive their influence and role in the municipal organisation and thereby their possibilities to influence local policymaking through intersectoral agency.

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Introduction: The implementation of a new structural reform, the Coordination Reform, prioritizing a new public health agenda, was initiated to develop a more decentralized, integrated health care system in Norway in 2012. The same year, new health legislation was implemented and due to the new Public Health Act the responsibility for implementing a new public health agenda was decentralized to the local level. Historically, due to lack of fundingthese issues have got low priority among local authorities. The new public health legislation reflects a shift in policy focus from treatment to illness preventionwhere planning and partnership among primary end specialist health care, as well as horizontal partnerships at the local level are mandatory by law. Theory and methods: Neo-institutional theory, or a multiple logic approach, is applied to discuss findings obtained from descriptive data and qualitative interviews among managers and professionals from local authorities in two counties in the West and South of Norway. Conclusions: The article concludes that public health policy may not be fulfilled because of the existence of multiple logics giving rise to many obstacles to successful multi-professional collaboration, as well as lack of economic incentives following the mandatory reform initiative.