BackgroundIn this study we investigated the distribution of self-reported health care utilisation by education and household income in a county population in Norway, in a universal public health care system based on ideals of equal access for all according to need, and not according to wealth.MethodsThe study included 24,147 women and 20,608 men aged 20 years and above in the third Nord-Trøndelag Health Survey (HUNT 3) of 2006–2008. Income-related horizontal inequity was estimated through concentration indexes, and inequity by both education and income was estimated as risk ratios through conventional regression.ResultsWe found no overall pro-rich or pro-educated socioeconomic gradient in needs-adjusted utilisation of general practitioner or inpatient care. However, we found overall pro-rich and pro-educated inequity in utilisation of both private medical specialists and hospital outpatient care. For these services there were large differences in levels of inequity between younger and older men and women.ConclusionIn contrast with recent studies from Norway, we found pro-rich and pro-educated social inequalities in utilisation of hospital outpatient services and not only private medical specialists. Utilisation of general practitioner and inpatient services, which have low access threshold or are free of charge, we found to be equitable.

Through the last 3 decades, the previous socio-economic differences in GP utilization have diminished. Despite this, highly educated people were more prone to utilize hospital outpatient consultations throughout the period 1984-2008.

The overall level of income-related inequity in dental services utilisation was low compared to other European countries as reported in two recent international studies of socioeconomic inequalities in dental care utilisation. Pro-rich and pro-educated inequity is a public health challenge mainly in the older part of the population.

Background Thirty‐day mortality after hospitalization for stroke is commonly reported as a quality indicator. However, the impact of adjustment for individual and/or neighborhood sociodemographic status ( SDS ) has not been well documented. This study aims to evaluate the role of individual and contextual sociodemographic determinants in explaining the variation across hospitals in Norway and determine the impact when testing for hospitals with low or high mortality. Methods and Results Patient Administrative System data on all 45 448 patients admitted to hospitals in Norway with an incident stroke diagnosis from 2005 to 2009 were included. The data were merged with data from several databases to obtain information on vital status (dead/alive) and individual SDS variables. Logistic regression models were compared to estimate the predictive effect of individual and neighborhood SDS on 30‐day mortality and to determine outlier hospitals. All individual SDS factors, except travel time, were statistically significant predictors of 30‐day mortality. Of the municipal variables, only the municipal variable proportion of low income was statistically significant as a predictor of 30‐day mortality. Including sociodemographic characteristics of the individual and other characteristics of the municipality improved the model fit. However, performance classification was only changed for 1 (out of 56) hospital, from “significantly high mortality” to “nonoutlier.” Conclusions Our study showed that those stroke patients with a lower SDS have higher odds of dying after 30 days compared with those with a higher SDS , although this did not have a substantial impact when classifying providers as performing as expected, better than expected, or worse than expected.

Global health crises require coordination and collaboration among actors and global health agendas including health security, health promotion, and universal health coverage. This study investigated whether national public health institutes (NPHIs) unify agendas and actors, how this can be achieved, and what factors contribute to success. We conducted semi-structured interviews with 24 public health leaders from 18 countries in six WHO regions between 2019 and 2020. Respondents described how NPHIs bridge agendas reporting five strategies that institutes employ: serving as a trusted scientific advisor; convening actors across and within sectors; prioritizing transdisciplinary approaches; integrating public health infrastructures, and training that builds public health capacity. Findings also revealed five enabling factors critical to success: a strong legal foundation; scientific independence; public trust and legitimacy; networks and partnerships at global, national, and local levels; and stable funding. The Covid-19 pandemic underscores the urgency of securing scientific independence and promoting national institutes’ responsiveness to public health challenges.