Addressing the social determinants of health at the local level: Opportunities and challenges

Abstract

Aims:The gradient in health inequalities reflects a relationship between health and social circumstance, demonstrating that health worsens as you move down the socio-economic scale. For more than a decade, the Norwegian National government has developed policies to reduce social inequalities in health by levelling the social gradient. The adoption of the Public Health Act in 2012 was a further movement towards a comprehensive policy. The main aim of the act is to reduce social health inequalities by adopting a Health in All Policies approach. The municipalities are regarded key in the implementation of the act. The SODEMIFA project aimed to study the development of the new public health policy, with a particular emphasis on its implementation in municipalities. Methods: In the SODEMIFA project, a mixed-methods approach was applied, and the data consisted of surveys as well as qualitative interviews. The informants were policymakers at the national and local level. Results: Our findings indicate that the municipalities had a rather vague understanding of the concept of health inequalities, and even more so, the concept of the social gradient in health. The most common understanding was that policy to reduce social inequalities concerned disadvantaged groups. Accordingly, policies and measures would be directed at these groups, rather than addressing the social gradient. Conclusions: A movement towards an increased understanding and adoption of the new, comprehensive public health policy was observed. However, to continue this process, both local and national levels must stay committed to the principles of the act.

Capacity building for intersectoral action for health by local governments is needed: a policy brief

“…un eje transversal en los ayuntamientos, no solo requiere el compromiso político, sino el convencimiento de toda la estructura administrativa responsable de ejecutar las decisiones políticas 8 . Son múltiples los elementos que condicionan esta situación como, por ejemplo, contar con una legislación que fomente la integración de la perspectiva de salud en todas las áreas 7 o la existencia de programas o estrategias del gobierno nacional coherentes con la perspectiva de los DSS 9 .…”

“…Además, se ha evidenciado una falta de compromiso 11 , responsabilidad política y rendición de cuentas en cuestiones de salud 7 . En términos generales, existe una falta de capacidad para abordar la promoción de la salud desde un enfoque intersectorial en los gobiernos locales 9,15,16 .…”

“…Junto a estas recomendaciones, las autoras proponen que sea el sector salud quien asuma el liderazgo en este proceso. Contar con un referente claro para avanzar en la integración de la perspectiva de la salud en todas las áreas es el apunte más frecuentemente realizado en la literatura, unido a la consolidación de un grupo de trabajo intersectorial 6,9,11,[14][15][16]31 . El sector salud puede acompañar los procesos de implementación de enfoques como la SeTP y la creación de capacidad en los sectores.…”

Legitimising Inter-Sectoral Public Health Policies: A Challenge for Professional Identities?

“…However, although municipalities' implementation of public health policies is regulated by law, they still have plenty of room to decide on how they want to implement these [5] -a task that many municipalities experience as complex and challenging. For example, some struggle to make public health a whole-of-government responsibility that is owned by the entire organisation across its boundaries and supported by leaders in different sectors, as opposed to being a concern for the health sector alone [6,7]. Gaining acceptance, support or legitimacy for public health issues within sectors, such as transport, education, culture and planning, is therefore a central but difficult concern, making the implementation of HiAP particularly interesting to investigate.…”

Advancing Health Disparities Research in Population Health

“…High obesity rates among African Americans continue to be a tremendous public health concern (9). High obesity rates have been linked to numerous factors, including biology, dietary consumption, population characteristics, access to care, socioeconomic status, and environment (10). Sterling and coauthors conducted research that monitored and analyzed changes in nut intake, other obesity-related foods (red or processed meats, added sugars), and body mass index during a 2-year weight loss intervention (11).…”