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

Abstract

The 2012 Norwegian Public Health Act stipulates that all Norwegian municipalities need to integrate public health concerns in their decision-making processes at all policy levels. Based on a Health in All Policies (HiAP) approach, population health and health equity are seen as whole-of-government responsibilities, making all municipal actors across sectors and professional boundaries responsible for health issues. Although many municipalities are well on their way towards implementing this goal, several experience a lack of legitimacy and inter-sectoral collaboration, as well as encounter conflicting professional identities. Theory and Methods: In this interview-based case study, we investigate the legitimacy of the HiAP approach in three Norwegian municipalities. We use an institutional perspective to analyse legitimacy, and we discuss how professional identities might relate to the implementation of this inter-sectoral collaboration. Results: Our findings suggest that the three municipalities are in the process of legitimising HiAP. Further, that legitimacy based on the integration of HiAP in planning and management structures and in formal documents seems easier or less complicated to achieve than other types of legitimacy related to personal understanding, values and norms. Conclusions and discussion: We argue that these findings may be related to the possible risk of identity conflicts, which could potentially pose challenges to collaborations, such as HiAP, and then again challenge the implementation of integrated care.

Contributing Factors in the Tuberculosis Care Cascade in India: A Systematic Literature Review

“…Yet, the unanswered question in this review is who is accountable for addressing these associated factors, whether the scope of the NTEP program or all other public health programs should converge and address collaboratively. The factors identified in this review such as poverty, myths/beliefs, addictions involve a strong socio-economic context and require long-term interventions; thus, efforts like “Health in All Policies (HiAP)” 48 , 49 might be the way forward and recommended to the country like India.…”

Evaluating ‘Health in All Policies’ in Norwegian Municipalities

“…Further, when producing public-health goals, informants experienced that plans do not always govern actions [19] and do not necessarily represent a common understanding of its policies [20]. As another example, our informants experienced the risk of health imperialism when implementing HiAP, which could result in distrust and opposition to the implementation process [20,21].…”

“…The evaluation of such outputs gives valuable information about sub-goals, forming the basis for evaluating outcomes [28]. An overview of Norwegian research [34] (p. 21) shows that that much of the earlier research on the implementation of the NPHA has measured these significant outputs, as such as plans, health overviews, the establishment of cross-sectoral groups, etc. However, less research has investigated the more relational or processual aspects of the HiAP implementation.…”

“…Unknown factors can be of importance for understanding why one has achieved the objective, or not [26,27,37]. In our earlier research on how Norwegian municipalities use planning as tool for implementing HiAP, we found that the process of implementing HiAP represented a complex process in several ways throughout the different steps in the planning circle (Figure 1) [19][20][21]. This complexity complicates evaluation.…”

“…I discuss these questions based on the HiAP literature in general and the results from two research projects in particular. One study investigates how Norwegian municipalities use planning as tool for implementing HiAP [19][20][21]. And one study evaluates 'The Local Environment Project (LEP)' run by the Norwegian Directorate of Health in the period of 2015-2019 [22].…”