Policies to Tackle Health Inequalities in Norway: From Laggard to Pioneer?

Abstract

This study addresses recent public health policies in Norway, asking how policies on health inequalities have developed over the past 20 years. The authors focus on how the problem has been defined, what goals have been set, and what means have been put forward to achieve them. The data consist of official documents and interviews of key actors in research and the health bureaucracy. The results indicate that the theme of health inequalities has developed from a non-topic to a high-priority topic in Norway's public health policy. This change has been accompanied by formulation of clear goals and an overarching and long-term strategy, including concrete means to reduce health inequalities. Over the past five years, the problem definition has changed from one of individualization with a focus on health behaviors to a structural understanding that emphasizes the problem of the gradient and social determinants of health. Norway is on the move from a state of political indifference toward action in developing comprehensive, coordinating policy.

What Enables and Constrains the Inclusion of the Social Determinants of Health Inequities in Government Policy Agendas? A Narrative Review

“…For example, Dahl describes the emergence of priority for SDHI in Norway alongside the election of a new government and a corresponding shift in the problem definition from “individualization with a focus on health behaviours” to a “structural understanding that emphasizes the problem of the gradient and the SDH” (p. 509). 32 In others, framing of target groups was viewed as problematic. For example, in Australia, Aboriginal and Torres Strait Islander peoples were often framed as irresponsible and incompetent at managing their health, with an underlying frame of ‘otherness.’ 28 Imagery and stories about ‘remote communities’ (ie, as distant from mainstream urban Australians) and a disproportionate use of an ‘Indigenous health crisis’ frame were used to support a conservative Government’s radical Indigenous affairs agenda.…”

“…For example, in Norway external technical publications (eg, the Black Report in the United Kingdom and WHO reports) were seen as driving a domestic research agenda, and subsequently new Norwegian data and evidence sparked public attention. 32 Data on disparities in the health status of Aboriginal and Torres Strait Islander people was found to be an important driver of increased funding and priority for Indigenous health research. 36 Comparative data demonstrating differences in health inequalities between national-, 32 and among local-level, 38 jurisdictions was found to be compelling to decision-makers in some studies.…”

“…In Norway the establishment of institutions with a public health mandate (eg, the Directorate of Health and Social Affairs), new divisions within existing departments (eg, a public health unit within a Department), technical bodies (eg, interdisciplinary expert groups), and mechanisms for community input (eg, committees and commissions), were seen as important in generating demand for action, building competencies, supporting nascent policy communities, and for formulating evidence and policy alternatives. 32 , 55 In Australia, the abolishment of the Aboriginal and Torres Strait Islander Commission was described as highly detrimental to advancing the Australian Indigenous health agenda. 28 , 54 …”

“… 31 , 33 , 55 , 62 Dahl and Lie report that in Norway a Christian/conservative government prioritised health inequalities when a focus on addressing poverty and social disadvantage through targeted behavioural interventions (eg, at low-income or poorly educated groups) rather than material-structural ones, was seen as fitting within that government’s ‘liberal social’ ideology. 32 Framing solutions in ways that appeal to other sectoral interests was also important. Lawless et al, for example, suggest that early engagement in the policy process and defining health broadly as important for engaging actors from non-health sectors, described as a “shared ownership of process and product” (p. 19).…”

A Comparison of the Cornerstones of Public Health Nursing in Norway and in the United States

“…Dahl () found that key values that supported the goal of reducing inequalities were social justice and the view that it was a community responsibility to ensure fair distribution of health services. Norwegian health policy emphasizes health promotion through improved living conditions, universal services that are not tied to one's position in the labor market, and fair distribution of resources through reducing the social inequalities that contribute to health inequalities (Fosse, ).…”