Promoting health by addressing living conditions in Norwegian municipalities

Abstract

Worldwide, inequalities in health are increasing, even in well-developed welfare states such as Norway, which in 2012, saw a new public health act take effect that enshrined equity in health as national policy and devolved to municipalities' responsibility to act on the social determinants of health. The act deems governance structures and "Health in All Policies" approaches as important steering mechanisms for local health promotion. The aim of this study is to investigate whether Norway's municipalities address living conditions - economic circumstances, housing, employment and educational factors - in local health promotion, and what factors are associated with doing so. All Norway's municipalities (n= 428) were included in this cross-sectional study, and both register and survey data were used and were subjected to descriptive and bi- and multivariate regression analyses. Eighty-two percent of the municipalities reported that they were capable of reducing inequalities in health. Forty percent of the municipalities defined living conditions as a main challenge in their local public health promotion, while 48% cited it as a main health promotion priority. Our study shows that defining living conditions as a main challenge is positively associated with size of municipality, and also its assessment of its own capability in reducing inequalities in health. The latter factor was also associated with actually prioritizing living conditions in health promotion, as was having established cross-sectorial working groups or inter-municipal collaboration related to local health promotion. This study underlines the importance of inter-sectoral collaboration to promote health and well-being.

The Norwegian policy to reduce health inequalities: key challenges

“…It also still remains to be seen whether the transferring of more responsibility to the municipalities in The Public Health Act will strengthen or weaken efforts to reduce social inequalities in health. Most of the municipalities (82 per cent) believe they are capable of reducing inequalities in health, and the larger municipalities more often than smaller ones see living conditions as a main challenge in health promotion (Hagen et al, 2016).…”

Advocating for Health Promotion Policy in Norway: The Role of the County Municipalities

“…Other research has shown that the municipalities have struggled to integrate health promotion in their planning processes. In a survey conducted in 2014, only 25% of the municipalities reported that they had conducted the overview of the health situation in their municipality that would serve as the data basis for the plan [24].…”

“…The surveys showed that the municipalities to a small extent had adopted the principles of HiAP and HI [23,24]. Many municipalities focused mainly on lifestyle-and health care-related measures.…”

Capacity to reduce inequities in health in Norwegian municipalities

“…Partisan trends are however not present in our data. Acknowledging living conditions as a public health priority is independent of political profile, first and foremost in the larger cities [10,21], leading us to believe that municipalities put policies to create health equity on the agenda when challenges are (27) 44 (19) manifest. Nevertheless, the laws are important institutional and organisational frameworks that set the rules by regulating policies, as well as public health activities in municipalities.…”

“…Institutions regulate the relation between the state and individuals, and because the decentralisation of service provision is an important feature of the Norwegian welfare state, municipalities are the institutions that provide services and communicate with citizens. This encompasses their two roles: their frontline responsibility to implement national policy goals and their role as democratic decision-making bodies [10].…”