Department of Health, Social and Welfare Studies, University College of Southeast Norway, Kongsberg, Norway.
Department of Maritime Operations, University College of Southeast Norway, Kongsberg, Norway.
Int J Health Policy Manag. 2018 Sep 1;7(9):807-817. doi: 10.15171/ijhpm.2018.22.
Norway is internationally known today for its political and socio-economic prioritization of equity. The 2012 Public Health Act (PHA) aimed to further equity in the domain of health by addressing the social gradient in health. The PHA's main policy measures were (1) delegation to the municipal level of responsibility for identifying and targeting underserved groups and (2) the imposition on municipalities of a "Health in All Policies" (HiAP) approach where local policy-making generally is considered in light of public health impact. In addition, the act recommended municipalities employ a public health coordinator (PHC) and required a development of an overview of their citizens' health to reveal underserved social segments. This study investigates the relationship between changes in municipal use of HiAP tools (PHC and health overviews) with regard to the PHA implementation and municipal prioritization of fair distribution of social and economic resources among social groups.
Data from two surveys, conducted in 2011 and 2014, were merged with official register data. All Norwegian municipalities were included (N=428). Descriptive statistics as well as bi- and multivariate logistic regression analyses were performed.
Thirty-eight percent of the municipalities reported they generally considered fair distribution among social groups in local policy-making, while 70% considered fair distribution in their local health promotion initiatives. Developing health overviews after the PHA's implementation was positively associated with prioritizing fair distribution in political decision-making (odds ratio [OR] = 2.54; CI: 1.12-5.76), compared to municipalities that had not developed such overviews. However, the employment of PHCs after the implementation was negatively associated with prioritizing fair distribution in local health promotion initiatives (OR = 0.22; CI: 0.05-0.90), compared to municipalities without that position.
Development of health overviews - as requested by the PHA - may contribute to prioritization of fair distribution among social groups with regard to the social determinants of health at the local level.
如今，挪威以其在政治和社会经济方面对公平的重视而在国际上享有盛誉。2012 年《公共卫生法》（PHA）旨在通过解决健康方面的社会梯度问题，进一步促进卫生领域的公平。PHA 的主要政策措施包括：（1）将确定和针对服务不足群体的责任下放到市级；（2）要求市政府采取“所有政策都关乎健康”（HiAP）的方法，即从公共卫生影响的角度考虑当地的决策制定。此外，该法案建议市政府聘请公共卫生协调员（PHC），并要求制定公民健康概览，以揭示服务不足的社会群体。本研究调查了在 PHA 实施过程中，市政府对 HiAP 工具（PHC 和健康概览）的使用变化与市政府对社会群体之间公平分配社会和经济资源的优先排序之间的关系。
将 2011 年和 2014 年进行的两项调查的数据与官方登记数据合并。包括所有挪威市（N=428）。进行描述性统计以及双变量和多变量逻辑回归分析。
38%的市政府报告称，他们在地方决策制定中普遍考虑社会群体之间的公平分配，而 70%的市政府认为在地方卫生促进举措中考虑了公平分配。与未制定此类概览的市政府相比，PHA 实施后制定健康概览与在政治决策中优先考虑公平分配呈正相关（优势比 [OR] = 2.54；CI：1.12-5.76）。然而，PHA 实施后，PHC 的雇用与在地方卫生促进举措中优先考虑公平分配呈负相关（OR = 0.22；CI：0.05-0.90），与没有该职位的市政府相比。
根据 PHA 的要求制定健康概览可能有助于在地方一级优先考虑社会群体之间与健康的社会决定因素有关的公平分配。
