Cross-sectoral cooperation at the ministerial level in three Nordic countries - With a focus on health inequalities.

To reduce health inequalities requires interventions that address the social determinants of health. The responsibilities, at the ministerial level, for these determinants are mainly situated outside the ministry of health. Accordingly, interventions to reduce health inequalities require coordination between the ministry of health and other ministries. Yet, a large literature in public administration has demonstrated that cross-sectoral cooperation is hard to achieve. The goal of this paper was to examine whether inter-ministerial cooperation relating to the reduction of health inequalities is occurring in practice. Semi-structured interviews were performed with senior officials at 26 ministries in Finland, Norway, and Sweden. The interviews were analyzed both qualitatively and quantitatively. The point of departure was a question if the ministries had initiated substantial measures, such as reforms, regulations, funding, or fiscal strategies, aiming to promote health equity in the population and, if so, if this was done in cooperation with other ministries. The informants reported 80 measures intended to promote health equity and stated inter-ministerial cooperation for 65 of these measures. Many informants described that cooperation between the ministries was routine and well-functioning. Thus, there was no recorded lack of inter-ministerial cooperation. However, the measures that were reported, seemed to be insufficient to reduce health inequalities, both due to lack of extent and lack of effectiveness. This might be due to insufficient political commitment to tackle health inequalities. If so, the WHO Health in All Policies approach might not be effective.