Public Health Agency of Sweden, Folkhälsomyndigheten, SE-171 82, Solna, Sweden; Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
Public Health Agency of Sweden, Folkhälsomyndigheten, SE-171 82, Solna, Sweden; Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
Soc Sci Med. 2020 Jul;256:112999. doi: 10.1016/j.socscimed.2020.112999. Epub 2020 Apr 18.
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.
要减少健康不平等，就需要采取干预措施来解决健康的社会决定因素。这些决定因素的部长级责任主要在卫生部之外。因此，减少健康不平等的干预措施需要卫生部与其他部委之间的协调。然而，公共行政学的大量文献表明，跨部门合作很难实现。本文的目的是检验减少健康不平等方面的部际合作是否在实践中发生。在芬兰、挪威和瑞典的 26 个部委，对高级官员进行了半结构化访谈。对访谈进行了定性和定量分析。出发点是一个问题，即各部委是否已经采取了重大措施，如改革、法规、供资或财政战略，旨在促进人口健康公平，如果是这样，是否与其他部委合作进行。这些信息提供者报告了 80 项旨在促进健康公平的措施，并表示其中 65 项措施是在部际合作的基础上进行的。许多信息提供者描述说，部委之间的合作是例行公事，运作良好。因此，没有记录到部际合作的缺乏。然而，报告的这些措施似乎不足以减少健康不平等，这既是由于缺乏范围，也是由于缺乏效果。这可能是由于解决健康不平等问题的政治承诺不足。如果是这样，世卫组织的“所有政策促进健康”方法可能就不会有效。
