Wenche Bekken
1*1 Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Oslo, Norway.
Abstract
The Norwegian Public Health Act of 2012 (PHA)1
states that the social causes of inequality in health have not been
devoted sufficient attention in Norwegian health policy. Different means have been implemented to pay more
attention to health inequalities at a local level, one is the use of a designated public health coordinator (PHC). Hagen
et al2 reveals in a new study, however, that the presence of PHCs’ does not add to the priority of reducing inequality as a
health objective. This negative association is, by the authors, explained by a widespread use of coordinators before the
Act, and as such, not really a new measure. Another factor emphasized is that the PHC position is not empowered by
bureaucratic backing. I agree with these explanations. However, the study by Hagen et al2
lacks a critical discussion of
how the role of the PHC is situated in an administrative intersection between national health policy based on universal
initiatives and social policy in the municipalities historically driven by a focus on poverty and specific target groups.
This commentary reflects upon how social inequalities in health at a local level and the responsibilities imposed on
the municipalities contest the principals of universalism. The tension between universalism and selectivity needs
to be more prominent in the debate on how health inequalities should be abated at the local level, if universalism
shall prevail as the overarching principle in Norwegian health policies. The commentary concludes by asking for
a more nuanced discussion on how work with health related social problems can support universalistic initiatives.
It is also suggested as a task for the PHC to make sure that public health initiatives are systematically evaluated.
Documentation of effects will provide knowledge needed about how initiatives affects the social gradient over time.