Abstract
Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.