Health Promotion at Local Level in Norway: The Use of Public Health Coordinators and Health Overviews to Promote Fair Distribution Among Social Groups

Document Type : Original Article


1 Department of Health, Social and Welfare Studies, University College of Southeast Norway, Kongsberg, Norway

2 Department of Maritime Operations, University College of Southeast Norway, Kongsberg, Norway

3 Institute for Urban and Regional Research, OsloMet – Oslo Metropolitan University, Oslo, Norway

4 Department of Health Promotion and Development, University of Bergen, Bergen, Norway


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.


Commentaries Published on this Paper

  • Understanding the Promotion of Health Equity at the Local Level Requires Far More than Quantitative Analyses of Yes-No Survey Data; Comment on “Health Promotion at Local Level in Norway: The Use of Public Health Coordinators and Health Overviews to Promote Fair Distribution Among Social Groups”

            Abstract | PDF

  • Challenging Institutional Norms to Improve Local-Level Policy for Health and Health Equity; Comment on “Health Promotion at Local Level in Norway: The Use of Public Health Coordinators and Health Overviews to Promote Fair Distribution Among Social Groups”

            Abstract | PDF

  • Public Health Coordinator – How to Promote Focus on Social Inequality at a Local Level, and How Should It Be Included in Public Health Policies?; Comment on “Health Promotion at Local Level in Norway: The Use of Public Health Coordinators and Health Overviews to Promote Fair Distribution Among Social Groups”

            Abstract | PDF

  • Rethinking the Theory of Change for Health in All Policies; Comment on “Health Promotion at Local Level in Norway: The Use of Public Health Coordinators and Health Overviews to Promote Fair Distribution Among Social Groups”

            Abstract | PDF


Authors' Response to the Commentaries

  • Health Promotion at Local Level in Norway – Who, What, When, and How: A Response to Recent Commentaries

            Abstract | PDF


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  • Receive Date: 10 July 2017
  • Revise Date: 19 February 2018
  • Accept Date: 24 February 2018
  • First Publish Date: 01 September 2018