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”

Document Type : Commentary


National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark


This commentary discusses the interesting and surprising findings by Hagen and colleagues, focusing on the role of the public health coordinator as a Health in All Policies (HiAP) tool. The original article finds a negative association between the employment of public health coordinators in Norwegian municipalities and consideration of a fair distribution of social and economic resources between social groups in local policy-making and planning. The commentary contemplates whether this surprising negative association should be interpreted as a failure of implementation, as suggested by the authors, or whether it might be the theory of change that has failed. On this basis, it is suggested that the very notion of HiAP could be flawed by the assumption that health should function as an overarching aim across government sectors. Potentially, the social determinants of health (SDH) might be more efficiently addressed by means of sectoral action by the corresponding sectors, emphasizing equity rather than health.


Main Subjects

  1. Hagen S, Ivar Øvergård K, Helgesen M, Fosse E, Torp S. Health Promotion at Local Level in Norway: The Use of Public Health Coordinators and Health Overviews to Promote Fair Distribution Among Social Groups. Int J Health Policy Manag. 2018;7(9):807-817. doi:10.15171/ijhpm.2018.22
  2. Krogstrup HK. Evalueringsmodeller. Vol 3. Hans Reitzels Forlag; 2016.
  3. Holt DH, Carey G, Rod MH. Time to dismiss the idea of a structural fix within government? An analysis of intersectoral action for health in Danish municipalities. Scand J Public Health. 2018;46(22_suppl):48-57. doi:10.1177/1403494818765705
  4. Scheele CE, Little I, Diderichsen F. Governing health equity in Scandinavian municipalities: The inter-sectorial challenge. Scand J Public Health. 2017;46(1):57-67. doi:10.1177/1403494816685538
  5. Carey G, Crammond B, Keast R. Creating change in government to address the social determinants of health: how can efforts be improved? BMC Public Health. 2014;14:1087.
  6. de Leeuw E, Clavier C, Breton E. Health policy - why research it and how: health political science. Health Res Policy Syst. 2014;12(1):55.
  7. Carey G, Crammond B. Action on the social determinants of health: Views from inside the policy process. Soc Sci Med. 2015;128(0):134-141. doi:10.1016/j.socscimed.2015.01.024
  8. Williams P. The Competent Boundary Spanner. Public Adm. 2002;80(1):103-124. doi:10.1111/1467-9299.00296
  9. Williams P. We are all boundary spanners now? International Journal of Public Sector Management. 2013;26(1):17-32. doi:10.1108/09513551311293417
  10. World Health Organization. The Helsinki Statement on Health in All Policies. Paper presented at: The 8th Global Conference on Health Promotion, Helsinki, Finland; 10-14 June 2013; Helsinki, Finland.
  11. Degeling P. The significance of 'sectors' in calls for urban public health intersectoralism: an Australian perspective. Policy Polit. 1995;23(4):289-301. doi:10.1332/030557395782200518
  12. Exworthy M, Hunter DJ. The Challenge of Joined-Up Government in Tackling Health Inequalities. Int J Public Adm. 2011;34(4):201-212. doi:10.1080/01900692.2011.551749
  13. Synnevåg SE, Amdam R, Fosse E. Public health terminology: Hindrance to a Health in All Policies approach? Scand J Public Health. 2017;46(1):68-73. doi:10.1177/1403494817729921
  14. Holt DH, Frohlich KL, Tjørnhøj-Thomsen T, Clavier C. Intersectoriality in Danish municipalities: corrupting the social determinants of health? Health Promot Int. 2017;32(5):881-890. doi:10.1093/heapro/daw020
  15. van Eyk H, Harris E, Baum F, Delany-Crowe T, Lawless A, MacDougall C. Health in All Policies in South Australia—Did It Promote and Enact an Equity Perspective? Int J Environ Res Public Health. 2017;14(11):1288.
  16. Irwin A, Scali E. Action on the Social Determinants of Health: learning from previous experiences. Social Determinants of Health Discussion Paper 1 (Debates). Geneva: World Health Organization; 2010.
  17. Graham H. Social determinants and their unequal distribution: clarifying policy understandings. Milbank Q. 2004;82(1):101-124. doi:10.1111/j.0887-378X.2004.00303.x
  18. de Leeuw E. Policy, theory, and evaluation: stop mixing the fruit salad; Comment on “Developing a Framework for a program theory-based approach to evaluating policy processes and outcomes: Health in All Policies in South Australia.” Int J Health Policy Manag. 2018;7(8):763-765. doi:10.15171/ijhpm.2018.35
  19. Chircop A, Bassett R, Taylor E. Evidence on how to practice intersectoral collaboration for health equity: a scoping review. Crit Public Health. 2015;25(2):178-191. doi:10.1080/09581596.2014.887831
Volume 7, Issue 12
December 2018
Pages 1161-1164
  • Receive Date: 11 August 2018
  • Revise Date: 19 September 2018
  • Accept Date: 22 September 2018
  • First Publish Date: 01 December 2018