Interaction between Norwegian counties and municipalities to reduce social health inequalities: an exploratory study

Background: Social inequalities in health are systematic differences in health between social groups, and are considered as unjust. The social determinants of health are factors external to the human body, which affects health. These factors must be acknowledged in order to reduce social inequalities in health. These are important to acknowledge to be able to reduce social inequalities in health. Reducing social inequalities in health has been on the political agenda in Norway for several years. In 2012, the Public Health Act was implemented as a means to reduce health inequalities and level the gradient. The law gave Norwegian counties and municipalities more concrete responsibilities towards public health issues. They are supposed to make an overview of the health situation and the positive and negative factors that affect health. Objectives: The main objective of this study is to find out the degree of consistency in the work on reducing social health inequalities between and within counties and municipalities. The study has two main research questions: RQ 1: How is the counties’ work towards reducing social health inequalities? RQ 1.2: How is the work reflected in the counties’ contribution to municipal public health work? RQ 1.3: What geographic or sociodemographic factors are associated with the patterns that emerge? RQ 2: To what degree is the work on reducing social health inequalities at the county level similar to the work at the municipality level? RQ 2.1: How is this reflected in the focus on the social determinants of health? RQ 2.2: How is this reflected in the focus on multilevel collaboration and partnership? RQ 2.3: What geographic or sociodemographic factors are associated with these similarities and differences? This is an explorative study with a cross-sectional design. The dataset comes from a baseline survey conducted by the Norwegian Institute for Urban and Regional Research in 2011. The analyses mainly consist of observations, descriptive statistics, independent t-test and correlations. Results and discussion: The data shows that counties offer much support to the municipalities, and that there is much intersectoral work towards public health. However, from a Health in All Policies perspective we would have liked to see that their intersectoral work moved away from the general public health work and towards including more and other sectors. The work on reducing social health inequalities at the county level is quite similar to the work at the municipal level. The focus is primarily on individual health behavior. They should have prioritized, focused on, and perceived living conditions as main health challenges more than health behavior, to reduce social health inequalities. Conclusion: The counties seem to have some control over the political guidelines, but they do not necessary bring the message down to the municipal level. The counties have an important advisory role towards the municipalities. However, they still have a way to go to really take on their role, and to inspire and push the municipalities to move the public health focus towards structural living conditions