Faktorer som ligger til grunn for arbeidet mot antibiotikaresistens innad og på tvers av de ulike sektorene folkehelse, dyrehelse og miljøhelse

Background: There has been a dramatic increase in antibiotic-resistant microbes (AMR) within almost all ecological niches over the past decades. WHO stated in 2012 that antibiotic resistance is one of the biggest treats to the human health. The Global Action Plan Against Antibiotic Resistance emphasizes a strong link between human-, animal- and environmental health and recommends these sectors to focus on a One-health approach. The Global Action Plan encourage all countries to have in place national action plans against AMR. Objective: The National Strategy against Antibiotic Resistance 2015-2020 sets out goals and focus areas related to AMR. This is a common overall strategy within human health, food producing animals and household pets, fish and climate and environment. The purpose of this study is to gain an insight of the factors that form the basis for the work against AMR within the various sectors of public health, animal health and environmental health in Norway. Methods: A qualitative multiple case study has been conducted with four visitor interviews and one telephone interview. The informants work within the national work against antibiotic resistance at senior level within the Ministry of Health and Care Services, the Norwegian Institute of Public Health, The Norwegian Food Safety Authority, The Veterinary Institute and a Reference Laboratory. Thematic analysis was used to analyze the results. Results: Norway has low consumption and low prevalence of AMR compared to other countries and much of the work within each sector it about keeping it at a low level. The informants believe that because Norway is a small country makes it easier to collaborate as there are fewer people working with AMR and it is easier to have a good network and know who to contact when. The informants thinks that there is good collaboration across sectors, especially within human health and animal health, the environment is to a lesser extent involved in this collaboration. Summary: The informants believe we have a good situation regarding AMR in Norway, the findings indicate that travel and import of AMR is one of the biggest challenges in this country. There is an agreement among the informants that policymaking and policyadvice associated with AMR in all sectors are knowledge-based and little influenced by other factors. The informants perceive the One-health approach as present in the fight against AMR, but there is some disagreement about the extent to which AMR should have a One-health approach. More research is needed on the possible impact the environment has on the development and spread of AMR