Leveling the Social Gradient in Health at the Local Level: Applying the Gradient Equity Lens to Norwegian Local Public Health Policy

Fosse, Elisabeth; Sherriff, Nigel; Helgesen, Marit

doi:10.1177/0020731419842518

Cited by 9 publications

(11 citation statements)

References 21 publications

(33 reference statements)

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“…However, very few had an understanding that could be described as a gradient approach. Most respondents agreed that reducing health inequalities was important, but it was mostly described as developing policies and measures aimed at disadvantaged groups [17].…”

Section: Resultsmentioning

confidence: 99%

Addressing the social determinants of health at the local level: Opportunities and challenges

Fosse

Helgesen

Hagen

et al. 2018

Scand J Public Health

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Aims:The gradient in health inequalities reflects a relationship between health and social circumstance, demonstrating that health worsens as you move down the socio-economic scale. For more than a decade, the Norwegian National government has developed policies to reduce social inequalities in health by levelling the social gradient. The adoption of the Public Health Act in 2012 was a further movement towards a comprehensive policy. The main aim of the act is to reduce social health inequalities by adopting a Health in All Policies approach. The municipalities are regarded key in the implementation of the act. The SODEMIFA project aimed to study the development of the new public health policy, with a particular emphasis on its implementation in municipalities. Methods: In the SODEMIFA project, a mixed-methods approach was applied, and the data consisted of surveys as well as qualitative interviews. The informants were policymakers at the national and local level. Results: Our findings indicate that the municipalities had a rather vague understanding of the concept of health inequalities, and even more so, the concept of the social gradient in health. The most common understanding was that policy to reduce social inequalities concerned disadvantaged groups. Accordingly, policies and measures would be directed at these groups, rather than addressing the social gradient. Conclusions: A movement towards an increased understanding and adoption of the new, comprehensive public health policy was observed. However, to continue this process, both local and national levels must stay committed to the principles of the act.

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Section: Resultsmentioning

confidence: 99%

Addressing the social determinants of health at the local level: Opportunities and challenges

Fosse

Helgesen

Hagen

et al. 2018

Scand J Public Health

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“…Some studies reported that only a select few LGs regarded health determinants a high priority ( 5 , 42 ). Behavioral and lifestyle programs were perceived to be of higher priority in LG compared to addressing determinants of health ( 43 , 44 , 71 , 83 ). The level of policy priority for addressing determinants of health was challenged by a range of factors including the political attraction to lifestyle programs ( 82 ), the perceived lack of urgency ( 45 ) and competing with priorities such as healthcare, food safety or other nationally determined priorities ( 44 , 46 , 72 , 83 ).…”

Section: Resultsmentioning

confidence: 99%

“…Behavioral and lifestyle programs were perceived to be of higher priority in LG compared to addressing determinants of health ( 43 , 44 , 71 , 83 ). The level of policy priority for addressing determinants of health was challenged by a range of factors including the political attraction to lifestyle programs ( 82 ), the perceived lack of urgency ( 45 ) and competing with priorities such as healthcare, food safety or other nationally determined priorities ( 44 , 46 , 72 , 83 ). Larger municipalities in Norway were more likely to prioritize policies regarding living conditions, while smaller municipalities prioritized lifestyle issues ( 44 , 47 ).…”

Section: Resultsmentioning

confidence: 99%

“…Five sources applied the MSF explicitly to inform or interpret the research findings ( 29 , 36 , 45 , 66 , 86 ), while others mention the MSF, but do not discuss how it informed the study design, results or interpretation of findings ( 33 , 35 , 55 ). Other frameworks that were applied included network analysis ( 54 ), or other conceptual frameworks adapted for exploration of the policy process ( 34 , 44 ). For example, Fosse et al ( 44 ) applied the Gradient Evaluation Framework, which had been adapted from the stages heuristic policy framework to evaluate the extent to which policies considered health inequities.…”

Section: Resultsmentioning

confidence: 99%

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Factors of the policy process influencing Health in All Policies in local government: A scoping review

Lilly

Kean²,

Hallett³

et al. 2023

Front. Public Health

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ObjectivesThis review aimed to identify factors in the policymaking environment that influence a Health in all Policies approach in local government, how these vary across different municipal contexts, and the extent that theories of the policy process are applied.MethodsA scoping review was conducted to include sources published in English, between 2001 and 2021 in three databases, and assessed for inclusion by two blind reviewers.ResultsSixty-four sources were included. Sixteen factors of the policy process were identified, expanding on previously reported literature to include understanding and framing of health, use of evidence, policy priority, and influence of political ideology. Eleven sources applied or referred to theories of the policy process and few reported findings based on different local government contexts.ConclusionThere are a range of factors influencing a Health in All Policies approach in local government, although a limited understanding of how these differ across contexts. A theory-informed lens contributed to identifying a breadth of factors, although lack of explicit application of theories of the policy process in studies makes it difficult to ascertain meaningful synthesis of the interconnectedness of these factors.

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“…Addressing social inequalities and the differences in the opportunities that people have to improve their health is one of the major challenges faced in health promotion (Borrell & Pasarin Rua, 2004;Chesire, 2012;Reid, 2011;World Health Organization & UN-Habitat 2016). However, removing them is not easy because they are complex, with multiple structural causes and without simple, easy solutions (Fosse, Sherriff, & Helgesen, 2019).…”

Section: Introductionmentioning

confidence: 99%

Theory‐based capacity building intervention for intersectoral action for health at local governments: An exploratory pilot study

Hernantes

Bermejo‐Martins

Øvergård

et al. 2022

Journal of Advanced Nursing

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Aim To design, implement and evaluate a nurse‐led capacity building intervention (PromoGOB) for intersectoral action for health at local governments. Design The programme was based on theories of the policy process and organizational change and facilitated by a nurse developing a health broker role. A complex intervention perspective was adopted in carrying out the study. The intervention was evaluated using a mixed method embedded design. Methods Quantitative component relied on a specific questionnaire. This tool, designed and piloted ad hoc, measured the capacity in terms of knowledge, awareness, resources, skills, and commitment, both at sectoral and government levels. For the qualitative component, semi‐structured interviews were conducted. These explored the perceived capacity and feasibility and acceptability issues. The programme was initiated at the end of October 2019, and it lasted a total of 5 weeks. Nineteen individuals representing various sectors at a local government in northern Spain participated in the study. The data analysis was concluded by the end of March 2020. Findings PromoGOB positively influenced participants' capacity for addressing health promotion. Awareness component, intersectoral work and the nurse as health broker were essential in the programme. The necessity of political participation was identified as an issue to be prioritized in future studies. Conclusion This study highlights the relevance of capacity building at local governments and the role that nurses can play in it. Further work should be undertaken to continue developing Health in All Policies approach at local level. Impact This study offers a starting point for nurses to get involved in the policy process of health promotion, performing a specific role as health brokers, building capacity at local governments for addressing social determinants of health, and delving into theories and concepts of the Health in All Policies field.

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Leveling the Social Gradient in Health at the Local Level: Applying the Gradient Equity Lens to Norwegian Local Public Health Policy

Cited by 9 publications

References 21 publications

Addressing the social determinants of health at the local level: Opportunities and challenges

Addressing the social determinants of health at the local level: Opportunities and challenges

Factors of the policy process influencing Health in All Policies in local government: A scoping review

Theory‐based capacity building intervention for intersectoral action for health at local governments: An exploratory pilot study

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