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Child poverty is an increasing challenge for Norwegian society and its municipalities. Policies to reduce it include housing as one particularly important health determinant. The capability approach allows us to focus on determinants for health. Methods were triangulated and literature and document studies, interviews and participating observations were part of the data-gathering process. Thematic analyses were used to analyse data. Children and adults view housing as important. Housing determines families' possibilities of consuming other goods and choosing what functionings they will convert their resources into. Municipalities can change the course of development by engaging with the Norwegian Government Housing Bank and implementing instruments such as social housing, housing allowances and starter loans giving families the possibility to become homeowners. Housing determines intra- as well as inter-generational life chances. Housing is a corrosive functioning if children live in families that have low-quality housing or high housing costs. Housing is a positive functioning for children if families own their housing. Housing is defined as a market good and a welfare asset. Policies enable some families to buy their own housing, whereas the number of poor children still increases.

Background: The Norwegian National government has developed public health policies that reflect health promotion principles, and these are particularly reflected in the recent Public Health Act (PHA). The counties (CMs) have been given a central role in the implementation of the PHA, and in this paper we explore how the CMs fill this role. Methods: Qualitative as well as quantitative data have been applied; a survey, a document study and personal interviews have been conducted. Results: The findings show that the CMs find it challenging to influence all sectors to change the focus from classical lifestyle issues to a focus on the social determinants of health. The Directorate of Health has the main responsibility for implementing the PHA, but the signals from the Directorate are not always consistent. The Directorate still launches campaigns and interventions to improve diets and stimulate physical activity, without launching them in the context of the PHA. Conclusion: The CMs regard the supporting role toward the municipalities as their highest priority. However, they find it hard to anchor and integrate the principles of the PHA. They explain this partly with the sectorised government organisation. ; publishedVersion

The Norwegian National government has recently developed policies to reduce health inequalities; this should be achieved by a Health in all Policies approach (HIAP). Most policies are to be implemented at the local level and municipalities are responsible for the implementation. The aim of this paper is to answer this question: How can municipalities reduce social inequalities and among families with children through a mixed methods approach, using surveys as well as qualitative interviews in the collection of data? The main conclusion is that they are in different places when it comes to implementing public health and health promotion policies. The responsibility for public health and health promotion is to a large degree still left to the health sector, including those in positions as public health coordinators. To achieve HIAP, these positions should have an executive function in order to coordinate and influence local policies using a combination of universal and targeted measures. However, no extra funding has been allocated via the national budgets, and intensified efforts are still funded via projects. Still, we observe a change towards increased awareness of the HIAP approach to reduce social inequalities. ; publishedVersion

AbstractThis article focuses on the new role of municipalities–as negotiators in multilevel governance of health services. The 2012 health care coordination reform in Norway involves a partnership between health services at the national and municipal levels. Negotiations in these regional partnerships result in regionally different solutions concerning the provision of health services. What does this new role of municipalities require with regards to political steering and administrative management? From interviews in nine municipalities and two regional health authorities, the authors find that the formal cooperation agreements have affected the interaction between municipalities and regional health authorities, with a shift from professional deliberation to strategic negotiations. The new negotiating role of the municipalities requires political will to clarify the room of maneuver for the negotiating actors and support the negotiating solutions when these are within the defined frames. The negotiations stimulate integration between management and professionals, in order to inform the chief executive officer, who is often the negotiator. The negotiators assume an essential role as bridge-builders between the political and professional world in the municipalities, and the professional world of the hospitals and regional health authorities.

Abstract Background: 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. Methods: 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. Results: 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. Conclusion: 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. Keywords: Equity, HiAP, Public Health Coordinator, Norway, Health Promotion ; publishedVersion

Abstract Background: 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. Methods: 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. Results: 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. Conclusion: 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. Keywords: Equity, HiAP, Public Health Coordinator, Norway, Health Promotion ; publishedVersion