Public Health Coordinator - How to Promote Focus on Social Inequality at a Local Level, and How Should It Be Included in Public Health 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".
The Norwegian Public Health Act of 2012 (PHA)1 states that the social causes of inequality in health have not been devoted sufficient attention in Norwegian health policy. Different means have been implemented to pay more attention to health inequalities at a local level, one is the use of a designated public health coordinator (PHC). Hagen et al2 reveals in a new study, however, that the presence of PHCs' does not add to the priority of reducing inequality as a health objective. This negative association is, by the authors, explained by a widespread use of coordinators before the Act, and as such, not really a new measure. Another factor emphasized is that the PHC position is not empowered by bureaucratic backing. I agree with these explanations. However, the study by Hagen et al2 lacks a critical discussion of how the role of the PHC is situated in an administrative intersection between national health policy based on universal initiatives and social policy in the municipalities historically driven by a focus on poverty and specific target groups. This commentary reflects upon how social inequalities in health at a local level and the responsibilities imposed on the municipalities contest the principals of universalism. The tension between universalism and selectivity needs to be more prominent in the debate on how health inequalities should be abated at the local level, if universalism shall prevail as the overarching principle in Norwegian health policies. The commentary concludes by asking for a more nuanced discussion on how work with health related social problems can support universalistic initiatives. It is also suggested as a task for the PHC to make sure that public health initiatives are systematically evaluated. Documentation of effects will provide knowledge needed about how initiatives affects the social gradient over time.
CommentOn: Int J Health Policy Manag. 2018 Mar 14;7(9):807-817 PMID 30316229
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".
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 policymaking 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.
CommentOn: Int J Health Policy Manag. 2017 Jul 31;7(1):10-14 PMID 29325398