Tackling Health Inequalities Locally: the Scandinavian Experience

Research output: Book/ReportReportResearchpeer-review

Finn Diderichsen, Christian Elling Scheele, Ingvild Gundersen Little

The Scandinavian countries and their welfare policies have long been known for their ability to reduce income inequality while boosting economic growth. Recent research from OECD has indicated that the Scandinavian countries are indeed examples of a more general positive relationship between equality and growth (64). Health equity has been anexplicit political goal in Scandinavia for decades. Nevertheless, in the health domain, average improvement has not been followed by reduced inequality – at least not between socioeconomic groups. It has in other words turned out to be a challenge of translating small inequalities in wealth into small inequalities in health.
Denmark, Norway and Sweden all have legislation that indifferent ways offers local governments key roles in public health. This is partly due to local governments’ responsibility for many policy areas of great relevance to health and health equity. National governments have thus largely made the WHO and EU recommendation of ‘Health in All Policies’a local responsibility.
In his analysis for the Nordic Council of Ministers, former Swedish Minister of Health Bo Könberg identifies tackling health inequalities as one of 14 prioritised areas for future Nordic collaboration on health (94). The fact that all of the Nordic countries share this growing problem as well as a political ambition to deal with it brought the issue onto Könberg’s list. The Nordic Council of Ministers also recently listed the sustainability of the Nordic welfare state model, including its health policy, as an area of Nordic collaboration (104).
However, realising the principle of health (equity) in all policiesis no simple matter. The national authorities and local government federations in Denmark, Norway and Sweden have therefore initiated various activities to support local governments in this process. One has been to ask the Department of Public Health at the University of Copenhagen to undertake an explorative study on what we can learn from experiences so far in regions and municipalities in the three countries. Political, professional, and organisational issues are all relevant here.

Can we identify obstacles to and means of promoting the involvement of local policymakers within education, social care, labourmarket, environment etc. in a coordinated effort to tackle health inequalities in a Scandinavian context?

The present report is the result of this study. It is based on three sources:
1. Interviews with policymakers (administrators and politicians) within healthcare administrations, childhood/education, and labour market administrations from September 2014 to March 2015*.
2. Textual analysis of available policy documents from regions and municipalities.
3. Meetings with an expert group** of individuals from the three countries, who possess considerable experience of research and/or policymaking within the area.
It is important to emphasise that because we have only been able to include a small number of municipalities, our results must be regarded as exploratory and not representative. The conclusions do not represent the positions of any of the involved authorities or experts but of the authors alone.

The study was commissioned by:
Danish Health and Medicines Authority (www.sundhedsstyrelsen.dk)
Norwegian Directorate of Health (www.helsedirektoratet.no)
Public Health Agency of Sweden (www.folkhalsomyndigheten.se)
Local Government Denmark (www.kl.dk)Local Government Organisation of Norway (www.ks.no)
Swedish Association of Local Authorities and Regions(www.skl.se)*

The municipalities have been selected by the national authorities to represent those, both large and small, which have experience in developing intersectoral policies to tackle health inequalities.
Denmark: Copenhagen, Ishøj, and Vordingborg
Norway: Innherred Samkommune, Fredrikstad, and Kristiansand.
Sweden: Botkyrka, Degerfors-Karlskoga, Malmö, Luleå, and Västra Götaland Region**

Expert group: Anna Balkfors, Espen Dahl, Göran Dahlgren, Elisabeth Fosse, Lars Iversen, Bo Pettersson, Morten Hulvej Rod, Anne Smetana, and Lennart Svensson.
Original languageEnglish
Place of PublicationKøbenhavn
PublisherKøbenhavns Universitet
Number of pages49
ISBN (Print)978-87-90233-45-7
Commissioning bodySundhedsstyrelsen
Publication statusPublished - 30 Nov 2015

ID: 148429072