RESUMEN
INTRODUCTION: The two pillars of public health are health promotion and disease prevention. Based on a notion of governance in the state -local relation as changing from hierarchical via New Public Management (NPM) to New Public Governance (NPG), the governance of public health in Norway is contrasted to governance of public health in the other Nordic states: Denmark, Finland and Sweden. AIM: The article aims to present and discuss the governance of public health as it is played out in the state-local relationship. METHODS: The method is to study central state documents in the four countries, as well as articles, research reports and papers on public health. RESULTS: The article shows that the governance modes (hierarchy, NPM and NPG) exist in parallel, but that their mechanisms actually vary in use. Legal, economic and informational mechanisms are, to a varying degree, in use. CONCLUSIONS: In Finnish and Swedish public health policies, health promotion is at the forefront; while Danish and Norwegian public health policies spur the local governments to carry out interventions to prevent disease and hospital admissions.
Asunto(s)
Gobierno Local , Administración en Salud Pública , Gobierno Estatal , Política de Salud , Promoción de la Salud , Humanos , Noruega , Servicios Preventivos de Salud , Países Escandinavos y NórdicosRESUMEN
Norwegian national policies have been distinguished by their focus on equity, contributing to comprehensive policies to reduce the social inequities in health (SIH). The newly adopted Public health act, which aims at reducing the SIH, endorses these acknowledgements while highlighting the importance of municipalities as the key actors in public health. Municipal obligations include inter-sectoral policies for health, health impact assessments (HIA), and the development of local health overviews. Against the background of a system of local autonomy in Norway, this article illuminates whether, and how, municipal public health policies reflect national priorities. Our data are based on one qualitative study, combining document content analysis and expert interviews conducted in 2011, and one quantitative questionnaire sent to municipal chief administrative officers in 2011. Our findings indicate a divide between national and municipal public health strategies. Many municipalities focus on life-style and health-care related measures. Only few municipalities acknowledge the social determinants of health and have implemented HIA and health overviews. Arguing for the importance of concerted multi-level action to reduce the SIH, we need to better understand the gap between national and municipal approaches. We thus suggest further research to illuminate the challenges and success factors faced at local levels.