“An overall inter-sectorial aim to reduce social inequalities in health is needed”

Even though reducing social inequalities is one of the main aims of the Nordic welfare model, this aim is not always explicitly connected to the current policies. The model has also been challenged by global economic trends and social inequalities are increasing.

– There is an awareness of this situation in the Nordic countries and reducing social inequalities in health is included in general policy recommendations in all the countries. However, regarding concrete policies and measures, it is often the individual approaches, most often related to lifestyle issues, that are being preferred. These are mostly initiated by the health sector, says professor Elisabeth Fosse from University of Bergen in Norway.

The municipalities play an important role

An important common factor is the role of the municipalities. In all the countries they play an essential role, both as implementers of national policies and independent political units.  The municipalities are responsible for services which are important in reducing social inequalities, like schools, day care institutions, and housing.

The exception among the Nordic countries is Norway, which has adopted a public health act, that is followed up by the national government, with a particular aim to reduce social inequalities in health, by applying a health in all policies approach. However, the municipalities still have a high degree of freedom in making priorities, and there are few sanctions for those who don’t follow up all the intentions of the act, the study states.

Policy recommendations

The study includes three policy recommendations highlighting inter-sectorial collaboration, facilitating of structures and institutionalization.

– An important question is what types of inter-sectorial collaboration should be in place in order to strengthen the whole of government/whole of society involvement in reducing health inequalities. Stakeholders in different sectors should agree on the overall aim to reduce social inequalities in health. Facilitating of structures that promote a whole of government approach and inter-sectoral organisation, should be carried out, Elisabeth Fosse points out.

– When looking into long-term commitment, the concept of institutionalization is important. If policies to reduce social inequalities in health are reliant on government constellations, they seem to be vulnerable and may be subject to inconsistency, Elisabeth Fosse sums up.

The study Policies to address the social determinants of health in the Nordic countries analyses national policies in the Nordic countries based on the recommendations from the report Tackling Health Inequalities Locally – The Scandinavian Experience (University of Kopenhagen, 2015). The study was conducted in co-operation with University of Bergen.