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Abstract
Building heavily on the Health in All Policies (HiAP) approach, Norway implemented the Public Health Act in 2012 to reduce social inequalities in health. Local public health coordinators (PHCs) at municipal levels were seen as tools to provide local intersectoral public health work. In this study, we examine factors related to intersectoral agency and if intersectoral work is understood as relevant to securing social justice in local policy outcomes. A national web-based survey in 2019 of all Norwegian PHCs (n = 428) was conducted with a response rate of 60%. Data were analysed through multiple linear regression, hierarchical regression modelling and structural equation modelling. Neither factors relating to community contexts nor individual characteristics were associated with intersectoral agency. Organisational factors, especially position size, being organised at the top level and having a job description, were significantly associated with perceptions of intersectoral agency. PHCs seeing themselves as intersectoral agents also found themselves able to affect annual budgets and policy outcomes. We conclude that municipal PHC positions can be important HiAP tools in local public health policies. However, organisational factors affect how PHCs perceive their influence and role in the municipal organisation and thereby their possibilities to influence local policymaking through intersectoral agency.
Highlights
We found that the major determinants of experienced intersectoral agency in municipal public health work were being in high positions in the organisational hierarchy, having formal job descriptions specifying tasks, expectations and responsibilities for their positions as public health coordinators (PHCs), and being allowed and expected to execute public health coordination on a full-time basis
To fulfil intersectoral and interdisciplinary coordination, which is the essence of municipal public health work according to the Public Health Act [14,15], we found that PHCs located at the administrative top level had a higher statistical probability to report acting as intersectoral agents and acting as bureaucratic elite-level policy entrepreneurs [40,43,44,47]
This study indicates that municipal PHC positions can be important Health in All Policies (HiAP) tools in affecting local public health policies
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The Health in All Policies (HiAP) approach [1,2] has become central to the current understanding of population health and health promotion globally. HiAP principle is to examine determinants of health that can be altered to improve health, which implies that these determinants are mainly controlled by sectors other than health [1]. The approach highlights the importance of public policy and practice at all political levels and public and social sectors, ranging from international arenas to national, regional and municipality levels, to improve population health and health equity [3,4]
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