Developments in the Conceptual Understanding of Public Health in Norwegian Municipalities

Background

In Norway, The Public Health Act of 2012 aimed to address environmental, social, and structural determinants of health. However, actors involved in implementing the law were unfamiliar with the Act and public health work was often understood in a biomedical frame. In 2016 the Office of the Auditor General found that a lack of sufficient knowledge base and cross-sectoral coordination hindered the municipal efforts to strengthen public health in the population. In response, the Norwegian Directorate of Health launched the Program for Public Health Work to help County Councils support municipalities in strengthening both the public health competence and to support the municipalities in their public health work. This study aims to examine the development in the understanding and execution of municipal public health responsibilities following the Program launch.

Methods

A longitudinal interview study was conducted with municipal actors involved in public health work from 12 municipalities, at the program’s outset and again after three years. In total, 72 interviews were conducted with approximately 60 different actors in Norway. Data is analyzed using thematic analysis.

Results

There has been a shift in how public health is understood, practiced, and assigned responsibility at the municipal level. From defining public health in medical terms with focus on obesity, smoking cessation and physical activity, public health efforts now increasingly emphasize mental health, social networks, and enabling population to make informed health choices. Organizationally, public health work has evolved from being a concern for healthcare units to becoming more and more a cross-sectoral responsibility in the municipalities.

Conclusions

Investing in national programs that build awareness and competence has contributed to a broader understanding of public health, promoting the development of broad preventive measures rather than a focus on specific medical conditions.

Key messages

• Municipal understanding of public health in Norway has shifted from a narrow medical focus to a broader, cross-sectoral approach emphasizing prevention, mental health, and health literacy.

• National initiatives like the Program for Public Health Work have been crucial in enhancing local competence and enabling more effective, knowledge-based public health strategies.