Leveling the Social Gradient in Health at the Local Level: Applying the Gradient Equity Lens to Norwegian Local Public Health Policy

Elisabeth Fosse, Nigel Sherriff, Marit Helgesen

Research output: Contribution to journalArticle


The gradient in health inequalities reflects a relationship between health and social circumstance demonstrating that health worsens as you move down the socioeconomic scale. Norway’s Public Health Act (PHA) specifically aims to tackle the gradient by addressing the social determinants of health. In this article, we draw on data from 2 studies that investigated how municipalities in Norway deal with these challenges. In doing so, we apply theoretical perspectives, as defined in the Gradient Evaluation Framework (GEF), to analyze the implementation of the PHA at the municipality level. The article aims to describe and analyze how local governments follow the requirements of the act. In doing so, we address the following research questions: Which policies are implemented at the local level to reduce social inequalities in health among families and children? How is intersectoral collaboration carried out, and who is taking part in the collaboration? The article draws on both quantitative survey data from questionnaires sent to all Norwegian municipalities and qualitative interview data in 6 municipalities. The findings show that there is raised awareness of the significance of social determinants among an increased number of municipalities, indicating that the PHA is being implemented according to its objectives.

Original languageEnglish
Pages (from-to)538-554
Number of pages17
JournalInternational Journal of Health Services
Issue number3
Publication statusPublished - 23 Apr 2019



  • health gradient
  • health inequalities
  • health promotion
  • Norway
  • public health policy

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