Aims: The gradient in health inequalities reflects a relationship between health and social circumstance, demonstrating that health worsens as you move down the socio-economic scale. For more than a decade, the Norwegian National government has developed policies to reduce social inequalities in health by levelling the social gradient. The adoption of the Public Health Act in 2012 was a further movement towards a comprehensive policy. The main aim of the act is to reduce social health inequalities by adopting a Health in All Policies approach. The municipalities are regarded key in the implementation of the act. The SODEMIFA project aimed to study the development of the new public health policy, with a particular emphasis on its implementation in municipalities. Methods: In the SODEMIFA project, a mixed-methods approach was applied, and the data consisted of surveys as well as qualitative interviews. The informants were policymakers at the national and local level. Results: Our findings indicate that the municipalities had a rather vague understanding of the concept of health inequalities, and even more so, the concept of the social gradient in health. The most common understanding was that policy to reduce social inequalities concerned disadvantaged groups. Accordingly, policies and measures would be directed at these groups, rather than addressing the social gradient. Conclusions: A movement towards an increased understanding and adoption of the new, comprehensive public health policy was observed. However, to continue this process, both local and national levels must stay committed to the principles of the act.

A higher proportion of adolescents from families in a lower socioeconomic position (SEP) tends to have more unhealthy dietary behaviours, and overweight and obesity, than their counterparts in higher SEPs. More research is needed to understand the causes of these differences, in particular the influence of the neighbourhood environment, which has been explored less. The presented qualitative study explores how adolescents and their parents from higher and lower SEP neighbourhoods perceive the social and physical environment influencing adolescents' dietary behaviours. We conducted 6 semi-structured focus groups with 35 13-14 year olds and 8 interviews with some of their parents. The interviewees were recruited from one higher and two lower SEP neighbourhoods in Oslo, Norway. Theme-based inductive coding was used for analysis, and the results discussed in light of an ecological framework. The results indicate that all the adolescents experience several barriers to healthy dietary behaviours. For adolescents in the lower SEP neighbourhood, one or both parents desired their cultural cuisine served at home, whereas the adolescents wanted and often consumed western dishes. Fast-food restaurants or hanging out at the mall was perceived as the preferred social arena, often due to lack of involvement in either leisure-time physical activities or youth clubs as a safe, engaging option. The adolescents in the higher SEP neighbourhood perceived social norms which accentuated healthy dietary choices. When more possibilities for activities were present and the adolescents expressed being highly engaged in leisure-time physical activity, this also seemed to facilitate healthier dietary behaviours. These findings indicate how several factors simultaneously can influence dietary behaviour. Use of a multi-layered approach when exploring the environmental influences could increase knowledge about tackling social inequalities in dietary behaviours among adolescents.

Reducing social inequalities in health has been an important aim in the development of the Nordic welfare states. This Commentary presents the development of Norwegian policies in this area from 1987 to 2021. Social inequalities entered the political agenda in Norway in the 1980s, but were mostly defined as a problem for selected marginalised groups. The World Health Organization project led by Michael Marmot was an inspiration for Norwegian policy-makers and the concept of the social gradient was introduced. From 2005, levelling the social gradient in health became a central strategy in Norwegian policy-making and culminated in the Public Health Act 2012. This Act focuses on the structural determinants of health and the municipalities have a central role in its implementation. However, the municipalities are mostly responsible for services providing downstream measures and have little control over social determinants such as tax or labour market policies. The Public Health Act is important because it institutionalises social inequalities as a policy field within public health. Not only the municipalities, but all administrative levels have to contribute to meet the aim of reducing the social gradient.

Background: The Norwegian National government has developed public health policies that reflect health promotion principles, and these are particularly reflected in the recent Public Health Act (PHA). The counties (CMs) have been given a central role in the implementation of the PHA, and in this paper we explore how the CMs fill this role. Methods: Qualitative as well as quantitative data have been applied; a survey, a document study and personal interviews have been conducted. Results: The findings show that the CMs find it challenging to influence all sectors to change the focus from classical lifestyle issues to a focus on the social determinants of health. The Directorate of Health has the main responsibility for implementing the PHA, but the signals from the Directorate are not always consistent. The Directorate still launches campaigns and interventions to improve diets and stimulate physical activity, without launching them in the context of the PHA. Conclusion: The CMs regard the supporting role toward the municipalities as their highest priority. However, they find it hard to anchor and integrate the principles of the PHA. They explain this partly with the sectorised government organisation.

More than half of the municipalities in Norway report drug misuse as the most important public health challenge. Following a whole‐of‐government tradition, the ambition is to achieve horizontal and vertical coordination between different policy areas to address complex problems, such as youth drug use, and avoid fragmented services. This study aims to offer new perspectives on how governmental structures shape local drug prevention. By including the perspective of both local policy makers and outreach social workers, we can come closer to understanding how local drug prevention transforms policy into practice. The study will thus explore how policy makers and outreach social workers describe the local drug prevention strategy and how the outreach social workers implement it in practice. An instrumental case study of one Norwegian municipality was used to investigate the structures for drug prevention in detail. Data were gathered through 14 interviews with public officials from the relevant policy areas and outreach social workers from a drug prevention outreach service. The data were analysed using a thematic framework analysis. This study demonstrated that the policy makers’ and outreach social workers’ descriptions of drug prevention highlighted the creation of good living conditions and promotion of protective factors surrounding at‐risk youths. This perspective may offer a broader approach to drug policy, which includes many policy areas. While collaboration was regarded as paramount, the policy makers described a “siloed” organisation that made it difficult to collaborate. The outreach social workers, however, indicated that they were able to navigate the “siloed” structures. We discuss the structural conditions surrounding outreach social workers that shape the implementation of policies, such as the resource perspective. The discussion shows that outreach social workers may act as a safety net for a potentially fragmented municipal structure for drug prevention.

Dette prosjektet studerte hvilken nasjonal politikk de nordiske land utvikler for å påvirke helsens determinanter. Fokus på helsens determinanter krever bevissthet om strukturelle betingelser for god helse. Prosjektet hadde en kvalitativ tilnærming, data besto av dokumenter og intervjuer. Vi undersøkte om landene hadde en helhetlig tilnærming, om politikken var et ansvar for alle sektorer og om den var forpliktende. Sosiale ulikheter kan kalles et innfløkt (wicked) problem, der det finnes politiske konflikter som bidrar til problemer med å gjennomføre politikk som ivaretar determinant perspektivet. Alle landene har formulert politiske målsetninger om å utjevne sosiale helseforskjeller, men tiltak finnes mest på lokalt nivå og fokuserer mest på levevaner. De bredere helsedeterminantene blir ofte ikke anerkjent og innfløkte problemer blir omdefinert til tamme problemer, som er mer ukontroversielle og lettere å implementere.