Prescriptions for a Healthier Norway a Broad Policy for Public Health 2 Report No

Ministry of Social Affairs Report No. 16 (2002–2003) to the Storting Short version Prescriptions for a Healthier Norway A broad policy for public health 2 Report No. 23 to the Storting 2001-2002 Improving urban environment Table of Contents 1 Introduction ......................................... 5 4.3 Mental health........................................ 20 1.1 The broad approach .............................. 5 4.4 The surrounding environment ............21 1.2 Objectives ............................................... 6 1.3 Personal responsibility 5 Building alliances to and social responsibility ........................ 6 promote public health ..................... 23 1.4 Scope of the White Paper ..................... 6 5.1 Partnership model in local government.............................. 24 2 The diagnosis ....................................... 8 5.2 Public health in social planning.......... 24 2.1 State of health and trends ..................... 9 5.3 Impact assessments and health.......... 25 2.1.1 The health of the population ................ 9 5.4 Environmental health ..........................25 2.1.2 Risk factors ........................................... 10 5.5 Alliances with NGOs ............................25 2.2 Trends and social features .................. 10 2.2.1 Medicalization and focus on risk ....... 11 6 The health services: Prevention 2.2.2 Youth culture is better than cure .............................27 – «Cool to be grown up» 11 6.1 From pills to green prescriptions ...... 28 2.2.3 A multi-cultural Norway ...................... 11 6.2 Better preventive health services 2.2.4 Health and globalization ..................... 12 for children and young people ............ 28 2.3 Challenges............................................ 13 6.3 A stronger role for healthcare 2.3.1 Lifestyle as a risk factor ...................... 13 institutions in prevention..................... 28 2.3.2 Mental health....................................... 13 7 Building up new knowledge........... 30 2.3.3 Focus on prevention............................ 14 7.1 Health surveillance and research ....... 31 3 Four prescriptions for 7.2 Education .............................................. 31 a healthier norway............................ 16 8 A strategy for women’s health ....... 33 4 Make it easier for people 8.1 Decision-making processes................. 34 to take responsibility for 8.2 Building up and transferring their own health................................ 17 knowledge............................................. 34 4.1 Healthy lifestyle choices..................... 18 8.3 Health practice ..................................... 34 4.2 Reducing social 8.4 Violence and abuse .............................. 35 inequalities in health ........................... 20 2002–2003 Report No. 16 (2002–2003) to the Storting. Short version 5 Prescriptions for a Healthier Norway 1 Introduction 1.1 The broad approach by the need to help here and now. Giving priority to prevention can also be difficult because this is Report No. 16 (2002-2003) to the Storting throws not dealing with people’s illnesses here and now; the spotlight on health in Norway. It addresses it is dealing with statistical risks and future ill- factors that play a part in creating health pro- nesses – about what may happen, often far into the blems or which help to combat disease. Looking future. In this sense, public health work is more after the health of the population means relating «invisible». As a society, we should adopt a policy to the factors that affect health. These include the which also takes responsibility for directing curative, rehabilitative and nursing/caring activi- future needs and challenges and which tries to ties of the health services. This is important work, reduce future illnesses. which naturally receives a great deal of attention, The main focus of this White Paper is on fac- but the health sector alone is not the most decis- tors that we know effect health, because: ive factor in the development of health and • Each determinant of health often contributes sickness. Our own choices and the way we jointly to several different health problems. organize and adapt society in a number of diffe- • Focusing on factors that affect health helps to rent areas play a far more important role. It is this bring to light the responsibility of other sectors broad approach which is the subject of this White and policy areas for the health of the popula- Paper. tion. This White Paper draws up strategies for a • When action is aimed at known determinants, healthier Norway. The more disease we can pre- we can measure the results in the form of vent, the less we have to cure. The attention of reduced health risks long before they develop politicians is often caught by acute illnesses and into real disease and death in the population. Box 1.1 Public health work – more energy to cope with everyday demands • Public health work means reducing factors tal and social well-being, and not merely an that entail a health hazard and strengthening absence of disease or infirmity» and this can factors that contribute to better health. The suggest that good health equals a good life. negative factors have an adverse effect on This White Paper takes the view that we want health, be it the things we eat and drink or good health in order to be able to live a good things that are to be found in our social and life, on a par with safe local communities and physical environment. The positive factors meaningful work. Health is then an invest- include, for example, our relationships with ment factor for a good life. the people closest to us and the networks we • Public health work is about promoting physi- become a part of, and the degree to which we cal health by, among other things, influenc- feel our lives are meaningful, predictable and ing living habits and living conditions. But it manageable. These can be called ‘protective’ also about promoting mental health, by help- or ‘coping’ factors and they give individuals ing people to feel that they can cope, giving and groups sustainability and resistance to them self-esteem, human dignity, security, wear. respect and visibility. • The World Health Organization defines health as «a state of complete physical, men- 6 Report No. 16 (2002–2003) to the Storting. Short version 2002–2003 Prescriptions for a Healthier Norway 1.2 Objectives community can and should influence these choices by providing information, dispensing know- There are several reasons why the Government ledge and shaping attitudes. Knowledge and atti- now – ten years after the Storting debate on White tude-shaping campaigns must be accompanied by Paper No. 37 (1992-1993) Challenges in health-pro- other measures. These may be measures that moting and preventive work – wishes to submit a make healthy choices easier and more attractive, new report containing strategies for the next ten- but they may also be measures that make health- year period. New trends in society bring new damaging choices more difficult. health challenges. Examples of these are globali- Influencing other people, whether individuals zation, a multi-cultural society, a demanding work- or groups, involves major ethical challenges. This place, and drug and alcohol problems. The World work must be based on respect for different Health Organization has shown that a third of the choices and have the fundamental support of the total burden of disease in industrialized countries community. For that reason, public health work is caused by five risk factors: tobacco, alcohol, must always be rooted in the democratic institu- high blood pressure, cholesterol and overweight. tions in society and build on knowledge and dis- At the same time, the knowledge base needed to cussions which embrace the largest possible sec- develop both policies and practice has improved tors of the population. Ethical assessments car- in a number of areas. ried out by central expert bodies are important, Against this background, the Government but they must be accompanied by an ongoing wishes to revitalize public health work. Its objec- debate in the population. If not, there is a danger tive is a healthier Norway through a policy which that measures will be regarded as uncalled for contributes to: interference. • More years of healthy life for the population as Individuals and local communities have a a whole responsibility for public health, but the health of a • A reduction in health disparities between social population is just as much the result of trends and classes, ethnic groups and the sexes. political choices beyond the control of the individual. The picture of disease reflects a general social This White Paper aims for a more systematic and development and the conditions under which we comprehensive policy than hitherto. The Govern- live. Responsibility must therefore be made trans- ment will attach importance to the connection bet- parent in all sectors when national policy is being ween the community’s and the individual’s respon- formulated. From the point of view of public health, sibility for and possibility of influencing the health we must care about what society does to make situation and to showing what the individual and cycling safe and what it does to encourage healthy the community have to gain from effective preven- eating habits. We must care about how schools tive healthcare. The Government seeks to strengt- deal with bullying and how the workplace can have hen public health work in all social

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