Understanding the Promotion of Health Equity at the Local Level Requires Far More than Quantitative Analyses of Yes-No Survey Data; Comment on “Health Promotion at Local Level in Norway: The Use of Public Health Coordinators and Health Overviews to Promote Fair Distribution Among Social Groups”

Document Type : Commentary

Author

School of Health Policy and Management, York University, Toronto, ON, Canada

Abstract

Health promotion is a complex activity that requires analytic methods that recognize the contested nature of it definition, the barriers and supports for such activities, and its embeddedness within the politics of distribution. In this commentary I critique a recent study of municipalities’ implementation of the Norwegian Public Health Act that employed analysis of “yes” or “no” responses from a large survey. I suggest the complexity of health promotion activities can be best captured through qualitative methods employing open-ended questions and thematic analysis of responses. To illustrate the limitations of the study, I provide details of how these methods were employed to study local public health unit (PHU) activity promoting health equity in Ontario, Canada.

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  1. Kawachi I, Subramanian SV, Almeida-Filho N. A glossary for health inequalities. J Epidemiol Community Health. 2002;56(9):647-652. doi:10.1136/jech.56.9.647
  2. Baum F. Cracking the nut of health equity: top down and bottom up pressure for action on the social determinants of health. Promot Educ. 2007;14(2):90-95. doi:10.1177/10253823070140022002
  3. Hagen S, Ivar Overgard K, Helgesen M, Fosse E, Torp S. Health promotion at local level in Norway: the use of public health coordinators and health overviews to promote fair distribution among social groups. Int J Health Policy Manag. 2018; Forthcoming. doi:10.15171/ijhpm.2018.22
  4. Lasswell HD. Politics: Who Gets What, When, How. Whitefish, MT: Literary Licensing, LLC; 2011.
  5. Lincoln YS, Guba E. Naturalist inquiry. Newbury Park CA: Sage; 1985.
  6. Brassolotto J, Raphael D, Baldeo N. Epistemological barriers to addressing the social determinants of health among public health professionals in Ontario, Canada: a qualitative inquiry. Crit Public Health. 2014;24(3):321-336. doi:10.1080/09581596.2013.820256
  7. Raphael D, Brassolotto J, Baldeo N. Ideological and organizational components of differing public health strategies for addressing the social determinants of health. Health Promot Int. 2015;30(4):855-867. doi:10.1093/heapro/dau022
  8. Raphael D, Brassolotto J. Understanding action on the social determinants of health: a critical realist analysis of in-depth interviews with staff of nine Ontario public health units. BMC Res Notes. 2015;8:105. doi:10.1186/s13104-015-1064-5
  9. Raphael D, Sayani A. Assuming policy responsibility for health equity: local public health action in Ontario, Canada. Health Promot Int. 2017. doi:10.1093/heapro/dax073
  10. Muellmann S, Steenbock B, De Cocker K, et al. Views of policy makers and health promotion professionals on factors facilitating implementation and maintenance of interventions and policies promoting physical activity and healthy eating: results of the DEDIPAC project. BMC Public Health. 2017;17(1):932. doi:10.1186/s12889-017-4929-9