Bridging global health actors and agendas: the role of national public health institutes.

Global health crises require coordination and collaboration among actors and global health agendas including health security, health promotion, and universal health coverage. This study investigated whether national public health institutes (NPHIs) unify agendas and actors, how this can be achieved, and what factors contribute to success. We conducted semi-structured interviews with 24 public health leaders from 18 countries in six WHO regions between 2019 and 2020. Respondents described how NPHIs bridge agendas reporting five strategies that institutes employ: serving as a trusted scientific advisor; convening actors across and within sectors; prioritizing transdisciplinary approaches; integrating public health infrastructures, and training that builds public health capacity. Findings also revealed five enabling factors critical to success: a strong legal foundation; scientific independence; public trust and legitimacy; networks and partnerships at global, national, and local levels; and stable funding. The Covid-19 pandemic underscores the urgency of securing scientific independence and promoting national institutes' responsiveness to public health challenges.

Asylum seekers' health and use of health services in Norway. / Asylsøkeres helse og bruk av helsetjenester i Norge.

BACKGROUND: Many asylum seekers arrived in Norway during autumn 2015, and there has been a call for more knowledge regarding the health of this group. The aim of this exploratory literature review was to investigate the state of knowledge about asylum seekers' health and use of healthcare services in Norway. MATERIAL AND METHOD: We conducted two literature searches for the periods 2007-2017 and 2017-2019 in 12 databases using the keywords 'refugees' and related terms, with a filter for research undertaken in or about Norway and published in Norwegian or English. The title and summary were read first, after which relevant articles were read in full text. Publications concerning asylum seekers in Norway and related to health and/or use of health services were included. RESULTS: A total of 28 publications met the criteria for inclusion: 22 peer-reviewed articles and six reports. The most common topics were mental health and infectious diseases. Other topics that the studies dealt with were nutrition, functional impairment and healthcare services. INTERPRETATION: Little research has been undertaken on asylum seekers' health and use of healthcare services. Research on asylum seekers' health in Norway primarily concerns mental health and infectious diseases, and there is little research on other somatic disorders.

Hospital Variation in 30-Day Mortality for Patients With Stroke; The Impact of Individual and Municipal Socio-Demographic Status.

Background Thirty-day mortality after hospitalization for stroke is commonly reported as a quality indicator. However, the impact of adjustment for individual and/or neighborhood sociodemographic status ( SDS ) has not been well documented. This study aims to evaluate the role of individual and contextual sociodemographic determinants in explaining the variation across hospitals in Norway and determine the impact when testing for hospitals with low or high mortality. Methods and Results Patient Administrative System data on all 45 448 patients admitted to hospitals in Norway with an incident stroke diagnosis from 2005 to 2009 were included. The data were merged with data from several databases to obtain information on vital status (dead/alive) and individual SDS variables. Logistic regression models were compared to estimate the predictive effect of individual and neighborhood SDS on 30-day mortality and to determine outlier hospitals. All individual SDS factors, except travel time, were statistically significant predictors of 30-day mortality. Of the municipal variables, only the municipal variable proportion of low income was statistically significant as a predictor of 30-day mortality. Including sociodemographic characteristics of the individual and other characteristics of the municipality improved the model fit. However, performance classification was only changed for 1 (out of 56) hospital, from "significantly high mortality" to "nonoutlier." Conclusions Our study showed that those stroke patients with a lower SDS have higher odds of dying after 30 days compared with those with a higher SDS , although this did not have a substantial impact when classifying providers as performing as expected, better than expected, or worse than expected.

Social inequalities in patient experiences with general practice and in access to specialists: the population-based HUNT Study.

BACKGROUND: In countries with gatekeeping and equitable access to general practitioners (GPs), social inequalities in GP-patient interaction could be an important mechanism by which inequalities in access to medical specialists arise. The aim of this study was to investigate whether socioeconomic inequalities in experiences with general practice are associated with socioeconomic inequalities in access to specialist services. METHODS: The study included 6,067 participants in the third survey of the Nord-Trøndelag Health Study (HUNT3, 2006-08) who were asked to evaluate their experiences with primary care and their regular general practitioner in Norway. Self-reported data on health status and number of visits to GP and specialist services in the last 12 months were included in the study. Socioeconomic status was measured by education and household income and rescaled to relative index of inequality (RII). Relative risks were calculated using Poisson regression. RESULTS: We found that a majority of patients reported positive experiences with general practice. Low socioeconomic status (SES) and male gender were associated with negative experiences. Patient experiences both directly and indirectly related to referrals were associated with the probability and quantity of specialist utilization: perception of low subjective influence on decisions about choice of medical care was associated with lower probability and quantity of specialist utilization, whereas desire to change the regular GP or to use GPs other than the regular GP and critical evaluations of the GP were associated with higher specialist consultation frequency. However, the level of education-related inequity in access to specialists was not sensitive to adjustment by survey responses. CONCLUSION: Patient experiences with general practice were associated with the patients' level of utilization of specialist services. There are socioeconomic inequalities in patient experiences with general practice, however the aspects measured in this study do not explain the observed socioeconomic inequity in access to specialists.

Socio-economic inequalities in Norwegian health care utilization over 3 decades: the HUNT Study.

BACKGROUND: The aim of this study was to investigate socio-economic inequalities in health care utilization from the 1980s and through the last 3 decades in a Norwegian county population. METHODS: Altogether, 166 758 observations of 97 251 individuals during surveys in 1984-86 (83% eligible responses), 1995-97 (51% eligible responses) and 2006-08 (50% eligible responses) of the total population of adults (≥ 20 years) from Nord-Trøndelag county in Norway were included. Health care utilization was measured as at least one visit to general practitioner (GP), hospital outpatient services and inpatient care in the past year. Socio-economy was measured by both education and income and rescaled to measure relative indexes of inequality (RII). Relative and absolute inequalities were estimated from multilevel logistic regression. Estimates were adjusted for age, sex, municipality size and self-reported health. RESULTS: GP utilization was higher among individuals with higher education in 1984-86. Among men the RII was 0.54 (CI: 0.48-0.62), and among women RII was 0.67 (CI: 0.58-0.77). In 2006-08, the corresponding RII was 1.31 (CI: 1.13-1.52) for men and 1.00 (CI: 0.85-1.18) for women, indicating higher or equal GP utilization among those with lower education, respectively. The corresponding RIIs for outpatient consultations were 0.58 (CI: 0.49-0.68) for men and 0.40 (CI: 0.34-0.46) for women in 1984-86, and 0.53 (CI: 0.46-0.62) for men and 0.47 (CI: 0.41-0.53) for women in 2006-08. CONCLUSION: Through the last 3 decades, the previous socio-economic differences in GP utilization have diminished. Despite this, highly educated people were more prone to utilize hospital outpatient consultations throughout the period 1984-2008.

Socioeconomic inequalities in dental services utilisation in a Norwegian county: the third Nord-Trondelag Health Survey.

AIM: To assess the level of socioeconomic inequity in dental care utilisation in Norway and enable comparison with recent international comparative studies. METHODS: We studied dental care utilisation among 17,136 men and 21,414 women in the third Nord-Trøndelag Health Survey (2006-08). Respondents aged 20 years and above were included in the study, and analyses were also performed within subgroups of age and gender (20-39, 40-59, and ≥60 years). Income-related horizontal inequity was estimated by means of concentration indices. Education-related inequity was estimated as relative risks. RESULTS: We found consistent pro-rich income inequity among men and women of all ages. The level of income inequity was highest among men and women ≥60 years, and in this group the income gradient was steepest between the poorest and the middle quintiles. Pro-educated inequity was found exclusively among men and women ≥60 years. General attendance was high (77%). CONCLUSION: The overall level of income-related inequity in dental services utilisation was low compared to other European countries as reported in two recent international studies of socioeconomic inequalities in dental care utilisation. Pro-rich and pro-educated inequity is a public health challenge mainly in the older part of the population.

Socioeconomic inequalities in health care utilisation in Norway: the population-based HUNT3 survey.

BACKGROUND: In this study we investigated the distribution of self-reported health care utilisation by education and household income in a county population in Norway, in a universal public health care system based on ideals of equal access for all according to need, and not according to wealth. METHODS: The study included 24,147 women and 20,608 men aged 20 years and above in the third Nord-Trøndelag Health Survey (HUNT 3) of 2006-2008. Income-related horizontal inequity was estimated through concentration indexes, and inequity by both education and income was estimated as risk ratios through conventional regression. RESULTS: We found no overall pro-rich or pro-educated socioeconomic gradient in needs-adjusted utilisation of general practitioner or inpatient care. However, we found overall pro-rich and pro-educated inequity in utilisation of both private medical specialists and hospital outpatient care. For these services there were large differences in levels of inequity between younger and older men and women. CONCLUSION: In contrast with recent studies from Norway, we found pro-rich and pro-educated social inequalities in utilisation of hospital outpatient services and not only private medical specialists. Utilisation of general practitioner and inpatient services, which have low access threshold or are free of charge, we found to be equitable.