Background: I Norway several epidemiological studies have documented that immigrants have a higher burden of and are at greater risk of lifestyle- and diet-related disorders, mental health problems, infectious diseases and complications of reproductive health compared to the ethnic Norwegian majority population. Furthermore the Government’s National Strategy to reduce social inequalities in health and other reports from institutions like the Directorate of Health, the Public Health Institute and the Norwegian Medical Association have underlined these health inequalities. However despite the existence of the evidence, these public health challenges to a large extent have not been translated into policy.
The report no.47 (2008-2009) to the Parliament, The Coordination Reform (Samhandlings- reformen) lays great emphasis on prevention and early intervention in the course of illness and states that “creating a framework in which the public must take responsibility for its own health will become a more prominent component of health policy”. The Ministry states that it “will attach importance to dialogue with all relevant stakeholders in order to reach a mutual understanding of the challenges we face in implementing the Coordination Reform”. This should apply to all users including the most vulnerable groups, like immigrants.
In Norway there is a growing body of epidemiological research of immigrants’ health, but research on access and utilization of health services for migrants and whether the services are appropriate and relevant is scarce, and on policy development non- existent. There is a great need for appropriate preventive and promotive measures. Despite existing gaps in the evidence base with regard to immigrants’ health status the evidence is nonetheless substantial for immediate action.
Other European countries have already studied and reviewed national health policies with regard to inequity and migrant health. These studies will provide a good basis for comparison with Norway and could provide direction with regards to the recommendations for the future.
Methods and materials: The main objective of this study is to analyse if the evidence-based knowledge on the public health challenges of immigrants in Norway has translated into con-crete actions in the national health policies, strategies and plans. This has been done by con-ducting a content analysis of 10 white papers and 18 strategies and action plans.
Results: In Norway, health policies that govern the health and care services are explicit about equity in terms of availability, utilization and results. The documents which have been ana-lysed emphasise equity as the overall value of the Norwegian health care system, reduction of social inequalities as a main goal and that vulnerable groups should be prioritised.
In several of the reports challenges of the health status of immigrants are adequately de-scribed, but when it comes to the formulation of concrete measures in action plans and na-tional strategies it is rather diffuse and non-committal. The ten white papers have sections on immigrants as a specific group describing the immigrant population, health inequalities and challenges of health care provision. Suggestions and proposed actions are not comprehensive, and formulated in a general and normative manner. There are few explicitly stated measures and they are not in concordance with the situation analysis.
Action plans and strategies are tools for implementing decided policy. Five of the documents did not mention immigrants as a group while five ‘barely’ mentioned. Eight action plans or strategies on essential areas like mental health, nutrition, physical activity, drugs and alcohol use, HIV and sexual health had a ‘broader’ approach to immigrants and their specific chal-lenges. However the documents vary a lot when it comes to specification of measures and it is difficult to see which concrete actions should follow.
There is no doubt that a lot of the public health challenges of immigrants are known and rec-ognised, but whether appropriate, relevant actions are being taken is more uncertain. The re-sults show that there is a huge gap between the described challenges, proposed actions and the explicitly stated measures.
Conclusions: Despite a solid body of evidence on immigrants’ health status and the recogni-tion of these challenges in various reports to the Parliament the last decade, the attempts to meet and incorporate the health needs of migrants and ethnic minorities into the Norwegian Health Care Services are still fragmented and uncoordinated. The measures described are on a small scale but mainstreaming these measures has yet to happen. There is a lack of an overall strategy and policy from the national health authorities and Norway could learn from work done in other European countries like Scotland and Spain. Greater attention needs to be paid to research and policy implementation in order to address ethnic inequalities in health. Analy-sis of health policies needs to be continued to identify gaps both in research and implementa-tion in order to support governments in developing more structured, comprehensive and coor-dinated policies when it comes to migrant health.