In this chapter, the macrosystem-level influence on health promotion developments in Norway is analysed by demonstrating how the development of the Norwegian welfare state, initiated before World War II, has been influenced by shifting political foci and priorities. The development of the welfare state has been largely a political matter guided by left wing governments with high priorities on improving structural conditions and securing healthy living conditions in work-places, housing, education and access to health services. Similarly, development of the Norwegian Health Promotion Policy over the last two decades has been influenced by varying levels of politicalization.
Under left wing governments, health policies were developed as opposed to policies primarily focused on prevention of disease; there was also an increase in local autonomy in implementation of national health policy and a focus on equity in health. In all these change processes, emphasis was given to how public health could be improved through the governing system from national to local implementation and by involvement of an increasing number of sectors. During the periods when right wing governments were in power, more emphasis was given to individual responsibility for health and health policy declined in political importance. This pendulum swing in the politicalization of health policies is analysed through White Papers and action plans. It traces how Norwegian governments have acted upon the international health promotion movement initiated at the Alma Ata conference and through the Ottawa Health Promotion Charter. Similar pendulum swings are also found in other Western countries.
Keywords: Health promotion, public health, policy, macro-level, welfare state, pendulum swings, politicalisation, local autonomy, disease prevention, equity in health, change processes, implementation, cross-sectoral.