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.
