Healthy life centres in Norwegian municipalities

In general, public health in Norway is good and life expectancy is increasing. While in the past most health problems and deaths were caused by communicable diseases, a growing number of diseases are nowadays linked to our living habits. In order for the population to have as many years of good health as possible, and to spare society the financial burden of health services, a greater focus has been placed on preventing and stemming the further development of lifestyle diseases. Challenges such as sedentary lives, stress, smoking, high alcohol consumption, unhealthy diets, loneliness, social inequality etc. can reduce a person’s life expectancy considerably and lead to poor physical and mental health.

Healthy Life Centres (HLCs) offer an interdisciplinary primary health care service that provides effective, knowledge-based assistance to change living habits and cope with diseases and health problems. There is no statutory obligation for a municipality to establish an HLC, but the Norwegian Directorate of Health recommends that all municipalities create such a centre in order to manage the preventive health services they provide. The target group is persons of all ages with a high risk of contracting a disease, or who are already living with a disease and need help to change their living habits and manage their condition. This includes, for instance, people with complex and chronic diseases, who are not comfortable with other services, such as those provided in traditional training centres. Another aim of HLCs is to counteract social disparities in living habits and health among the population. The primary goal of this report has been to generate knowledge on preventive health services in the municipalities in general, and in HLCs in particular. Statistics Norway’s mapping of HLCs in 2013 enables a closer examination of this preventive health service in the municipalities in relation to establishment, organisation, personnel resources, activities and cooperation with other parties. An analysis has also been made of the disparities between municipalities, broken down by county, population size and degree of centrality.

The mapping shows a steady increase in the number of municipalities choosing to establish an HLC: the figure doubled during the period 2011-2014. The percentage of municipalities that have established an HLC differs, however, according to county, population size and degree of centrality. The results indicate that some counties have established more centres than others, and that large municipalities in central areas in particular are choosing to establish the service. The overall number of municipalities establishing an HCL is, nevertheless, increasing regardless of population size and degree of centrality. HCLs in larger and more central municipalities also tend to offer a wider range of services. The mapping also shows that HLCs are a relatively “small” health service in terms of use of resources and user numbers compared to other municipal health and care services. On average, each municipality had HLC positions corresponding to 0.9 full-time equivalents (FTEs) in 2013. This would make the service vulnerable if key personnel were to leave, particularly in the case of small municipalities. HLCs had around 16 000 users in total in 2013, who participated in one or more activities. Approximately half of these were referred from other services such as GPs. The large, central municipalities have the most users, however the small and less central municipalities with an HLC have the highest percentage of users. This may be an indication of the importance of HLCs as part of the preventive health service in the small municipalities.

Interviews with selected municipalities and County Governor offices highlighted the difficulties in getting municipalities to continue the HLCs once the support they receive from the County Governor to establish the centre comes to an end. Small municipalities are probably most at risk. It was also pointed out that the work involved in applying for such funding is time-consuming – both for the County Governor and the municipalities – compared to the size of the contribution. The interviewees did, however, report that the existing HLCs are functioning as intended. Key factors for succeeding include securing a good foundation in the political institutions and the administrative management, and ensuring a good working cooperation with other services.