1. Nordic Society of Gynecologic Oncology ( NSGO ) Denmark, Finland, Norway, Sweden
1 Population Health in Norway, Sweden and Denmark.
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Transcript of 1 Population Health in Norway, Sweden and Denmark.
1
Population Health in Norway, Sweden and Denmark
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Population Health in Norway, Sweden and Denmark
READINGS: course is about populations and we tend to think about individuals
KEEP YOUR READINGS IN CASE I or TA MISS ONE
Critical thinking skills
Trends in health with comparisons to US
Social and Historical factors in Scandinavia
Importance of early childhood:
Something rotten in the state of Denmark?
Agenda
United Nations Human Development Report 2007
77
78
79
80
81
82
83
JapanIceland
SwitzerlandAustralia
SpainSwedenCanada
IsraelItalyFrance
New Zealand
NorwayAustriaSingapore
NetherlandsGermany
MaltaCyprus
United Kingdom
FinlandGreeceBelgiumCosta Rica
Ireland
Luxembourg
United Arab Emirates
Chile
DenmarkKorea
United States
Life Expectancy (years)
510
1520
25
30
HEALTH OLYMPICS 2005
Oeppen Science 2002
Fem
al
e
Yanagishita & Guralnik 1998
Population Health Nordic CountriesYear Norway Sweden
1820-1900 Not as good as Sweden (less wealthy)
Better than England, France, Spain or Italy
1900 54.5/57 (m/f) better than Japan
19th century to 1978
Lowest IMR 1895 to 1935
Healthiest country
Esp. lowest IMR since 1945 to 1975)
lowest maternal mortality (midwives, hygiene, nutrition) with focus on breast feeding, infant care
Sweden United States
Parental leave
All parents have right to stay home for full year at 90% salary52 weeks at full payChild allowance ($700/month Norway for single parents, half for married), to age 18 for all
Six weeks unpaid leave in some states, no uniform policySome financial assistance if very poor
Day care Free, government runMaster's degree in play required to work in daycare
Vacations 5 weeks paid per year Extensive sick leave benefits
2 weeks unpaid if permanent employees (business with more than 50 workers-varies by state), no mandatory vacations for tempsNo one guaranteed sick leave
Health care Everyone covered, including dental care, modest co-pay to yearly maximum ($300 in Norway)(resident or citizen)Queues
Medicare for oldMedicaid for very poor40-75 million without insuranceNothing for illegal immigrantsWaits for appointments are common (if you can pay up front for those without insurance)
Sweden United StatesImmigration ~12 % foreign born, many
Muslims (NYT Mag 060205)13% foreign born
Energy Policy
All electricity from nuclear and hydroelectric power (nuclear phase out)
Fossil fuels only for transport
Oil free by 2020
Heating converting to steam and hot water generation by geothermal energy or waste heat
Bush: US "addicted to oil"
Large increase in nuclear power planned
Current Account
Surplus of $10 billionDeficit >>>$ 646.5 billion
Ethos Pursue "policies designed to narrow the inequality of condition between social classes"
God helps those who help themselves
Education Free at all levels through university, vocational and adult education (who get stipends and time off work)
Gov't subsidized loans for other school expenses
Everyone attends public schools
Free primary & secondary education with varying quality depending on local funding formulas
Universities very expensive
Loans taken by most
Sweden United StatesJob training
Free to all citizens who desire it
Government gives a stipend
Limited and usually only for the poor
Trainees do not receive stipend
Employment Government believes every citizen has right to meaningful work
Unemployed receive benefits, retraining or job in public works project
Limited training programs usually only for the poor
Trainees do not receive a stipend
Social Security
All citizens receive pension from state, paying at least 75% of what earned while working, or a guaranteed amount if they did not work
Limited payments, usually not enough to live on
Housing Housing subsidy if you can't afford a house
No homelessness
No slums reported
Some citizens receive housing subsidy or access to public housing projects
15 million+ homeless
Slums in every major US city
Sweden United StatesGovernment Expenditure over half of GDP
(50.8% 2003 Miller)Expenditure 24.2% of GDP
Wealth tax
1.5% each year on the net worth of single-adult households in excess of 1.5 million kroner (or about $198,500), and above 3 million kroner for couples.
none
Child Poverty
4.2% living below national poverty line (below 50% of median income), has risen 1.2% in last decade
NORWAY 3.4% declined 1.8%
21.9% (has fallen 2.4% in last decade)
Children living with university degree parents
(2000), (1991)
Father (31%) (27 %)
Mother (32%) (23 %)
Father (29%) (24 %)
Mother (23%) (16%)
Decline in poverty through taxes and transfers
18% to 4.2% 26.6% to 21.9%
Media Public,
no advertisements on TV aimed at children under age 12 since 1991
Sweden United StatesVoter turnout (1945-1999)
86% 56%
Union density 83% 18% (early 1990s, less now)
Middle Class 70% 47%
90/10 income ratio
1.96 (top 10% make twice the income of the bottom 90%) early 1990s
5.65
Initial breast feeding
97% 70%
Lone parent households
7.9% 10.6% (early 1990s)
Household Poverty Rates (Household Head Aged 25-64)
( A )
Market Income
( B )
Col A +
Private Income
Transfers
( C )
Col B +
Universal and
Social Transfers
( D )
Col C –
Taxes
( E )
Col D +
Social Assistance Transfers
Percent Change
Columns A to E
Sweden (1992)
20.7 20.1 5.0 8.5 3.8 -81.6
US (1994)
23.2 21.0 18.4 20.5 18.9 -18.5
Social transfer: family allowances, disability, sickness benefits, formal daycare, unemployment insurance Not including spending on health care or education
SINGLE PARENT
Infant mortality differentials in Stockholm, by birth in and out of wedlock, 1901–1981 (Burstrom 2003).
Low-wage earners, social expenditures and percent lone-parent households
Percent of full-time workers
earning less than 65% of median earnings (1994)
Social expenditures on
the non-elderly as percent of GDP
(1999)
Percent of households that are lone parent
United States 25% 2.8 10.6
Finland 6% 12.1 5.7
Sweden 5% 12.6 7.9
Child Morbidity/Mortality Risksfor being from a single-parent family (Weitoff 2003)
Condition Girls BoysPsychiatric Disease 1.21 1.35
Suicide attempts 1.20 1.32
Alcohol-related Disease
1.24 1.22
Narcotics-related Disease
1.32 1.40
All-cause mortality 1.21 (ns) 1.54
USA Sweden
Norway history and society
Norway’s welfare state established following the brutal German occupation during World War II. a strong sense of camaraderie and national identity was forged.
Labor Party led the country until 1965, decided that government should take responsibility for the public welfare, striving for the highest possible level of equality and a just distribution of wealth.
Norway’s then elected a King Haakon set an example by serving fish balls, a common peasant food, to foreign dignitaries at his castle. Today, King Olav takes the street car
Laws:everyone has right to reasonable house, food, education, health care, child care, a livable pension
Hotel maids wages average $28,500 and CEO's of oil companies average $43,000 to $57,000 Everyone's incomes are public knowledge
Third largest oil exporter behind Saudi Arabia and Russia, but is state owed Statoil
Crime: lowest murder rates in world, despite 720,000 registered firearms, prisons with private rooms, TV and internet access
Trust highest among nations, bicycles not lockedNational ethic: thrift, self-effacement, leveling tax code. "if anything ruffles Norwegian
sensibilities more than special treatment under the law, it may be the open enjoyment of luxury" (NYT 931225) Consumer goods very expensive
Norway United StatesGovernment Expenditure over half of GDP, 29%
of revenue from oil$35,000 per person
Expenditure > 30% of GDP $13,000/personDecreasing royalties from oil companies
Surplus or deficit
Surplus invested for years when might have deficit and now have one GDP invested for recessions (or $40,000 per person)
Deficit (huge debt $8.5 trillion dollars 060421 debt clock about $133,000 per family)
Wealth
Billionaires
Poor country after WWII until oil discovered (contrast to Sweden which was richer, more industry)4 469
Foreign aid Over 1% of GDP 0.1% of GDP
Taxation 49% on incomeSales tax 33%
35% max on incomeVaries by state, max 8-9%
Women's status 36% of parliamentary seats 14%
Stigma taking money from government?
“I heard that people in the U.S. are embarrassed to take money from the government. What do they call it--‘welfare’? Is this true? I’m not ashamed because that is what it’s there for, to help children.” (student, single-mom)
TRUST Olympics
percentage of respondents, by country, to surveys who responded affirmatively to the the question ‘Generally speaking, would you say that most people can be trusted, or that you cannot be too careful in dealing with people?’ The surveys were done in person in 1996 using the native language, and the questions correspond to impressions of the respondents’ own countries. Strikingly, the data vary by an order of magnitude: while only 3% of those surveyed in Brazil and 5% in Peru say their compatriots are trustworthy, 65% of Norwegians and 60% of Swedes believe this to be so. The United States comes in at 36%, down from 50% in 1990; . Zak
%
United States AustraliaIrelandNew ZealandCanada United Kingdom
NorwayFinlandDenmarkSweden
High/Low Tax Country Comparisons
United States AustraliaIrelandNew ZealandCanada United Kingdom
NorwayFinlandDenmarkSweden
High/Low Tax Country Comparisons
United States AustraliaIrelandNew ZealandCanada United Kingdom
NorwayFinlandDenmarkSweden
High/Low Tax Country Comparisons
United States AustraliaIrelandNew ZealandCanada United Kingdom
NorwayFinlandDenmarkSweden
High/Low Tax Country Comparisons
United States AustraliaIrelandNew ZealandCanada United Kingdom
NorwayFinlandDenmarkSweden
High/Low Tax Country Comparisons
United States AustraliaIrelandNew ZealandCanada United Kingdom
NorwayFinlandDenmarkSweden
High/Low Tax Country Comparisons
United States AustraliaIrelandNew ZealandCanada United Kingdom
NorwayFinlandDenmarkSweden
High/Low Tax Country Comparisons
Arithmetic Scores for Youth Aged 16-25, 1994
Parents’ Level of EducationParents’ Level of Education
Eff
ect
Siz
eE
ffec
t S
ize
L
eve
l 1
L
eve
l 2
L
eve
l 3
Le
vel 4
Lev
el 1
Le
vel 2
Lev
el 3
L
eve
l 4
SwedenSweden
SwitzerlandSwitzerland
NetherlandsNetherlands
GermanyGermany
BelgiumBelgiumCanadaCanada
USAUSAPolandPolandIrelandIreland
N IrelandN Ireland G BritainG Britain
New ZealandNew Zealand
Organisation for Economic Co-operation and Development and Statistics Canada. (1995).
0
0.1
0.2
0.3
0.4
USABritain
W
GermanyFinland Canada
DenmarkSweden Norway
International comparisons of intergenerational social mobility
Source: Blanden J, Gregg P, Machin S. Intergenerational mobility in Europe and N. America. Centre for Economic Performance, London School of Economics. 2005
Higher columns show that people’s social position is more strongly determined by their parents’ position
Breast Feeding Olympics
United Nations Human Development Report 2007
77
78
79
80
81
82
83
JapanIceland
SwitzerlandAustralia
SpainSwedenCanada
IsraelItalyFrance
New Zealand
NorwayAustriaSingapore
NetherlandsGermany
MaltaCyprus
United Kingdom
FinlandGreeceBelgiumCosta Rica
Ireland
Luxembourg
United Arab Emirates
Chile
DenmarkKorea
United States
Life Expectancy (years)
510
1520
25
30
HEALTH OLYMPICS 2005
Something rotten in the state of Denmark
Hel
weg
-Lar
sen
et. a
l. W
omen
in D
enm
ark-
why
do
they
die
so
youn
g?
Ris
k fa
ctor
s fo
r pr
emat
ur d
eath
Sca
nd, J
. Soc
Wel
fare
199
8
Hel
weg
-Lar
sen
et. a
l. W
omen
in D
enm
ark-
why
do
they
die
so
youn
g?
Ris
k fa
ctor
s fo
r pr
emat
ur d
eath
Sca
nd, J
. Soc
Wel
fare
199
8
Hel
weg
-Lar
sen
et. a
l. W
omen
in D
enm
ark-
why
do
they
die
so
youn
g?
Ris
k fa
ctor
s fo
r pr
emat
ur d
eath
Sca
nd, J
. Soc
Wel
fare
199
8
Hel
weg
-Lar
sen
et. a
l. W
omen
in D
enm
ark-
why
do
they
die
so
youn
g?
Ris
k fa
ctor
s fo
r pr
emat
ur d
eath
Sca
nd, J
. Soc
Wel
fare
199
8
Hel
weg
-Lar
sen
et. a
l. W
omen
in D
enm
ark-
why
do
they
die
so
youn
g?
Ris
k fa
ctor
s fo
r pr
emat
ur d
eath
Sca
nd, J
. Soc
Wel
fare
199
8
Juel 2000
Mor
tali
ty (
fem
ale-
lung
can
cer
1952
-199
3)
Life expectancy trends for 20 year old's DENMARK
Brønnum-Hansen 2005
Juel 2000