A comparative project on social determinants of health in the Nordic countries

Projektin yksityiskohdat

Kuvaus

The main aim of this project was to examine strategic subareas of socioeconomic inequalities in health related outcomes. In addition to educational, occupational class and income inequalities in health, also employment status inequalities were studied. Furthermore, socioeconomic health inequalities were specified by jointly analysing the role age and gender to these inequalities. The importance of labour market participation was particularly emphasised. Finally, an analysis of health inequalities in the Nordic welfare states within the European context was made. Health was measured by using standard self-reported indicators of generic health, such as self-rated health and limiting long-standing illness. Additionally, inequalities in body weight and obesity were studied. Both cross-sectional and time trend analyses were made. Nordic survey data were collated to a data bank which was used as the data source in this project. This data source allowed for highly comparable analyses to be ca rried out and reported as articles in international journals and an edited book. The main results from the substudies can be summarised under the following five points: Firstly, studying income inequalities in health in Sweden, Finland and Norway in the 1990s suggested that the relative position in the income distribution contributes to health irrespective of the consumption power; i.e. health was the poorer, the lower the relative income in these three countries.
Secondly, health among Finns has been poorer that and in the other Nordic countries. This was found to hold true in particular for men in the older age groups and with low education.
However, these health inequalities were rapidly declining and differences between the countries practically disappeared by the mid 1990s. The poorer health and larger health inequalities among Finns as compared to their Danish, Norwegian and Swedish counterparts is likely to be a cohort effect resulting from their poorer past living conditions prior to the 1950s.
Thirdly, comparing inequalities in body weight and obesity in Denmark and Finland showed that Finnish women and men had higher relative weights and more obesity than their Danish counterparts. Overall the socioeconomic patterning of obesity was similar in both countries, with lower status implying higher body weights. However, relative socioeconomic inequalities among Danish women were particularly large and larger than those among Finnish women. While there were no marital status differences in obesity among Finns, the non-married Danes were more often obese than their married counterparts.
Fourthly, the importance of employment status to health was studied by specifying role of marital status and the family. It was found that employment status is a key health divide in all four studied Nordic countries, with the employed having the best health. Marital and parental status did not contribute to this health divide. Finnish and Swedish women who occupied multiple roles, i.e. having a job and being a spouse and mother had particularly good health. Income only slightly affected this patterning. Lone mothers constitute a particularly disadvantaged group whose health was much worse than their employed and partnered counterparts.
Fifthly, the available evidence suggests that health inequalities are not necessarily smaller in the Nordic countries than in other western European countries. However, health inequalities are likely to be more stable over time in the Nordic countries than elsewhere in Europe where tendencies towards widening health inequalities are visible. This stability held true even when Finland and Sweden underwent a serious economic recession in the early 1990s. This may indicate that the Nordic welfare states have particular potential to buffer against adverse health effects of economic downturns.
The network established during two successive NOS-HS projects continues to collaborate. The Swedish partners (Olle Lundberg) have sta rted a Nordic network supported by a Swedish grant in 2004-2007. This network consists of participants from NOS-HS projects. Joint workshops will be organized to discuss ongoing research on health inequalities and start new ones. Also further bilateral studies are ongoing. Finnish and Swedish partners from the NOS-HS network have started collaborative programme in doctoral training within health inequalities. The network also participated in the application round for a Nordic centre of excellence.


Cooperation

University of Helsinki, Dep. of Social Policy
University of Helsinki, Dep. of Sociology
Stockholm University, CHESS, Stockholm, Sweden
NOVA Norwegian Social Research, Oslo, Norway
Fafo Institute for Applied Social Science, Oslo, Norway
National Institute of Public Health, Copenhagen, Denmark
Department of Public Health, Karolinska Institute, Stockholm, Sweden
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