1 Population Health in Norway, Sweden and Denmark

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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



















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

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Hel

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et. a

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omen

in D

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ark-

why

do

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Ris

k fa

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Sca

nd, J

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fare

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8

Juel 2000

Mor

tali

ty (

fem

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lung

can

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1952

-199

3)

Life expectancy trends for 20 year old's DENMARK

Brønnum-Hansen 2005

Juel 2000

Documents

1 Population Health in Norway, Sweden and Denmark