The Status of Public Health in Norway 2010 - report

These findings come from a report, “Helsetilstanden i Norge - Folkehelserapport 2010" (The State of Public Health in Norway - Public Health Report 2010). The report looks at public health through the ages and the health of different population groups in different life phases.

As the report is only available in Norwegian, here is a summary of the main findings.

Summary

Over the past 20 years health and life expectancy have improved for all population groups in Norway, regardless of education and income. Nevertheless, improvements have been greater for groups with higher education and higher income than for those with lower education and lower income. The differences are present throughout the entire socioeconomic hierarchy, and include the mental and physical health of children, young people, adults and the elderly.

A large part of society’s resources are spent on health care services; chronic diseases and conditions being the largest challenges. The prevalence of serious infectious diseases is lower in Norway than in most other countries. Improved hygiene, housing conditions and standard of living, in addition to good health care services and vaccines, have contributed to the fact that epidemics and serious infectious diseases are no longer major public health challenges in Norway.

Today’s public health in many ways reflects the earlier environmental impact on the population. Accordingly, future public health will be influenced by various factors. Outdoor air pollution, noise and poor indoor air quality cause health problems for many people. An increasing problem regarding safe and sufficient water supply is poor post-war water mains.

Pregnancy

The age of first-time mothers has risen slightly each year, but the trend now seems to be levelling out. The average age of first-time mothers is now 27.5 years.

The prevalence of gestational diabetes has been increasing steadily since the late 1980s, in particular from 2006 until today. The increase may partly be explained by changes in diagnostic criteria and increased focus on this condition in antenatal care. Nevertheless, the increase raises concerns. The number of women who smoke during pregnancy has decreased and is now at an average of nine per cent, but smoking is still quite frequent among the youngest mothers.

Children and adolescents

Norwegian children are on the whole healthy. The infant mortality rate is very low, around three per 1,000 live-born die during the first year of life. Very few children die of sudden infant death syndrome. The number of large newborns with a birth weight over 4500 grams increased considerably during the 1990s, but has been reversing from 2000. The number of large newborns is now back to the “normal level” of the 1980s.

Boys are considerably more exposed to injuries than girls. While home, school- and leisure-related injuries amount to 90 per cent of all accidents in the age group of 0-4 years; many injuries in the age group of 15-24 years are caused by sports or exercise. Injuries are a common cause of children and adolescents seeking emergency medical assistance at casualty wards or hospitals. Over the past decades, the number of traffic related deaths have decreased significantly. Nevertheless, traffic accidents and other accidents are still among the most common causes of death among children and adolescents.

We assume that approximately 70,000 children and adolescents suffer from mental illnesses requiring treatment. In the age group of 6-12 years, two out of three with diagnosed illnesses are boys. The most common diagnoses are hyperactivity, concentration difficulties and behaviour disorders. During adolescence, more girls than boys suffer from symptoms of anxiety and depression.

Many children and adolescents use prescribed drugs, mainly antibiotics, analgesics and drugs for relieving asthma and allergies.

Dental health among children and adolescents is on the whole good. In 2008, close to 80 per cent of all 5-year-olds and almost 50 per cent of 12-year-olds did not have any history of dental decay. The numbers have been increasing steadily over the past 25 years.

Smoking is decreasing among adolescents, but an increasing number use moist snuff. The number of children exposed to passive smoking is decreasing as the number of adult non-smokers increases.

Alcohol consumption among young adults is rising, especially among students, and more among women than among men. Alcohol consumption among adolescents is decreasing.

Children are more physically active than adolescents and adults. Eighty to ninety per cent of 9-year-olds fulfil the recommended 60 minutes of daily physical activity. The share among 15-year-olds is 50 per cent.

About 15 per cent of 8-9-year-olds and 15-year-olds are overweight or obese. Obesity amounts to under five per cent, which is on level with the other Nordic countries.

Adults

Fewer people die before retirement, mainly explained by the decrease in cardiovascular diseases. Yet, a substantial part of the working population claims disability pension, around ten per cent in 2009. Additionally, a considerable number claim sickness allowance for shorter or longer periods of time. Skeletal and muscular diseases combined with pain, and mental illnesses are important factors contributing to these high figures, resulting in a significant number of lost working years. At any given time, 30 per cent of the adult population suffers from chronic pain. Prevalence increases with age, and women are more exposed than men. Anxiety and depression are, together with drug abuse and addiction, the most common mental illnesses. About five per cent of the population suffers from alcoholism.

Support from family, friends and colleagues is important to both mental and somatic health. People lacking close familiar relations have higher mortality, especially in terms of cardiovascular diseases. Good social networks, both in the local community and at work, are important factors for maintaining good health. Limited social support reduces the ability to deal with stress and has a direct negative impact on health and quality of life.

Smoking is the single factor with the most significant negative effect on several major chronic diseases. Former smoking habits are causing an increase in prevalence of the lung disease COPD (Chronic Obstructive Pulmonary Disease) in the population and a strong increase in lung cancer among women. Smoking also leads to greater risk of cardiovascular disease and several other types of cancer. Every year, approximately 6,700 people die of smoking, each of them having lost an average of 11 years of life. In the adult age group, a high number are still smoking, especially in population groups with lower education and income. Differences in smoking habits may explain a large part of the social inequalities in health.

The prevalence of obesity and type 2 diabetes increases, but the obesity rise is not as steep as before. Lack of physical activity is an important risk factor for both type 2 diabetes and other chronic diseases. In the adult population, only one in five fulfil the recommended 30 minutes of daily physical activity. In terms of diet and eating habits, we still consume too much sugar, salt and saturated fats. On the other hand, today’s diet is on the whole sufficient in terms of adequate amounts of nutrients, except vitamin D and folate.

Over the past years, we have obtained more knowledge on the health of refugees and immigrants in Norway. Some come from countries with an entirely different panorama of diseases than Norway. Different diets, new bacterial flora and stress related to the integration into a new society may increase the risk of illness. Some immigrant groups, however, have cultural health benefits related to less use of tobacco and drugs than the majority population.

The elderly

An increasing number of people reach an old age and so far there are no indications that the increase in life expectancy will stop. Better medical treatment and lifestyle changes may have contributed to this development. High consumption of prescribed drugs provides on one hand relief from afflictions and postpones severe cases of illness, but on the other hand, it may increase the risk of incorrect use and side effects. Among people over 70 years of age one in five uses more than 10 different drugs simultaneously, including potentially addictive drugs.

Age is an important risk factor for cancer and the increase of the aged population will lead to a rising number of people with cancer. Prevalence has increased over the past decades, partly because of a generally greater risk of getting cancer. Improved diagnosis has resulted in earlier detection of cancer and also detection of more cases than before.

Age is also an important risk factor for dementia. One in four people over 85 years of age gets dementia. Due to increased life expectancy more people will need treatment for dementia in the future.

Cardiovascular diseases are still the most common cause of death in the age group of 65 years and older, and amount to 35 per cent of all deaths each year.

In the course of the next decades, a large group of elderly people will need assistance due to lower functional ability and treatment for poor health. Simultaneously, we will see a large group of healthy senior citizens with satisfactory daily functional ability, despite one or several chronic diseases. Today’s elderly have better self assessed health and functional ability than before.