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Review of Social Inequalities in Health in Norway English Summary Review of Social Inequalities in Health in Norway English summary Espen Dahl, Heidi Bergsli and Kjetil A. van der Wel Faculty of Social Sciences, Social Welfare Research Centre 2 Foreword In 2008, the Global Commission on Social Determinants Professor Dahl, the expert panel appointed to administer of Health of the World Health Organisation (WHO) asked the project consisted of Professor Finn Diderichsen, its member countries to examine all aspects of public the Institute of public health, Copenhagen University; policies related to the question of fairness in health care. Senior Researcher Jon Ivar Elstad, Norwegian Social The World Health Assembly subsequently adopted two Research; Associate professor Astrid Louise Grasdal, resolutions committing countries to develop strategies Department of Economics, University of Bergen; aimed at reducing social inequalities in health by Director of the Department of Health Statistics Else- targeting the social determinants of health. This resulted Karin Grøholt, Norwegian Institute of Public Health; in investigations in a number of member countries Professor Olle Lundberg, Centre for Health Equity including England and Denmark. Studies, Stockholm University/Karolinska; Petter Kristensen, Director of the Department for Occupational In 2007, the Norwegian government initiated a national Medicine and Epidemiology, National Institute of strategy to reduce social inequalities in health and 5 Occupational Health; and Research Professor Axel West years later, the government commissioned a study of Pedersen, Institute for Social Research. factors impacting on social inequalities in health. This resulted in a review initiated by the National Directorate This report has been written by a team consisting of of Health focused on five aspects of social inequalities Professor Espen Dahl, researcher Heidi Bergsli, and in health in Norway. The first of these addressed the Associate Professor Kjetil A. van der Wel. social distribution of health as well as an evaluation of The members of the expert panel represent a broad the health status of the poorest strata in society. The spectrum of disciplines and expertise encompassing second presented analyses of the consequences of social occupational medicine, public health sciences, health inequalities in health. The third provided an overview economics, social medicine, sociology and political of the development of social inequalities in health science. The panel has held six meetings where chapter and their social consequences over time. The fourth drafts were discussed. The panel has also discussed and identified social conditions explaining inequalities in commented the commissioned supplementary reports. health in Norway, while the fifth framed the findings The work with the report has mainly consisted of of analyses of social inequalities in health in Norway reviews of national and international research literature in a comparative perspective. The report also identified on relevant topics and studies of available statistical those policy areas and social institutions having the material. In addition, the report presents findings from a greatest impact on social inequalities in health. This number of original data analyses. was followed by recommendations for changing as well as initiating programs contributing to the reduction of Supplementary reports have been compiled by health inequalities and their social effects in Norwegian experts from various disciplines and research areas. society. They are responsible for the content of these reports currently available at www.hioa.no/helseulikhet. The This report presents a summary of these findings and recommendations presented in the supplementary recommendations. The review has been organised as reports do not necessarily correspond with the an independent and autonomous project at Oslo and recommendations presented in the full report based on Akershus University College of Applied Sciences a global evaluation of the social determinants of health. (HiOA) chaired by Professor Espen Dahl. In addition to 3 The authors and titles of the supplementary reports are We express our gratitude for the advice and assistance listed below. With the exception of the contributions of colleagues in Norway and abroad: Elling Bere, Torkel by Schmidt and Elstad, the reports are only available Bjørnskau, David Blane, Elling Borgeraas, Annechen in Norwegian. The report titles presented here are in Bugge, Astrid Austvoll-Dahlgren, Runar Døving, Terje English in order to provide an overview of the topics and A. Eikemo, Inger Elisabeth Fosse, Peter Goldblatt, areas investigated in the commissioned reports: Marianne Nordli Hansen, Hege Hofstad, Håkon Johannessen, Angela Kreher, Olaug Lian, Inger Marie - Annett Arntzen (Vestfold University College): Lid, Nanna Lien, Eifred Markussen, Lars Mehlum, Social inequalities in the health of children Sille Ohrem, Øyvind Næss, Hilde Pape, Kristine Pape, - Heidi Bergsli (HiOA): Health and secondary school Ingeborg Rossow, Kristine von Simson, Sidsel Sparre, drop-out Maria Tindberg, Einar Øverbye and colleagues at the Social Welfare Research Centre, HiOA. Last but not - Jon Ivar Elstad (HiOA): Two statistical analyses for least, we are grateful to Kristian Heggebø, Kristin Dahl the project Tindberg and Anne Grete Tøge for assistance with the - Jon Ivar Elstad (HiOA): The hierarchical diffusion literature. model (in English) - Øyvind Giæver: National strategy to reduce social The project leader has presented work in progress to inequalities of health - in theory and practice the Health Directorate’s Scientific Board on Social - Geir Godager and Tor Iversen (University of Oslo): Inequalities in Health, members of which have given Empirical literature on social inequalities in the use valuable comments to our work. of health services in Norway - Kristian Larsen and Gro Hansen (University Espen Dahl, of Aalborg): Social inequalities in health: more conditions than choice. Insights and explanations Chair, Professor at the Social Welfare Research Centre, in the Norwegian case August 2014. - Ingrid Sivesind Mehlum (National Institute of Occupational Health): The role of the working environment in relation to the social inequalities in health - Axel West Pedersen (Institute of Social Research): Income and health - Börge Schmidt: (The University of Duisburg-Essen): Genetics and Socioeconomic Inequalities in Health in the Era of Genome-Wide Association Studies (in English). - Bjørn Heine Strand, Ólöf Anna Steingrímsdóttir, Ingri Myklestad, Øyvind Næss and the research group on social inequalities in health (Norwegian Institute of Public Health): Changes in inequalities in mortality after education in Norway- a sub-report on possible explanations. 4 Content Foreword ..................................................................................................................................................3 Content .....................................................................................................................................................5 I. Social inequalities in health ............................................................................................................7 Unequal wealth .....................................................................................................................................................7 The social gradient ................................................................................................................................................7 A social problem ...................................................................................................................................................8 II. Policy and perspective .....................................................................................................................9 The social determinants of health ....................................................................................................................9 Health and the life course ...................................................................................................................................9 Policy principles .................................................................................................................................................10 Cross-political agreement ................................................................................................................................. 11 III. Lessons from research .................................................................................................................. 13 Patterns and development.................................................................................................................................13 Increasing health inequalities? ......................................................................................................................15 Norway is no exception to the “Nordic paradox” ........................................................................................ 17 Childhood, adolescence and learning ............................................................................................................18 Employment and working environment .......................................................................................................22 Economic inequalities .......................................................................................................................................27 Health behaviours
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