RE G I O NAL C O MPARIS O NS 2014 REGIONALöppna COMPARISONS jämförelser 2014 P ublic Healt h Public Health Regional Comparisons 2014 Public Health You are welcome to use quotes from the text or diagrams in the report, provided that you state the source, but you may not use the text in any commercial context. The National Board of Health and Welfare and the Swedish Association of Local Authorities and Regions have the sole right to decide how this work may be used, in accordance with the Act (1960:729) on Copyright in Literary and Artistic Works (Copyright Act). Images, photographs and illustrations are also protected by the Copyright Act and you must have the copyright holder’s permission to use them. National Board of Health and Welfare: Article number 2015-9-2, ISBN 978-91-7555-336-8 Photo: InaAgency (Cover). Production: Edita Bobergs AB Print: Edita Bobergs AB, september, 2015 Preface The Swedish Government has commissioned the National Board of Health and Welfare, in conjunction with the Public Health Agency of Sweden and the Swedish Association of Local Authorities and Regions (SALAR), to develop and publish regional comparisons in the field of public health. The first report was published in 2009 and this is the second report in this field. The report pre- sents a number of new indicators in addition to those presented in 2009. The measurement and comparison periods have been chosen in order to make it possible to monitor what has happened since the report of 2009. The aim of this report is to contribute to improving public health by stimu- lating systematic improvement efforts in various organisations at the regional and local level. Together with its members, SALAR has undertaken a develop- ment process that will make work in the next stage easier once this report has been published. The work has led to an online toolbox that will be of assis- tance in the forthcoming analytical and improvement process. This commission has been executed by a project group consisting of Marianne Aggestam, Petra Sundlöf and Martin Lindblom from the National Board of Health and Welfare, Elisabeth Skoog Garås from SALAR and Marlene Makenzius from the Public Health Agency of Sweden. The steering group was made up of Mona Heurgren from the National Board of Health and Welfare, Ulrika Johansson from SALAR and Saman Rashid from the Public Health Agency of Sweden. The project group has received valuable feedback from the following experts throughout the process: Per-Olof Östergren, Professor of Social Epidemiology, Lund University; Bo Burström, Professor of Social Medicine, Karolinska In- stitutet; Margareta Kristensson, Professor in Social and Preventive Medicine, Linköping University and a Scientific Advisor to the National Board of Health and Welfare; Juan Merlo, Professor of Social Epidemiology, Lund University. In addition, several specialists from each of the organisations have provided valuable input. We would specifically like to thank all the representatives from county councils and municipalities who participated in the work to produce a new regional comparison of public health for 2014. Lars-Erik Holm Håkan Sörman Johan Carlson Director General Director General Director General National Board of Swedish Association of Public Health Health and Welfare Local Authorities and Regions Agency of Sweden Contents New indicator Preface . 3 Altered indicator Summary . .9 INTRODUCTION . 11 Aim . 11 Limitations . 11 The report’s outline and appendices . 11 Regional comparisons public health . .. 12 What is an indicator? . 13. MATERIAL, METHOD AND PROCEDURE . .. 14 What do the comparisons show? . 14 Presentation of the data . 15 Confidence intervals . 15 Municipal reporting . 16 County and county council reporting . 16 PUBLIC HEALTH . 17 What determines health? . .. 17 Health equality . 18 Public health and sustainable development . .. 19 Strategic public health efforts at the regional and local level . 19 National public health policy perspective . 20 International public health policy perspective . 21 THE HEALTH OF THE POPULATION . 22 Overall health status . 22 1. Life expectancy . 22 2. Self-assessed general health . 27 3. Obesity . 30 4. Dental health . .. 34 Incidence of disease . 37 5. Myocardial infarction . 37 6. Lung cancer . 41 Mortality . .. 43 7. Policy-related avoidable mortality . 43 8. Avoidable deaths from ischaemic heart disease . 46 Mental ill-health . 48 9. Impaired mental well-being . 48 10. Regular treatment with soporifics or sedatives . 52 11. Suicide and deaths involving uncertain intent . 56 Injuries . 58 12. Injuries among children . .. 58 13. Fall-related injuries among the elderly . 60 SOCIAL CONDITIONS AND LIVING CONDITIONS . 63 The first years . 63. 14. Vaccination of children – measles-mumps-rubella (MMR) . 63 15. Children’s participation in preschool . 66 16. Teachers with formal training in preschools . 69 Education, work and self-sufficiency . 72 17. Eligibility for upper-secondary school . 72 18. Completed upper-secondary education . 76 19. Young people who neither work nor study . 79 20. Long-term unemployment . 83 21. Long-term assistance . 86 Participation in society . 89 22. Turnout at elections . 89 23. Inhabitants’ perceptions of their opportunity to influence decision-making in the municipality . 91 Recreation and transport . 93 24. Access to footpaths and cycle paths . 93 25. Access to parks, green spaces and the countryside . 96 Safety and social relationships . 98 26. Safe in school . 98 27. Unsafe environment - individuals who avoid going out alone . 100 28. Lack of trust in others . 103 29. Problems relating to isolation among the elderly . 106 Domestic violence . ..