Health and Inequality in Health in the Nordic Countries

Abstract

All five Nordic countries emphasise equal and easy access to healthcare. It is the purpose to explore to which extent the populations of these countries have reached good health and high degree of socio-economic equality of health. Each of the five countries has established extensive public health programmes, although with somewhat different emphasis on the causes of ill-health, such as individual behaviour or social circumstances. Attitudes have changed over time, though. We compare these countries to the UK and Germany by using data from the European Social Survey 2002 and 2012 in addition to OECD Statistics from the same years. Health is measured by self-assessed health in five categories, transformed to a cardinal scale using Swedish time trade-off weights. As socio-economic variable we use household income or length of education. Mean health, based on Swedish TTO weights applied to all countries, is above 0.93 in all the Nordic countries and the UK in 2012, while lower in Germany. Rates in good or very good health in the lower income half of the samples are above 0.6 in most countries and even higher in Iceland and Sweden, but below 0.5 in Germany. However, when displayed in a graph the concentration curves nearly follow the diagonal implying almost no income - or education related inequality in self-assessed health weighted by TTO based preferences. The difference is a natural consequence of using different methods. We compared four key life-style related determinants of ill health and found that while there were differences in relative levels between the countries, Germany had a relatively high level of three of these, followed by the UK. We found no association between level of resources used and health status. In general, the Nordic countries have accomplished good health for their populations and high degree of socioeconomic equality in health. Improvements in life-style related determinants of health would be possible, though.