Health care at a glance: Norwegians are living longer but not necessarily healthier lives
Inspired by the National Health Service in the UK, the government of Norway after the second world decided to include national health care as one of their main focuses in the development of the welfare state. This meant that the state is responsible to provide good and necessary health services for everyone (universal access). In present Norwegian health care, responsibility is divided between three levels of governmental responsibility. First the state government, second the county and lastly the local council.
In 2001, an arraignment was developed that gave each citizen the right to have a permanent doctor in the area they lived in. The city council in every county is responsible for this right, and they also initiate agreements and cooperation with the doctors. This improvement is one of several in the healthcare that Norway have to offer. The different reforms has in common that they all came as a reaction to an inefficient system that did not take full advantage of all available resources.
Public expenditure on health
According to Norwegian national health accounts, the annual per capita spending of health is 67770 NOK in 2019. The share of health expenditure financed by public sources was 85%, and the health expenditure, as part of GDP was 8.9%.
Health problems in Norway
The Global Burden of Disease (GBD) study is a powerful platform for understanding the main drivers of poor health at international, national, and local levels (Institute for Health Metrics and Evaluation (IHME), 2016; Vos et al., 2012). Coordinated by the Institute for Health Metrics and Evaluation (IHME), GBD measures all of the years lost when people die prematurely or suffer from disability. It estimates healthy years lost from over 300 diseases, injuries, and risk factors from 1990 to 2013. The GBD findings are available for 188 countries.
Between 1990 and 2013, Norway’s life expectancy increased by five years for males and by four years for females. The main reason for this is that fewer people die from causes such as cardiovascular diseases, suicide, road injuries, and lower respiratory infections. In contrast to other disease trends in Norway, early death from lung cancer, Alzheimer’s disease, colorectal cancer, chronic obstructive pulmonary disease (COPD), and drug use disorders rose between 1990 and 2013.
Compared to other countries, Norway had the 15th-highest life expectancy in the world. Norway’s life expectancy was higher than that of countries such as the United Kingdom, Germany, and Denmark, but lower than in countries such as Andorra, Japan, Iceland, and Sweden. Comparing rates of early death across 21 of Norway’s peer countries reveals that it performed significantly better than average for ischemic heart disease, lung cancer, stroke, road injuries, congenital anomalies, and breast cancer, but significantly worse for colorectal cancer, drug use disorders, prostate cancer, and falls. For some diseases and injuries, countries such as Switzerland, Japan, Italy, and the United States performed better than Norway.
However, not all of these additional years of life are spent living in good health. To gain a clearer picture Norway’s most important health problems, it is essential to compare the impact of different diseases and injuries by taking into account not just early death, but also disability (Institute for Health Metrics and Evaluation (IHME), 2016). The metric that allows us to compare years lost from early death and disability is known as “disease burden,” or disability-adjusted life years (DALYs).
Low back and neck pain was the single most important health problem in the country in 2013, surpassing ischemic heart disease, Alzheimer’s, stroke, and lung cancer.
An analysis of nationally representative survey data found that 18% of men and 27% of women in Norway reported suffering from musculoskeletal disorders that lasted more than six months in 2012 (Kinge, Knudsen, Skirbekk, & Vollset, 2015). Chronic musculoskeletal disorders were common in the general population, with higher prevalence among women compared to men, and increasing prevalence with age. Musculoskeletal disorders had considerable impact on the use of primary and specialist health services in Norway. Low back and neck pain were the most common diagnoses among patients and the top reason for seeking health care. Even though Norwegians frequently seek care for musculoskeletal disorders, the effectiveness of existing treatments is limited. More research and development is needed to find more useful therapies to reduce pain and suffering from this condition.(Kinge et al., 2015).
In the after-war period, drug-related problems did not exist in the public debate. Due to the growth of more liberal norms in society, and influencies by media (TV) from the naboring country of Sweden, a debate about the problems slowly emerged im the sixties. From the beginning the drug-related problems were associated with adolecent and the youth culture. In 1966, the Norwegian Director of Health Karl Evang claimed that the youth of today has major existential problems, they suffer from lonelyness, lack of ideologies, thus they are easily tempted by drugs. At this time Norway had less problems with drug abuse than Sweden, and the debate on drug abuse was in its early phase. Watch the interview (in Norwegian language) with Evang on the Norwegian National Broadcast (NRK). Notice the normative way he speaks about the challenges, compared to present debates in media:
Later this year, the drug problems in the Norwegian society was debated in the NRK, in terms of whether the “new” problems should be publically debated, or rather be kept in the shadows. When you watch this clip, notice the lack women. Gender-equality was in its early phase in the sixties, thus women were little visible as experts in the media:
Too many drug users die from opioid overdoses in Norway. One reason for this is that opioid maintenance treatment programs were implemented relatively late in Norway (Waal & Gossop, 2014). However, several other reasons could also help explain the high overdose death rates Norway compared to other European countries. First, Norwegian drug users are at a higher risk of death than users in other countries in Europe since they tend to use deadlier drugs, such as heroin and other opiates. Also, drugs like heroin are usually injected instead of being inhaled or smoked, which further increases the risk of overdose and death (Waal & Gossop, 2014). Second, the prevalence of diseases that increase the risk of death among illicit drug users, such as HIV/AIDS or viral hepatitis, is lower in Norway than in southern or
eastern European countries. Thus drug overdose may be selected as cause of death because there are fewer causes of death to consider when the death certificate is issued. Third, it is possible that Norway does a better job of recording deaths caused by illicit drug use than other European countries due to more frequent use of autopsies and careful assessment of drug levels in the blood.(Waal & Gossop, 2014).
Historically, Norway like many other countries has had a history of alcohol abuse, particularly among the poor. The abuse frequently led to economic ruin and disaster for the whole family. Due to this legacy, alcohol for decades has been restricted and put high taxes on, in Norwegian society. The previous and also present lack of a nuanced debate about drug-related problems in Norway are striking, considering the history of alcohol. Still today, meanings about drugs and how those with abuse-disorders should be treated, are often polarized.
References
Institute for Health Metrics and Evaluation (IHME). (2016). Norway: State of the Nation’s Health. Findings from the Global Burden of Disease. Retrieved from Seattle, WA:
Kinge, J. M., Knudsen, A. K., Skirbekk, V., & Vollset, S. E. (2015). Musculoskeletal disorders in Norway: prevalence of chronicity and use of primary and specialist health care services. BMC Musculoskelet Disord, 16, 75. doi:10.1186/s12891-015-0536-z
Vos, T., Flaxman, A. D., Naghavi, M., Lozano, R., Michaud, C., Ezzati, M., . . . Memish, Z. A. (2012). Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380(9859), 2163-2196. doi:10.1016/S0140-6736(12)61729-2
Waal, H., & Gossop, M. (2014). Making sense of differing overdose mortality: contributions to improved understanding of European patterns. Eur Addict Res, 20(1), 8-15. doi:10.1159/000346781
