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National strategy to reduce social inequalities in health

Report No. 20 (2006–2007) to the Storting

Norwegian Ministry of Health and Care Services - May 2007

Available online as PDF file [100p.] at: http://ec.europa.eu/health/ph_determinants/socio_economics/documents/norway_rd01_en.pdf

“…….The Norwegian population enjoys good health. However, averages conceal major, systematic inequalities. Health is unevenly distributed among social groups in the population. We have to acknowledge that we live in a stratified society, where the most privileged people, in economic terms, have the best health. These inequalities in health are socially determined, unfair and modifiable.

The government has therefore decided to initiate a broad, long-term strategy to reduce social inequalities in health. Many factors play a part in creating and perpetuating social inequalities in health. The situation is complex, but we can nevertheless state that it is generally social circumstances that affect health and not the other way round. Although in many cases serious health problems lead to loss of income and work and difficulties completing education, social status still has a bigger impact on health than health does on social status. An overview of current knowledge compiled under commission from the EU concludes that social inequalities in health in all countries in Europe, including Norway, are primarily due to inequalities in material, psychosocial and behaviour-related risk factors.

Social inequalities in health are an expression of systematic injustices, and this is happening in a society that upholds the principle that everyone should have equal opportunity to achieve good health.

The Government believes that public health work needs to be based on society assuming greater responsibility for the population’s health. Each individual is responsible for their own health, and it is important to respect the right of the individual to have authority and influence over their own life. However, the individual’s sphere of action is limited by factors outside the individual’s control.

Even lifestyle choices such as smoking, physical activity and diet are greatly influenced by socioeconomic background factors not chosen by the individual.

As long as systematic inequalities in health are due to inequalities in the way society distributes resources, then it is the community’s responsibility to take steps to make the distribution fairer.

A fair distribution of resources is good public health policy. The primary goal of future public health work is not to further improve the health of the people that already enjoy good health. The challenge now is to bring the rest of the population up to the same level as the people who have the best health – levelling up….”

Content:

1 Introduction

1.1 A fair distribution is good public health policy

1.2 Comprehensive policy to reduce social inequalities

1.3 Objective: To reduce social inequalities in Health

1.4 Four priority areas for reducing social inequalities in health

1.4.1 Reduce social inequalities that contribute to inequalities in health

1.4.2 Reduce social inequalities in health behaviour and use of the health services

1.4.3 Targeted initiatives to promote social inclusion

1.4.4 Develop knowledge and cross-sectoral tools

2 Facts about social inequalities in health in Norway

2.1 Systematic inequalities in health

2.1.1 Substantial and growing social differences in mortality among adults

2.1.2 Most of the main causes of death are unevenly distributed in society

2.1.3 Significant social inequalities in mental health

2.1.4 Inequalities in health through the life course

2.2 Social structures affect health

2.2.1 Income

2.2.2 Childhood conditions

2.2.3 Work and working environment

2.3 Systematic inequalities in health behaviour and access to healthservices

2.3.1 Health behaviour

2.3.2 Health services

2.4 Groups with special health challenges

2.4.1 Groups with long-term social problems

2.4.2 Children and young people at risk

2.4.3 Immigrants

2.4.4 Areas with Sami and Norwegian settlements

2.4.5 People living alone

3. Reduce social inequalities that contribute to inequalities in health

Income Objective: Reduce economic inequalities

Policy instruments

Taxation system.

Monitor developments in income inequalities

Childhood conditions Objective: Safe childhood conditions and equal development opportunities

Policy instruments

Kindergarten and school.

Maternal and child health centres and the school health service

Mental health services for children and young people

Child welfare service

Participation in organisations and cultural activities

Work and working environment Objective: Inclusive working life and healthy working environments

Policy instruments

Working environment legislation

The Norwegian Labour Inspection Authority

Company health services

Higher employment among immigrants

Action Plan against Social Dumping

National system for monitoring work and health

Increase research on sickness absence and exclusion from working life

Sickness absence and exclusion in high-risk industries ( continue…)

* * * *

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