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for those who don't fancy 200+ online pages, they tell me it's going to the prinetrs next week alex David McDaid wrote: > > > ------------------------------------------------------------------------ > *From:* Equity, Health & Human Development > [mailto:[log in to unmask]] *On Behalf Of *Ruggiero, Mrs. Ana > Lucia (WDC) > *Subject:* [EQ] The Nordic Experience: Welfare States and Public Health > > *The Nordic Experience: Welfare States and Public Health* > > */ > /**Olle Lundberg, Monica Åberg Yngwe, Maria Kölegård Stjärne, Lisa > Björk, Johan Fritzell* > > */ /* > > *Health Equity Studies No 12 - August 2008* > > *Centre for Health Equity Studies (CHESS) Stockholm > University/Karolinska Institutet * > > * * > > Available online as PDF file [229p.] at: > http://www.chess.su.se/content/1/c6/04/65/23/NEWS_Rapport_080819.pdf > > > > > > ".....Although diseases and their consequences in terms of suffering, > reduced function and premature mortality are biological events taking > place in human > > organs, their ultimate causes are often social rather than biological > in nature. > > > The social aspects of disease and mortality are particularly central > when we discuss ways to improve the health of nations and populations. > Biological disease processes are clearly important, but the > distribution of health risks, including biological ones such as > exposure to certain bacteria, is usually socially determined. > Prevention, therefore, is largely an issue of social rather than > biological change. This is also true for the treatment of disease as > long as the availability of medical care and proper medication are not > distributed on the basis of need only. > > > Hence, the /social distribution /of determinants of health is central > to the improvement of public health, both inside and between > countries. For example, the consequences of HIV for the human immune > system are certainly the result of biological processes, while the > AIDS epidemic is very much a consequence of poverty, poor education > and unequal power relations between men and women. > > > > The same could be said for TB and other contagious diseases throughout > history; improving people's social conditions through schooling, > poverty reduction and better housing, are important means for > combating disease. Needless to say, medical interventions such as > immunisation and treatment are also important, but there is a social > dimension to these services too. While the examples above refer to > infectious diseases, there is a social distribution of determinants > also for chronic diseases, and this is true for rich and poor > countries alike. > > > Over the past century, social developments have brought about massive > improvements in economic, social and political conditions for most > people in many countries. The 'state' has been transformed into the > 'welfare state', and 'citizenship' into 'social citizenship' (see > Marshall, 1950), at least in the West. However, while many countries > have become richer and implemented social and political reforms, there > are clear differences in the way they have designed their welfare > state institutions. > > > > These differences tend to be characterised according to the differing > relative importance of the market, the state and the family for the > provision of protection and services. In other words, the main > responsibility for common problems faced by most individuals in all > societies, such as care of small children and of the old, health care, > schooling, and economic security for the sick, the unemployed and the > old, can be given primarily to the individual through the market, or > to the family, or to the state. > > > > The Nordic countries are usually seen as a specific type of welfare > state in which the state has assumed a greater than usual > responsibility for social protection and care services. The Nordic > welfare states have also been regarded as consciously promoting class > and gender equality, high labour market participation, low poverty > rates and a high degree of social participation. > > > > How might the Nordic experience of social development through active > policy-making be of relevance for the WHO and its Commission on Social > Determinants of Health? There are at least two points we wish to > highlight here. *Firstly*, the growth of the welfare state in the > Nordic countries has been accompanied by considerable improvements in > public health. Several of the Nordic countries were world leaders in > life expectancy and infant mortality throughout the 20th century. > > *Secondly,* the Nordic welfare state model has had the explicit goal > of strengthening and expanding the resources available to its citizens > through welfare state institutions. Rather than being solely dependent > on the resources generated by the market or within the family, Nordic > citizens have in addition been able to draw on resources provided by > the welfare state. Thus, the economic consequences of reduced working > ability due to sickness or old age have been cushioned, the > professionalization of care for children and the old has relieved > families of care burdens, and public day-care and public schooling of > high quality for all children has evened out differences in life chances. > > > > Although many of these social policies were implemented to achieve a > better society for the majority of citizens rather than primarily to > improve public health, they seem incidentally to have targeted factors > that constitute the core social determinants of health. But while an > association between social policies and public health seems highly > plausible there is a need for more systematic evidence on the issue. > In this report we will therefore make a first attempt to provide > analyses of the extent to which the Nordic welfare state model has > actually contributed to improved public health, and we will do so on > basis of new as well as existing research from a variety of > disciplines....." > > > > *Content:* > > Foreword > > *I. INTRODUCTION* > > 1.1 Why is the Nordic Experience interesting? > > 1.2 The analytical framework > > 1.2.1 Welfare state institutions and public health outcomes -- a > general model > > 1.2.2 Comparisons across time and space -- country clusters and > institutional variability > > 1.3 The report -- what it is and what it is not > > 1.3.1 Delimitations and choices > > 1.3.2 Structure of the report > > *II. NORDIC COUNTRIES: SOCIETIES AND WELFARE * > > 2.1 The Nordic countries, past and present > > 2.2 Characteristics of the Nordic model > > 2.2.1 The Nordic model and welfare state typologies > > 2.3 Welfare regimes or institutional characteristics? > > 2.4 Education, equality and stratification > > *III. HEALTH AND HEALTH INEQUALITIES: THE NORDIC COUNTRIES IN A > COMPARATIVE PERSPECTIVE * > > 3.1 Levels and trends in life expectancy and mortality > > 3.1.1 Development of life expectancy and mortality in the Nordic > countries during the 20th century > > 3.1.2 Mortality and life expectancy: the Nordic countries compared to > other high income countries > > 3.2 The size of and trends in mortality variations across countries > > 3.2.1 Variability in the age of death -- the individual level > > 3.2.2 Social inequalities in mortality > > 3.3 Mortality in Nordic countries -- Concluding discussion > > > > *IV. GENERAL POLICY FEATURES AND PUBLIC HEALTH* > > 4.1 Poverty, income redistribution and health > > 4.1.1 Poverty risks and poverty alleviation > > 4.1.2 Income redistribution and health > > 4.1.3 Income and health -- evidence and explanations for the > individual level relationship > > 4.1.4 Income inequality and health > > 4.1.5 Poverty, income redistribution and health -- summing up the > discussion > > 4.2 Welfare state development and life expectancy > > 4.2.1 GDP and life expectancy > > 4.2.2 Age of the social insurance system and life expectancy > > 4.2.3 Social spending and life expectancy > > 4.2.4 Social rights and life expectancy > > 4.2.5 Pooled cross-sectional time-series analysis > > *V. POLICY AREAS * > > 5.1 Family and Children > > 5.1.1 From population policy to family policy institutions -- the > historical background > > 5.1.2 Stockholm at the turn of the 19th century -- a case study of > infant vulnerability in an urban context > > 5.1.3 Modern family policy in a comparative perspective > > 5.1.4 The impact of family policy institutions on infant mortality -- > comparative analyses of 18 OECD countries > > 5.1.5 Family policy institutions, labour force participation and > health among women -- cross sectional comparisons of 18 OECD countries > > 5.2 Nordic alcohol policies and the welfare state > > 5.2.1 Two centuries of waves of alcohol consumption: serious problems > and strong responses > > 5.2.2 Social class and the old Nordic alcohol control systems > > 5.2.3 Nordic alcohol controls in recent decades: The total consumption > model > > 5.2.4 Nordic alcohol policies today, in a broad perspective > > 5.3 Health care and dental care systems > > 5.3.1 The Nordic experience of dental care and dental health > > 5.4 Pension systems and health of elderly people > > 5.4.1 Pension rights and their potential importance for health > > 5.4.2 Public pensions and old-age mortality > > 5.4.3 Public pensions and ill-health among retired persons > > *VI. LESSONS LEARNED* > > 6.1. Welfare policy and health development -- summarizing findings > with the help of a conceptual framework > > 6.1.1 Social determinants and consequences of ill-health - a chronic > issue in welfare policies > > 6.1.2 Policy entry points illustrated by examples of Nordic social and > health policy. > > 6.2 Applicability > > 6.2.1 Applicability, development and type of relevance > > 6.2.2 Applicability and relevance of specific analyses and results > > 6.3 Conclusion and general observations > > 6.3.1 Policy foundations -- the importance of data and monitoring > > 6.3.2 Policy content -- important general features > > 6.3.3 Policy implementation -- how to make it happen > > 6.3.4 Policy evaluation -- what is good and what is not > > 6.3.5 General observations and final remarks > > > Appendix 1 > > Appendix 2 > > Appendix 3 > > REFERENCES > > > > *Core team of researchers at CHESS*: Professor Olle Lundberg, > Professor Johan Fritzell, PhD Monica Åberg Yngwe, PhD Maria Kölegård > Stjärne and MSc Lisa Björk. > > *A Nordic group of experts*: Professor Espen Dahl, Oslo University > College, Professor Finn Diderichsen, Social Medicine, University of > Copenhagen, Professor Jon Ivar Elstad, NOVA, Oslo, PhD Hólmfriður > Kolbrún Gunnarsdóttir, Research Center for Occupational Health & > Working Life, Reykjavik, PhD Mikko Kautto, The National Research and > Development Centre for Welfare and Health (STAKES), Helsinki/ Centre > for Pensions, Helsinki, Professor Olli Kangas, Institute for Social > Research, Copenhagen and KELA, Helsinki, Professor Eero Lahelma, Dept > of Public Health, University > > > > > > > > > > * * * * > > This message from the Pan American Health Organization, PAHO/WHO, is > part of an effort to disseminate > information Related to: Equity; Health inequality; Socioeconomic > inequality in health; Socioeconomic > health differentials; Gender; Violence; Poverty; Health Economics; > Health Legislation; Ethnicity; Ethics; > Information Technology - Virtual libraries; Research & Science issues. > [DD/ KMC Area] > > > "Materials provided in this electronic list are provided "as is". > Unless expressly stated otherwise, the findings > and interpretations included in the Materials are those of the authors > and not necessarily of The Pan American > Health Organization PAHO/WHO or its country members". > ------------------------------------------------------------------------------------ > > PAHO/WHO Website: http://www.paho.org/ > > EQUITY List - Archives - Join/remove: > http://listserv.paho.org/Archives/equidad.html > > > > > > > IMPORTANT: This transmission is for use by the intended > recipient and it may contain privileged, proprietary or > confidential information. 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Thank you. > > > > Please access the attached hyperlink for an important electronic > communications disclaimer: > http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm -- **************************************************************************** Dr Alex Scott-Samuel EQUAL (Equity in Health Research and Development Unit) Division of Public Health University of Liverpool Whelan Building Quadrangle Liverpool L69 3GB UK Tel (+44)151-794-5569 Fax (+44)151-794-5588 http://pcwww.liv.ac.uk/~alexss e-mail [log in to unmask] ****************************************************************************