Health in Norway

The total fertility rate per women in 2018 was 1,62, while the regional average was 1,6 and global average was 2,44.[3] Prevalence of tuberculosis was 10 per 100 000 in population and the regional average was 56 while global average was 169.[4] In Norway today, there are 5371 HIV positive people, 3618 men and 1753 women. In 2008 the incidence of HIV positive people had a peak and the highest incidence of HIV positive. Since that, there have been a decrease in new cases.[5]

Norway was awarded first place according to the United Nations Human Development Index (HDI) for 2018 .[6]

A new measure of expected human capital calculated for 195 countries from 1990 to 2016 and defined for each birth cohort as the expected years lived from age 20 to 64 years and adjusted for educational attainment, learning or education quality, and functional health status was published by the Lancet in September 2018. Norway had the seventh highest level of expected human capital with 25 health, education, and learning-adjusted expected years lived between age 20 and 64 years.[7]

Demographic measures for Norway:[1][2][3][4]

Early on, there were no statistics kept for the whole country on infant mortality, but in Asker and Bærum in 1809 infant mortality was 40 percent for all live births.[10] In 1900, infant mortality was higher in Norway than in any other European country. Development of the welfare state has contributed to a great decrease in infant mortality rates. This can be attributed to better nutrition and living conditions, better education and economy, better treatment possibilities and preventive health care (especially immunization).[8] The infant mortality rate increased again between the 1970 and 1980 due to sudden infant death syndrome (SIDS). SIDS was unknown from earlier, but the increase was dramatic. The trend was reversed when Norwegian parents were encouraged to lay their children on their backs and not their stomachs when sleeping.[8]

At the beginning of the 19th century the total population was just under 1 million, however it doubled within the next hundred years even though many decided to emigrate. Industrialization resulted in many people emigrating from the countryside to the major cities for work.[8] At the beginning of the 1900s the population was 2.2 million and increased to about 4.5 million through the 1900s. 15 percent of the country's population lived in Oslo and Akershus. The proportion of people associated with agriculture, forestry and fishing declined while the percentage affiliated with industries increased.[8]

The Norwegian government recognized that the population needed to improve its health if the country was to become a nation with strong economic development.[11]

• Cholera and typhoid fever were common communicable diseases in the 1800s. Norway experienced several epidemics; cholera was the worst. The last epidemic outbreaks were around the 1840s. Even though these were not as severe as the Black Death in the 1300s, mortality rates were high.[8]
• Sexually transmitted diseases also caused widespread problems. These were, however, not defined and divided into gonorrhea and syphilis until later on.[8]
• Smallpox was the most serious disease in the years around 1800; legislation for vaccination against smallpox was introduced in 1810. At first, the law was not strictly enforced but when people were commanded to show their vaccination cards at confirmations and weddings, there was an increase in the vaccinating of children and Norway finally gained some control over this disease.[8]
• Leprosy, also known as Hansen's disease, ravaged the west coast of Norway. Patients were isolated in leprosy hospitals with room for up to 1000 patients. Gerhard Armauer Hansen (1841-1912), working in Bergen, discovered the leprosy bacillus. He revealed the association between hospitalization for infected patients and a decrease in the number of new cases.[12][13]
• Tuberculosis caused many deaths in the late 1800s while leprosy rates declined. Mortality of tuberculosis was high around 1900, but decreased steadily for the next fifty years. The greatest decrease in tuberculosis happened before vaccinations and medical treatments were available; the decrease was caused by improved living conditions, nutrition, and hygiene.[8]
• The Spanish flu of 1918 affected the country. This influenza pandemic took many lives, especially those of young people who lacked immunity to the new flu virus.[8]
• Diphtheria, a common childhood disease, raged during the early years of World War II, but with new vaccines available, the country experienced an immediate positive response.[8]
• Polio had its last major outbreak in 1951 when 2100 cases were registered.[14] In 1956 immunization of polio started.[8]

In the late 1800s microbes were discovered and prevention of diseases were now possible. Until now, spreading of infections had only been debated. With new discoveries within the field and greater understanding on how bacteria and viruses transfer and spread among humans it was possible to make significant changes in treatment and care of patients. One example was to isolate people with leprosy and tuberculosis in order to stop spreading.[15]

In the 1900s many vaccines were developed and the first antibiotic, penicillin, came about in the 1940s. These introductions were very powerful tools in preventing and treatment of childhood diseases.[8]

More vaccines became available and the child-vaccination-program was growing rapidly. Almost all feared childhood diseases were going extinct. Vaccines against measles (rubella) were introduced to the childhood immunization program in 1978. Rubella is dangerous to the fetus if the mother is affected during pregnancy. Today, all children are offered free vaccines and the offer is voluntary. The coverage for most vaccines is high.[8]

In the early 1980s AIDS came as an unknown disease. Norway was early in preventing it in high-risk groups, through information campaigns. The HIV virus was later discovered and HIV tests became available from 1985.[8]

Incidences of tuberculosis became fewer and an increase in cases and mortality of chronic diseases appeared, especially cardiovascular disease. Tobacco is one of the most important causes of cardiovascular and cancer diseases. During World War 2, the tobacco use in Norway was limited because of strict rationing. After the war, sale of tobacco bloomed and so did the implications from consuming it.[8] In the late 1900s, chronic diseases are dominating and because of increased life expectancy, people live longer with these chronic diseases. Around millennium new treatment and prevention for cardiovascular diseases ensured a decrease in mortality, however, these diseases are still one of the greatest public challenges in the country.[8] The incidence of coronary heart disease in Norway reduced significantly between 1995 and 2010 about 66% of the reduction due to changes in modifiable risk factors like activity levels, blood pressure, and cholesterol. Mortality reduced from 137 per 100,000 Person-years to 65.[16]

Lifestyle diseases are a new concept from the second half of the 1900s. Tobacco use and increases in cholesterol levels show a strong correlation to higher risk of cardiovascular disease.[8]

Mental health services are part of the Norwegian special health care services. In some cases this includes involuntary mental health treatment.[17] The four regional health service institutions, owned by the state, receive fixed economic support from the state budget. They are responsible for special health services including mental health care in hospitals, institutions, district mental health centers, child and adolescent mental health services and nursing homes.[18]

In addition to providing treatment, the mental health care services provide research, education for health personnel, and follow-up of patients and their relatives.[18]

There are different sectors within the mental health services. District mental health centers are responsible for general mental health service. They have outpatient facilities, inpatient facilities and emergency teams. Patients can be referred to the district mental health center by a general practitioner for diagnosing, treatment or admission.[19]

There are specialized centers, ideally at central hospitals, for children and adolescents, the elderly, and severe cases such as drug addiction, personality disorders, obsessive compulsive disorders etc.[19] Normally people who are discharged from treatment at central hospitals are referred to the district mental health centers for follow-up and treatment. Treatment can consist of psychotherapy with or without medications. Physical treatments, such as electroconvulsive therapy, are used for specific disorders. Treatment usually starts at the hospital, with the aim of continuing treatment at home or at the district mental health center.[19]

Child and adolescent mental health outpatient facilities offer mental health care for children and adolescents between 0–17 years of age. Central child and adolescent mental health service is aimed at challenges which cannot be handled in the regional state facilities, such as the general practitioner, school nurse, school, outreach services for youth and child services. The child and adolescent mental health services work closely with psychologists, child psychiatrists, family therapists, neurologists, social workers etc. Their aim is to diagnose and treat psychiatric disorders, behavioral disorders and learning disorders in close collaboration with care givers.[20] For patients below the age of 16, parents must consent to admission.[20][21]

Involuntary mental health care in Norway is divided into inpatient and outpatient facilities and observation.[21] In involuntary inpatient facilities patients can be held against their will, and can be picked up by the police if needed.[21] In involuntary outpatient services the patient lives at home or is voluntarily in an institution, but regularly has to report to the district mental health center. These patients cannot be held against their will, but can be picked up by the police in the case of missed appointments.[21] For involuntary observation in hospital a person can be held for up to ten days, or in some cases for twenty days, in order for the hospital to decide whether the criteria for involuntary mental health care are met.[21] The control committee has as their main task to ensure that every patient's rights are secured and protected in a meeting with involuntary care.[22]

Mental health services are financed through needs-based basic funding to the regional health services, outpatient clinic refunding, deductibles and ear-marked grants from the state budget. Rates for outpatient work are partly based on hours worked and partly based on procedures; there are rates for diagnosing, treatment and follow-up per telephone or in collaborative meetings. In addition patients pay a deductible for outpatient consultations.[18]

A survey done in 2011 showed that 10.2% of the population of Norway reported to have experienced symptoms of anxiety and depression within the last two weeks.[23] The lifetime prevalence of severe depression is estimated to be 15.6%. Treatment and social services for the mentally ill cost society about 70 million Norwegian kroner (more than 10 million US dollars) yearly.[24]

One of the major findings from the report (2016), is that an unhealthy diet is the most important risk factor for premature deaths in Norway.

“46 per cent of all deaths before the age of 70 in Norway can be explained by behavioural factors such as unhealthy diet, obesity, low physical activity and the use of alcohol, tobacco and drugs” says Professor Stein Emil Vollset, Director of the newly established Centre for Burden of Disease at the Norwegian Institute of Public Health.

“If we consider the population as a whole, it appears that an unhealthy diet represents a greater risk to public health than smoking. This is not because an unhealthy diet is more dangerous than smoking but because fewer Norwegians now smoke. Since 1990, the percentage of smokers in Norway has decreased from 35 per cent to 13 per cent”, explains Vollset.

By addressing these risk factors, much of Norway’s disease burden could be reduced. Up to 100,000 years of life could be saved if Norwegians ate healthier diets.

Approximately 1 in 4 middle-aged men and 1 in 5 women have obesity with a body mass index of 30 kg/m² or higher in Norway. Among children, the proportion with overweight and obesity appears to have stabilised.[28]

Drug overdose and suicide rates are high. Among the under-49 age group, suicide and drug overdoses are the main causes of death in Norway, with the highest rates among the Nordic countries (Denmark, Iceland, Norway, Finland and Sweden).

The report shows that lower back pain, neck pain, anxiety and depression are among the main causes of poor health among the Norwegian population as a whole, while heart disease and cancer claim most lives.

[29]

A wealthy economy makes it possible to buy tobacco, fast food, sweets and sugary drinks that few people had access to or could afford until after 1950. These days many people have desk jobs, cars, and less demanding housework. In large, physical activity is decreasing, electronics, computers, social media, and the internet demands more of daily life. Drugs have also become more available in society. ‘New living conditions’ such as these give rise to new challenges for public health.[30] Only 30 percent of adults in Norway are fulfilling the advice to stay physically active for 150 minutes per week.[31]

The number of people smoking in Norway has fallen equally for both men and women since 2000. 11% of the adult population in Norway smoke on a daily basis while 8% are occasional smokers. Daily smoking is most common for the population with low educational attainment. Over the last two decades, efforts to reduce the population’s exposure to tobacco smoke combined with increased awareness of the health risks of smoking appear to be having an impact. For example, early death from tobacco smoke fell 28% between 1990 and 2013.[32]

In Norway 2017, 11 per cent was daily smokers, in 2007, it was 22 per cent daily smokers.[33]

The use of snus has during the same period become more common among the population. 12% of the population daily use snus and 4% are occasional snus users.[34]

The main causes of reduced health and disability in Norway are cardiovascular diseases, cancer, mental health and, and musculoskeletal disorders.[34]

Annually, 70,000 people are treated for cardiovascular diseases. Technological progress and development within medical treatment have since the 1970s had huge impact on survival of diseases, especially cardiovascular disease.[34]

Anxiety and depression are the most prevalent of mental disease. 6% of the population under 75 years takes antidepressants.[34]

Other communicable diseases such as COPD, diabetes and dementia also weights heavily on the burden of disease. As the life expectancy is increasing, more people are living longer with chronic diseases. As of that the prescription of drug consumption is high.[34]

The living standard of the Norwegian population has increased, though there are still differences between educational groups. Those with higher education and economy have generally the best health status and live 5–6 years longer than those with lower educational attainment.[34] New public health legislation (Folkehelseloven) came into play in 2012, and the purpose of this act is to contribute to a society that promotes public health and evens out social inequalities in health.[30]