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Public Health Report 2014 - Summary

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The latest Public Health Report(Folkehelserapporten) was released in 2014 in response to a white paper from the Ministry of Health and Care Services. The main report is only available in Norwegianbut here is the summary in English.

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The population of Norway at the turn of the millennium was just under 4.5 million and had surpassed 5 million inhabitants by 2012.

The population trend reflects a relatively high fertility rate, high immigration, high levels of urbanisation, many single person households and an increasing proportion of elderly people.

Immigrants and their children make up about 14 per cent of the population. The number of immigrants is expected to grow from 0.55 million in 2012 to around 1.3 million in 2050.

People over 70 years of age constitute about 10 per cent of the population and this proportion is expected to increase to around 20 per cent by 2070.

A more diverse population will provide new public health challenges in the future.

Life expectancy and burden of disease

In 2013, life expectancy in Norway was 83.6 years for women and 79.9 years for men. In the 1950s, Norway had the highest life expectancy in the world. By 2009, Norwegian women were in 12th place, 3.4 years behind Japanese women, while Norwegian men were in 9th place, 1.1 years behind Australian men.

The global burden of disease project (GBD) shows that two out of three lost years of life in Norway are due to cancer or cardiovascular disorders. Heart disease, stroke, lung cancer, colon cancer and chronic obstructive pulmonary disease (COPD) are the five main causes of lost life years. Known risk factors for these diseases include an unhealthy diet, smoking, harmful alcohol consumption and a sedentary lifestyle.

The GBD also shows that mental disorders, pain disorders and femoral (thigh bone) fractures contribute to poor health. The five leading causes of years lived with poor health in Norway are lower back pain, severe depression, anxiety disorders, neck pain and falls with subsequent fractures.

Social inequalities in health

The Norwegian population’s health is good. Yet behind the averages hide large differences in morbidity and mortality. The better the education and economy, the better the health. Those with the longest education and best financial situation have the best health.

Life expectancy has increased for all education groups since the 1960s, but the groups with higher education had the best development. For men, it appears that these differences have diminished since 2000. For women, however, the differences in life expectancy are still increasing and women with low education had the worst trends in life expectancy compared with other groups. Much of this can be attributed to increasing social differences in mortality from lung cancer and COPD.

Fewer immigrants report excellent or very good health compared to people born in Norway. The prevalence of psychological distress, mental disorders and certain chronic diseases is higher in some immigrant groups.

Non-communicable diseases

The disease picture in Norway is characterised by non-communicable diseases such as cardiovascular disease, type 2 diabetes, overweight and obesity, COPD and cancer. Approximately 225,000 people live with cancer and about 200,000 are estimated to live with diabetes. The number of people who develop cancer is expected to increase by 10-20 per cent in the years 2011-2016.

The increase in the incidence of non-communicable diseases is because we are living longer and social changes are affecting our lifestyle.

There are now signs that the rise in overweight and obesity has stopped in children and that the rise in obesity has become more moderate in adults. The level is still significantly higher than in the 1980s.

Smoking still takes many lives and many healthy years of life, and in Norway we will see a continued increase in smoking-related diseases such as lung cancer and COPD, especially in women. For men we see a flattening in the incidence rate because the decline in smoking began earlier in men than in women.

With regards to cardiovascular diseases, there has been a sharp decline in deaths over the last 40 years. We are now seeing an increase in hospital admissions for acute myocardial infarction (heart attacks) in young adults. The absolute numbers are not large, but the increase is a cause for concern and is a reminder of the need for prevention.

New knowledge about dementia disorders suggests that the subtypes of dementia are related to the state of the blood vessels in the brain. Measures to prevent cardiovascular disease may also prevent or delay some forms of dementia.
Medical advances and improved treatment of acute myocardial infarction and stroke, cancer and diabetes has led to increased life expectancy. With an increased number of elderly people in the population, the number of people with chronic diseases is increasing. An expression of this burden of disease is that 7550 patients had over 10,000 hospitalisations due to heart failure in 2012.

Many elderly people will have two or more chronic diseases simultaneously, such as COPD and heart disease, or a mental disorder and heart disease.

Hip fractures are more common in Norway than in many other countries, but it now appears that the frequency has decreased. Nevertheless, the number of hip fractures will probably increase in the coming years due to an increased number of elderly people in the population.

Nicotine addiction and nicotine in pregnancy

The proportion of the population who smoke daily or occasionally has gone down significantly but smoking is still a major health problem. About 15 per cent are daily smokers and 10 per cent smoke occasionally. Smoking during pregnancy has decreased but 5-8 per cent of pregnant women still smoke.

The use of smokeless tobacco (snus) has increased sharply. Nicotine administered this way is highly addictive. Since many young women use smokeless tobacco, this could mean that there will be more nicotine-dependent pregnant women. Nicotine from smokeless tobacco can affect foetal growth. We do not have an overview of how many pregnant women use smokeless tobacco.

Too much sugar, salt and lack of activity

The general diet in Norway is good and food is safe compared to many other countries.

Dietary patterns are constantly changing. Sugar intake is lower today than 10 years ago but the decline has stalled. On average, the annual intake was 29 kg sugar per person in 2012 but sugar intake is not evenly distributed. Children and adolescents have a high sugar intake and young people aged 16-24 drink significantly more sugary drinks than other groups.

Groups with a higher education or high income have a healthier diet than groups with lower socioeconomic status.
Salt intake in the population is also high, with three-quarters coming from processed foods.

Sedentary work, driving and less demanding chores are contributing to the decrease in physical activity. Electronic gadgets, computers, social media and the internet are taking more space in everyday life and offer new challenges for sleep and physical activity.

Only about 30 per cent of the adult population meets the recommendations for physical activity, and 30-year-olds are the least active. Adults spend an average of nine hours per day in sedentary activity.

Physical activity varies in different groups. Adults with college or university education have a higher level of activity and spend fewer sedentary hours than those with compulsory education.

The World Health Organization (WHO) has estimated that changes in diet, physical activity and smoking habits could prevent 80 per cent of heart attacks, 90 per cent of type 2 diabetes cases and over 30 per cent of cancers. Estimates from the burden of disease project suggest that diet is also an important factor for the burden of disease in Norway.

The majority of the population obtains enough vitamins and minerals but there are some vulnerable groups. Among these are some immigrant groups at risk of low vitamin D intake. If all women take preventive folate supplements before and in early pregnancy, the number of babies born with spina bifida will be reduced.

Mental health

Norway has, together with the other Nordic countries, the highest quality of life and happiness in the world. This applies to both adults and adolescents. However, coping ability varies more among nations and Norway is close to the European average.

Many people will experience poor mental health during their lifetime. About 15 per cent will have at least one episode of major depression, and about 10 per cent will have a period of harmful substance abuse or addiction during their lifetime.

In line with a growing number of older people in the community there is likely to be an increased need for health care for mental disorders, including dementia. Mental disorders in the elderly may have different characteristics than in younger people.

People with mental disorders in childhood or adolescence are at increased risk of experiencing mental problems later in life, but for many the psychological distress is temporary.

Of those with one mental disorder, half will have at least one other mental disorder. Many people who have mental disorders are not in contact with the health services.

People with mental disorders have higher rates of somatic diseases and live shorter than the general population. The use of medicines, an unhealthy lifestyle and suicide are important explanations. Every year about 500 people take their own lives.

Intoxicants and substance use

The number of people with alcohol and other drug problems is high, with between 10 and 20 per cent having problems caused by harmful alcohol or other substance use in their lifetime.

Substance use is also a major reason why young people are seriously injured in traffic and other accidents. Few drivers are intoxicated, but those that are have high levels of intoxication.

People with concurrent substance use and mental disorders are particularly vulnerable to accidents, domestic violence and premature death, and substance use is more common among people with mental disorders than in the general population.

Access to drugs is the main risk factor for substance use problems. The report shows that alcohol consumption has increased by 40 per cent over the past 20 years, mostly among women and the elderly. Alcohol consumption among adolescents has decreased. The availability of illegal drugs has increased and new synthetic drugs sometimes have unknown effects. Heart attacks have been registered in young people and deaths have been associated with the use of new synthetic drugs.

Infectious diseases

Many infectious diseases have declined globally. Higher standards of living and improved hygienic conditions are a major cause, as well as the use of vaccines. The introduction of the human papillomavirus (HPV) vaccine is likely to lead to a reduction in the number of cases of cervical cancer in the future.

Increased international travel and import of food is causing an increase in some infectious diseases in Norway. These include some foodborne infections and infections by antibiotic-resistant bacteria.

The number of new cases of sexually-transmitted infections has increased in recent years. This partly reflects the fact that too few people use condoms.

In the future, new epidemics of influenza for which we do not have the vaccine today can be expected. Other epidemics with new viruses may occur. We must also be prepared for new viruses that cause illness in humans or existing viruses that spread to Norway. Therefore, good preparedness, both nationally and internationally, is vital for infectious diseases.

The drinking water pipe network in Norway is poorly maintained. The number of cases of food and waterborne diseases may increase if maintenance is not improved.