Mottot för den WHO-kommission som lämnade en rapport år 2008 var att ”eliminera de sociala skillnaderna inom en generation”. Syftet med denna artikel är att diskutera ett antal dilemman inom området. De nordiska länderna präglas av väl utvecklad välfärdspolitik. Trots detta har de relativa skillnaderna i dödlighet ökat snabbare i dessa länder, jämfört med övriga Västeuropa och Sydeuropa. Det finns ingen given förklaring till denna utveckling. Utvecklingen i Storbritannien under perioden 1997–2010 är tänkvärd. Regeringen lanserade ett omfattande program som syftade till att reducera hälsoskillnader. Trots detta ökade både de relativa och absoluta hälsoskillnaderna under perioden. En förklaring kan vara att den sociala skiktningen av hälsa hänger samman med individens totala tillgång till resurser, det som ibland kallas den ”fundamentala orsaken”. Genomgången visar att kunskaperna om effektiva åtgärder ofta är ofullständiga. Detta kan dock inte utgöra hinder för politiska initiativ. Uppenbart behövs ytterligare forskning inom området.
The WHO Commission on Social Determinants of Health, published in 2008, calls for closing the social gap in health within a generation. In order to achieve this goal, a number of dilemmas have to be solved. In spite of well-developed welfare policies, the relative social differences in health during recent decades increased more in the Nordic countries compared to other parts of Western Europe and Southern Europe. There is no obvious explanation. The development in Great Britain in the period 1997-2010 is worth considering. In the beginning of the period, the government launched an extensive programme aimed at reducing social inequalities in health. Yet both relative and absolute social health inequalities increased. One explanation might be that the social stratification of health is related to the individuals’ total access to resources, often named “the fundamental cause”. The review demonstrates that knowledge of effective measures is often inadequate.
The Norwegian strategy for reducing health inequalities from 2007 has been recognised as one of the most ambitious and encompassing in Europe. By proposing action on the social determinants of health, such as income structure, employment opportunities and affordable child-care, the strategy was able to approach the entire social gradient rather than just the socially disadvantaged. In this article, we present the main features of the health equity strategy, and discuss possible obstacles to a successful implementation and a prolonged commitment to reducing health inequalities in Norway. We raise three major concerns: 1) a stubborn fundamental inequality structure, 2) a lack of focus on the gradient in the implementation of cross-sectoral reforms and 3) a possible re-orientation of policy away from redistribution and universalism.
Governmental policies during an economic recession may protect the welfare system or undermine it. In this paper we address the economic crisis in Iceland following the collapse of its three major banks in October 2008. We aim to outline governmental response to the ensuing economic recession with focus on vulnerable groups in times of austerity, in particular the unemployed and children, and use indicators on child health and well-being to gauge policy impact. For the analysis, we use published research, governmental documents, and other relevant material. The post-crisis government faced a huge budget deficit while aiming to keep the social security system in place intact. There is evidence that it was rather successful in doing so, for example through redistribution of tax revenues and labour market initiatives. Despite the crisis, there are indications that the health and well-being of children has not been negatively impacted and has even improved in some aspects, judging by commonly used child health indicators. Concerns about long-term consequences prevail.
Social investment policy has become a central response to the demographic and economic challenges facing European welfare states. This focus on investment in human capabilities and their efficient use is, however, challenged by health inequalities where education, health and employment are increasingly linked. This paper outlines the main principles of social investment policies (learning, activation and protection) and links them to a conceptual model of health inequalities and the policy entry-points tackling them by addressing the processes of social stratification, differential exposure and vulnerability as well as differential consequences of illness. It illustrates, with reference to selected empirical studies from the Nordic countries, how the balance between the elements of social investment policies might be adjusted, resources allocated differently and policies supplemented by more direct investments in health so as to enable social investments to tackle the health divide.
The health of the population in Finland improved dramatically during the 20th century, but differences between socioeconomic groups prevail and have even widened during the past decades. Reducing health inequalities has been the goal for health policy since the 1970s. One instrument for addressing the problem has been public health programmes. However, they have not proven to be very powerful in reducing inequalities. This is connected with the nature of socio-economic health differences, which are generated in a wider societal context and are linked to social and economic inequalities. By the turn of the 1990s, Finland was one of the most egalitarian countries but after the economic depression of the 1990s the basis of the welfare state was weakened. Improving the conditions and health-related habits of the more disadvantaged groups has been articulated in the programmes of the present government and a major healthcare reform is underway, but it seems that the root causes of inequalities do not receive the attention needed to reduce health inequalities.
I kölvattnet efter WHO:s Commission on Social Determinants of Health har arbetet för mer jämlik hälsa i Sverige i hög grad drivits lokalt och regionalt. Den nuvarande svenska regeringen satte dock vid sitt tillträde som mål att sluta de påverkbara hälsoklyftorna inom en generation. Som ett led i det arbetet tillsattes en kommission för jämlik hälsa med uppdrag att ge förslag på åtgärder som kan bidra till att nå detta mål. Kommissionen ska bedriva sitt arbete på ett utåtriktat och inkluderande sätt, och därmed ta tillvara de insikter och erfarenheter som redan finns. Kommissionen skall i maj 2017 lämna sitt slutbetänkande. I denna artikel beskrivs kortfattat Kommissionens arbete så långt, men även en del av den svenska kontexten med de lokala och regionala processer som initierats för att minska ojämlikhet i hälsa.
Kommissionens huvudfokus är hälsoskillnader mellan socioekonomiska grupper samt mellan män och kvinnor. Utgångspunkten är de sociala bestämningsfaktorerna för hälsa samt den svenska folkhälsopolitiken som antogs 2003. Mot bakgrund av tidigare initiativ och forskning har Kommissionen identifierat sju områden där skillnader i livsvillkor och möjligheter är avgörande för jämlik hälsa. Kommissionen har därtill identifierat ett behov av insatser för en mer strategisk styrning och uppföljning inom ramen för den svenska folkhälsopolitiken, men även mer generellt.
In the wake of the WHO Commission on Social Determinants of Health, work towards equity in health in Sweden has to a large extent been pursued locally and regionally. However, the present Swedish government has set as an objective to close the avoidable health gaps within one generation. In order to achieve this, a Commission for Equity in Health has been appointed. This Commission has been assigned the task to propose measures that can contribute to this end. The Commission will conduct its work adopting an open and inclusive process, and thereby take onboard the insights and experiences already gained in local and regional initiatives. The Commission will submit its final report in May 2017. This article briefly describes the Commission's work so far, as well as the wider policy context in Sweden with a number of local and regional processes initiated to reduce health inequalities.
The Commission's main focus is health disparities between socioeconomic groups and between men and women. The starting point is the social determinants of health and the Swedish public health policy, which was adopted in 2003. In light of the previous initiatives and research, the Commission has identified seven areas in which differences in living conditions and opportunities are vital for health equity. The Commission has also identified a need for more strategic governance and evaluation within the Swedish public health policy framework, but also governance issues more generally.