3 Health challenges in the 21st century

3.1 State of health

In the 1950s, Norway had the highest life expectancy in the world, while today there are several other countries with better life expectancies. Japan, Australia, Switzerland, Italy, Iceland, Sweden, Singapore and Israel all have higher life expectancies than Norway for both men and women. In addition, French and Spanish women live longer than Norwegian women.

A key feature of this global development is decreased mortality among young people, increased mortality in older age groups, fewer deaths due to infectious diseases and more deaths due to cardiovascular diseases, cancers and other diseases that are not caused by infection. In 1990, infectious diseases caused over half of all deaths. Twenty years later, two in three people died of illnesses other than infectious diseases. In 2010, the five main causes of death worldwide were coronary heart disease, stroke, COPD, lower respiratory tract infections and lung cancer. These diseases are also among the six most important causes of mortality in Western Europe.

The situation in Norway is in line with global trends. A distinctive feature is reduced mortality among the young and increased mortality in older age groups. Another distinctive feature is fewer deaths due to infectious diseases and more deaths due to cardiovascular diseases, cancers and other diseases that are not caused by infection. A third distinctive feature is that the risk factors are the same for most countries. These include smoking, high levels of alcohol consumption, an unfavourable diet and physical inactivity. Even though the new global trends have not reversed the favourable development of increased life expectancy in recent decades, there is much evidence to suggest that trends in unhealthy diets, a lack of physical activity and increasing obesity will slow progress. Increasing life expectancies and ageing populations have resulted in more people living with chronic illnesses. Despite an increase in the incidence of disease, the proportion of elderly people with a need for medical and other assistance has declined over the last 20 to 30 years.

Even though the health of all groups within the population has improved, social inequalities in health remain a challenge. Groups with higher education and high incomes have experienced the greatest increase in life expectancy. Cardiovascular diseases create the greatest social inequalities in terms of premature mortality.

Source Steingrímsdóttir and colleagues (Eur J Epidemiol 2012; 27: 63 – 71). Published with the permission of Springer Science & Business Media B.

Almost a quarter of the adult Norwegian population suffer from a mental disorder, and between a third and a half of the population will be affected once or more in their lifetime. Around 10 per cent of the adult population report having sought treatment for mental health problems at some point during their lifetime. However, the actual need is probably somewhat higher. The most common conditions include anxiety, depression, and alcohol and drug-related disorders.

3.2 Conditions that affect health and life expectancy

Physical and mental health is the result of an interaction between individual characteristics and factors that may be protective or involve risk. Examples of protective factors include social support, positive life events and physical activity, while unemployment, drug abuse, insufficient social support, an unhealthy diet and obesity are examples of risk factors. These factors are interrelated and form part of a much larger overall picture. For example, changes in diet and physical activity do not usually occur in isolation but as a part of changes in families, working environments, local communities, or society in general.

Conditions within wider society, the local community, and the individual’s social network may have an impact on health. A society characterised by mutual trust, social support and solidarity promotes health, while a local society with little sense of community and little social interaction provides an increased risk of health problems. A declining industrial base, extensive inward and outward migration and/or rapid social change can all have an adverse effect on health. Social support in the form of empathy, emotional support, practical assistance and social control has a direct positive effect on health, and can act as a buffer when the individual is exposed to stress or negative life events.

Health and illness are influenced by both present factors and factors dating almost all the way back to when the individual was conceived. A number of vulnerable periods exist throughout an individual’s lifetime. Many chronic illnesses are influenced by biological, psychological and social factors that culminate in and contribute to increased risk throughout an individual’s life. In many cases, it takes several years before a determinant results in illness. An example of this is smoking as a cause of lung cancer and COPD, in which the illness and symptoms first become apparent after 20 to 50 years of smoking. In the case of acute coronary thrombosis, however, the risk is already significantly reduced in the first year after quitting.