Healthier and stronger

Fewer and fewer infants and toddlers are dying in Norway, we are much taller, when we are sick we can be treated with medicines, we are spending shorter periods in hospital, we have access to more qualified and more specialised health personnel, and most importantly we are living much longer than before. A publication on health statistics shows that public health has improved dramatically in the past 150 years.

The fight against infectious diseases

A key reason for the mortality rate being lower today is that fewer of us die from tuberculosis and infectious diseases at a relatively young age. Poor living conditions, polluted water sources, a lack of hygiene, malnutrition, inadequate nutrition, a lack of knowledge on how diseases are caught, a lack of treatment options - all led to large numbers becoming sick and dying of infectious diseases in the second half of the 1800s.

Figure 1. Deaths by tuberculosis per 10 000 inhabitants, five-year averages. 1871/1875-2001/2004 (adjusted for age and sex by European standard) 

A number of scientific breakthroughs were made in this period, and we gradually learned how the diseases occurred and spread. The authorities took more responsibility for the health of the nation, and information campaigns, isolating the sick, and gradual access to vaccines and serum treatments led to a fall in the number becoming sick. Additionally, those who fell ill were less likely to die. Economic growth led to better living conditions and higher public sector budgets. From 1910 to 1940, medical personnel became more focused on the correlation between health and the environment, and a great deal of resources were used on providing information on the need for healthy living conditions, proper nutrition, physical education, personal hygiene, the working environment etc. A dramatic fall in the incidence of tuberculosis, among other things, occurred between 1900 and 1950 (see figure 1). After World War II, antibiotics and x-ray screenings were used in the fight against tuberculosis and other infectious diseases.

Norwegian recruits have shot up

Increased longevity and the falling mortality rate were linked to economic growth. The gross national product per capita doubled twice between 1900 and 1960 (measured in fixed 2000 prices), which naturally helped give people access to better housing and better nutrition. The improvement in the economy was literally visible on the body. From 1927 to 1977, the average height of Norwegian recruits increased by 1.5 cm each decade - from 171.7 cm to 179.4 cm.

Height is a type of collective code for all the aspects that are factored into a society's "well-being". Our height provides us with information on our birth and childhood, our class, our daily diet and our access to health services. The United Nations (UN) nowadays uses height data to monitor the nutrition of children in developing countries. When the body receives sufficient and proper nutrition and does not need to use much energy on fighting infections and diseases, more of the surplus can be used to grow. In relation to Norway, the question of course is why do we still have height differences between the inhabitants of various counties and provinces?

Dramatic development of the public health offer

The scientific breakthroughs in the field of medicine in the 1800s and 1900s meant that more people could be treated when they fell ill. There was also the expectation that the state should take greater responsibility for the health of the nation. A dramatic development took place in the public health offer at the end of the 1800s and in the 1900s. Among other things, the number of general hospitals tripled from 1853 to 1900. A number of tuberculosis sanatoriums were built towards the end of the 1800s, and from 1900 to 1920 a number of new asylums were built for the treatment of the mentally ill. The first public dental practice was established in 1910.

The number of hospital beds increased sharply from 1930 up to the mid 1970s. People also had more opportunities to receive services and care from qualified doctors, dentists and nurses, and the number of specialist medical personnel also increased. The length of hospital stays was reduced and the number of man-years per patient admitted increased steadily in the latter decades.

Figure 2. Public health spending, in per cent of GDP and of total public expenditure. 1884-2004 (1)

Access to health services was an important part of the development of the Norwegian welfare state in the 20 ^{t h} century. The share of total public expenditure that goes towards health has increased from between 6 and 7 per cent in 1970, to around 18 per cent today. During the same period, the share of the GNP that goes towards health increased from around 2 per cent to almost 8 per cent today.

Social inequalities remain in health

Although more and more public resources are being ploughed into the health sector, many studies indicate that major social inequalities still remain within health. People with a low level of education are more often affected, for instance, by heart diseases and vascular disorders than the highly educated. Priests live ten years longer than unskilled labourers. Better living conditions meant fewer people contracted infectious diseases after World War II, but improved well-being and a higher standard of living also entail a number of risk factors for health - smoking, unhealthy diets, a more sedentary lifestyle and more stress at work. The number of females meeting a violent death increased after World War II partly due to the increase in car use. In recent decades, when the health budgets have increased the most and people have earned more, heights have stagnated, even although 180 cm for men cannot be regarded as a physiological ceiling for a population. The health budgets are steadily increasing but figures indicate that it is more difficult to attain just as good health from each NOK now than it was a hundred years ago.

The publication På liv og død - Helsestatistikk i 150 år (Life and death - Health statistics for 150 years) contains 16 different articles linked to the health statistics and the health development since the 1850s.

Bibliography:

Larsen, Ø et al (1986): Legene og samfunnet, University of Oslo and The Norwegian Medical Association