Østfold pushes to reduce social inequalities in health PDF Print E-mail
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Friday, 28 October 2011 13:53
Østfold County Administration will conduct a population survey to focus efforts on dealing with social inequalities in health. An expert group has been established to contribute to policy formulation at the local and regional level to reduce social inequalities in health.
Those who already are in good health become even better, but those with health issues do not experience similar improvement. We expect equality in the Norwegian welfare state, not that social inequalities in health increase.

annett_arntzen_300x300Professor Annett Arntzen, Expert Group for HeprogressThere is reason for concern when statistics show unjust health disparities between men and women, between married and divorced, between ethnic groups and between those with higher and lower education. Those who work also differ from those without work and those on benefits. There are regional variations in health, and health differs between urban and rural communities and within neighbourhoods. This occurs despite the series of reforms, regional political efforts and the development of the welfare state.
The idea that social inequalities in health do not exist “among us” has been refuted, but the interpretation of research findings is disputed. Does the welfare state have inadequacies as a tool in terms of equalizing social and health differences? Whether it is the effect of neo-liberalism’s inherent social inequality is debatable, but that doesn’t provide an explanation.

Political efforts to equalize social inequalities in health - as Østfold County Administration is attempting through the project “Heprogress” and the establishment of the expert group - requires a conscious attitude toward explanatory models as a basis for efforts to reduce social inequalities.

Health differences can be explained as a result of differences in external circumstances. Different social groups have different material and physical environments, different cultures and different lifestyles. For example, those with high incomes can afford to choose expensive and healthier food, and are less exposed to noise and pollutants at the workplace.

There is social inequality in lifestyles and risk factors - such as smoking and dietary habits. If the risk factors are reduced, this contributes to better health. Preventive efforts must therefore be directed at the causes of unhealthy habits. We need to know why people smoke or eat unhealthy food. Health habits are not merely individual choices. Different groups have different capabilities of and different motivations for following the experts’ recommendations. Social, structural and physical factors are important preconditions for our opportunities and choices of health habits.

Our psycho-social environment also affects health. Frightening or sad experiences can trigger anxiety or depression. One can “drink to forget” or smoke a lot when worried of losing one’s job. Stress can also trigger physical illness. We have different coping and problem-solving abilities in the face of frustrating experiences and different opportunities to mobilize support through social networks (“social capital”).

People with good health have the energy to work their way up the social hierarchy, but those with health problems do not have the same opportunities for education, good jobs or promotions. Thus they move downwards, and the social differences between those with good and poor health increase. For example, poor health results in less work activity, and thus lower income.

The health services also play an important role in the social distribution of health. The ideal is that everyone has access to the same health care, regardless of where they live and their ability to pay. However, achieving greater equality in health assumes a certain unevenness in the distribution of health services. One should distinguish between supply equality (the same health problem, equal treatment no matter who and where) and result equality (everyone has virtually the same health by prioritizing those with the worst health). The equality ideology is based on a principle of fairness. This involves a means test, not in relation to ability to pay, but in terms of the health problem.

The explanations are many, but the causes of social inequalities in health remain to be identified. Østfold County Administration will focus on health disparities that arise as a result of social characteristics in work and daily life, in living habits and local communities, and social differences that arise as a result of poor health. Studying individual health is something other than studying the health of Østfold’s population. The question “Why was this person affected by disease X?” requires other answers than “Why do so many people suffer from disease X in this population?” For example, being born in Malawi or Norway is more important for health and life expectancy than any individual characteristic.

Public health policy has until recently been based on average conditions, rather than looking at the diversity of the population’s health conditions. To reach those who are not “average”, we must know what characterizes their situation and what is “their problems”. Policy must be focused on those parts of the population where both challenges and opportunities (potential for prevention) are greatest. At the same time attention must be paid to the consequences of policy in several sectors for the living conditions and opportunities for the disadvantaged. It is important to stress individual choice and actual responsibility for living habits, but social inequality in health is primarily a political and social matter. When the differences follow distinct social patterns, it is not the individual’s choice of health behaviour and lifestyle that is the cause.

This is why Østfold County Administration will conduct a population study through the “Heprogress” project to determine where public health efforts should be focused. The goal is to identify the barriers that reduce participation in society and contribute to social and gender inequalities in health. This will allow for targeted interventions where the need is greatest, and that different initiatives at all administrative levels and in many sectors can be targeted to reduce social health inequalities.

Designing policy requires not only quantifying, raising awareness and understanding of the problem, but also knowledge about the problem’s causes and willingness to act. The welfare state is about political choices. The major reforms of the last century helped to reduce social inequalities. Now developments are going in the opposite direction. The cuts in welfare benefits are systematically unfair. Unfortunately, reforms and cuts in welfare benefits are far too frequently implemented without recognition of imbalances in society.
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