Interview with Per-Olof Östergren, Professor from Lund University Print
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Monday, 31 October 2011 07:35
Per-Olof Östergren, Professor from Lund University, HEPRO expert on local health profiles talks to HEPROGRESS on his latest analyses on alcohol consumption and usefulness of health profiles for policy planning in municipalities.
HEPRO activities have been continued in the HEPROGRESS project that focuses on how local communities and services can prevent or reduce the marginalization effects of poor health in relation to school drop-outs, healthy ageing and marginalisation in work life. HEPRO data, collected in 2006 from six countries in Baltic Sea Region, are used to support the HEPROGRESS activities. Per-Olof Östergren, who did the HEPRO analysis on alcohol consumption, shares his findings and conclusions on health equity. 

– There is no doubt that alcohol and other lifestyle choices contribute to social differences. We know, and it’s proved by statistics, that people from different social groups drink differently and that the impact of their health is different regarding what social class they belong too. Alcohol is considered as one of the determinants of health.

As an example Östergren recalls the facts from Nordic countries:
–  Level of alcohol consumption in Finland is high and the tendency is growing. It has bad impact on the population’s health. Surprisingly, observed raising consumption of alcohol in Sweden doesn’t bring negative impact on health.

Östergren agrees that more targeted analysis is needed but one explanation can be that the growing group of alcohol consumers in Sweden is among the middle class – they drink more, but they are not heavy drinkers. Therefore the effect on health is smaller.

– Dynamics is different here, concludes the professor.

The surveys provide us not only with the data, but also help us to target the interventions.
– With the proper interpretation of the survey’s results we can learn where the prevention activities are needed. In the case of alcohol consumption we know that the action should be addressed to people with lower social status. Health literacy is a key here - adds Östergren – If you know where the limit of ‘’safe’’ drinking is, you don’t need anybody to tell you when to stop. But unfortunately, those which are unemployed drink more and more often require medical help. That obviously excludes them from the labour market.

This is a circle that needs to broken somewhere by the proper interventions of municipalities.

But what about women and their drinking habits?
– We see that gender roles and perception of drinking alcohol have been changing. Drinking alcohol has become more common among women, and therefore the risk of getting alcohol problems has increased, regardless of age. Moreover, drinking patterns of women resemble nowadays those of men. For example, sadly, well educated women in Baltic Countries are picking up more male habits when it comes to alcohol consumption.

HEPRO data also show that the level of women participation in a labour market is lower that men’s but Per-Olof Östergren says it is difficult to consider it as an effect of marginalization because of gender, education or health status. Many factors interplay in producing marginalisation from the labour market, and that poor health is only one among several factors which plays a role. The purpose of HEPROGRESS is to focus the role of poor health in marginalisation.

Östergren sees the great usefulness of the public health surveys for municipalities. Certainly the data from cities and communities help a lot to design a proper intervention policy. National analysis might be too general and do not bring as strong psychological effect as the municipality’s own data provide.

– The research made among people is much more valuable for politicians and policy makers and – if correctly interpreted and utilized – allows to create good interventions for sustainable health, concludes Östergren.

Per-Olof Östergren, Professor from Lund University, HEPRO expert on local health profiles talks to HEPROGRESS on his latest analyses on alcohol consumption and usefulness of health profiles for policy planning in municipalities

HEPRO activities have been continued in the HEPROGRESS project that focuses on how local communities and services can prevent or reduce the marginalization effects of poor health in relation to school drop-outs, healthy ageing and marginalisation in work life. HEPRO data, collected in 2006 from six countries in Baltic Sea Region, are used to support the HEPROGRESS activities. Per-Olof Östergren, who did the HEPRO analysis on alcohol consumption, shares his findings and conclusions on health equity.
htening 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.