Rapid review of inequalities in health andwellbeing in Norway
Michael Marmot@MichaelMarmot
http://www.instituteofhealthequity.org/about-our-work/latest-updatesfrom-the-institute/build-back-fairer

Why treat people and send them back to theconditions that made them sick?

• Norway is a country characterised bya high and increasing standard ofliving for much of the population• But with some significant andgrowing social and economic
inequalities.
• Despite a long tradition of reducing
these inequalities by introducing
welfare policies and structural
measures, inequalities in health andthe social determinants of healthpersist and are widening for somegroups3Marmot Principles
1.

Give every child the best start in life

5.

Create and develop healthy andsustainable places and communities

2.

Enable all children, young people andadults to maximise their capabilities
and have control over their lives

6.

Strengthen the role and impact of ill
health prevention

3.

Create fair employment and goodwork for all

7.

Tackle racism, discrimination and theiroutcomes4.

Ensure healthy standard of living forall

8.

Pursue environmental sustainability
and health equity together

Increases in life expectancy at birth stalling in England

Source: Office for National Statistics

Persistent inequalities in life expectancy by education– widening forwomen

NorwayJapan
Iceland
Australia
Switzerland

Countries
with thehighest life
expectancy on
the OECD
database:
males, 2020

IrelandSwedenIsraelNew Zealand
Korea
Italy
Luxembourg
Netherlands
Denmark
Spain
78

79

80

81

82

JapanKorea
FranceAustralia
Spain
Switzerland

Countries withthe highest life
expectancy on
the OECD
database:females, 2020

NorwayIsraelFinland
Iceland
Luxembourg
Italy
Irelan d
SwedenPortugal82838485868788

Persistent inequalities in life expectancy by income

Change in LE, 2019-21, US and 19 peer countries

Masters, Aron and Woolf medRxiv preprint April 29, 202211

Proportionate Universalism

Levelling–up the social gradient in healthThree challenges
Intergenerational Equity
Action on the social determinants of health
Rediscovering public purpose

14DO YOU THINK CHILDREN TODAY WILL HAVE A BETTER, WORSE OF ROUGHLYTHE SAME LIFE TO YOU?
A better life
GLOBAL AVERAGE

A worse life

44%

DK/NR

28%

NIGERIA

20%

90%

PAKISTAN

18%

43%

UNITED KINGDOM31%HUNGARY

29%

FRANCE

24%

SWEDEN

21%
14%

31%
26%

33%
53%

7%

6%

20%
28%

39%
40%

8%
6% 4%
0%

69%

UNITED STATEDSLOVENIA

Roughly the same

6%
15%

26%
23%

6%
13%

39%

7%
28%

5%

Source: Gallup

15

Social mobility: How many generations does it take to go from low income tomiddle income in different countries
Denmark

2

Finland3

Norway3

Sweden

3

OECD

4,5

United Kingdom

5

United States

5

Brazil9Source: OECD

16

Three challenges
Intergenerational Equity
Action on the social determinants of health
Rediscovering public purpose

17Marmot Principles
1.

Give every child the best start in life

5.

Create and develop healthy andsustainable places and communities

2.

Enable all children, young people andadults to maximise their capabilities
and have control over their lives

6.

Strengthen the role and impact of ill
health prevention

3.

Create fair employment and goodwork for all

7.

Tackle racism, discrimination and theiroutcomes4.

Ensure healthy standard of living forall

8.

Pursue environmental sustainability
and health equity together

A GIVE EVERY CHILD THE BEST START IN LIFE

20Child poverty (<60% median income)

UNICEF Report Card 16

Public spending early child education and care

OECD Family Database22UK Child Poverty RisingSource: Resolution FoundationA) GIVE EVERY CHILD THE BEST START IN LIFE

B. ENABLE ALL CHILDREN, YOUNG PEOPLE,AND ADULTS TO MAXIMISE THEIRCAPABILITIES AND HAVE CONTROL OVERTHEIR LIVESB) ENABLE ALL CHILDREN, YOUNG PEOPLE, AND ADULTS TO MAXIMISETHEIR CAPABILITIES AND HAVE CONTROL OVER THEIR LIVESPersistent inequalities in life expectancy by education– widening forwomenGap in life expectancy at age 30 between people withthe highest and lowest level of education, 2017 (ornearest year)Self-reported health and well being are socially gradedSelf-reported health and well being are socially gradedC. CREATE FAIR EMPLOYMENT AND GOOD WORKFOR ALL

IcelandGermany
Luxembourg
Finland

Countries
with thelowest
labourmarketinsecurity:OECD
Better Life
Index

Czech Republic
Austria
Belgium
Netherlands
IrelandJapan
NorwayKorea
FranceAustralia
United Kingdom
00,51

1,52

2,53

3,5

C CREATE FAIR EMPLOYMENT AND GOOD WORK FOR ALL

D. ENSURE A HEALTHY STANDARD OF LIVING FORALL

Impacts of the cost of living crisis• The cost of living crisis is deepening health and social andeconomic inequalities• Between January and June 2022, the financial situation of around
35% of Norwegians is reported to have worsened, with. around
25% in a vulnerable financial position in June 2022
• The most affected groups are households with younger
members, families with children and households with incomesslightly above average or lower.

D) ENSURE A HEALTHY STANDARD OF LIVING FOR ALL

Luxembourg
United StatesAustralia
United Kingdom
New ZealandCountrieswith thehighest
householdnet wealth:
OECD Better
Life Index

CanadaBelgium
IrelandSpain
Korea
Austria
Germany
FranceItaly
Japan
Norway0200 000 400 000 600 000 800 000 1 000 000

United States
Luxembourg
Switzerland

Countries
with thehighest
householdnet adjusted
disposable
income:OECD Better
Life Index

NorwayNew ZealandGermany
Australia
Austria
Netherlands
Belgium
CanadaFranceDenmark
SwedenFinland010 000 20 000 30 000 40 000 50 000 60 000

Norway
SwedenCountries
reporting theirincomedistribution to
the OECD : Gini
coefficient ofincome
inequality,
2020

Finland
CanadaNetherlands
New ZealandAustraliaLatvia
United Kingdom
United States
Costa Rica
00,10,20,30,40,50,6

41

Burn-Murdoch FT 16.09.22

Countries Disposable HH income $’000 PPP

42Finland
Iceland
Switzerland

Countrieswith thehighest life
satisfaction
score:
OECD
Better Life
Index

Netherlands
Denmark
Luxembourg
SwedenNorwayNew ZealandGermany
IsraelAustria
Australia
United States
Ireland678

E. CREATE AND DEVELOP HEALTHY ANDSUSTAINABLE PLACES AND COMMUNITIESE CREATE AND DEVELOP HEALTHY AND SUSTAINABLE PLACES ANDCOMMUNITIESNorwaySlovenia
Luxembourg
Austria

Countries withthe highest
percent ofwomen feelingsafe walking
alone at night:
OECD Better
Life Index

Switzerland
Finland
IcelandUnited Kingdom
Korea
IsraelDenmark
Spain
Portugal
Netherlands
Estonia
020406080100F. TACKLING THE SOCIAL EXCLUSION OF MINORITIES AND
OTHER LEFT BEHIND GROUPSF) TACKLING THE SOCIAL EXCLUSION OF MINORITIES AND OTHER LEFT
BEHIND GROUPSG. STRENGTHEN THE ROLE AND IMPACT OF ILLHEALTH PREVENTIONG) STRENGTHEN THE ROLE AND IMPACT OF ILL-HEALTH PREVENTIONH) PURSUE ENVIRONMENTAL SUSTAINABILITY AND HEALTH EQUITYTOGETHER
Map of planned public transport development in Norway: 2022-2033

Impacts of COVID-19• Exposed and amplified inequalities in health and socioeconomicconditions.
• Vaccination rates were lower among immigrants• Immigrants, especially African and Asian origin, and lower S-E
groups: overrepresented among those infected and seriously ill.
• Control measures had a major impact on children and youngpeople, especially those in more vulnerable situations• Unemployment increased more steeply for those with low levelsof education, young people and immigrants born outside the EU• Strict travel restrictions and closed borders affected the Sami
disproportionately

THE HEALTH EQUITY SYSTEM IN NORWAY

THE HEALTH EQUITY SYSTEM IN NORWAY

Three challenges
Intergenerational Equity
Action on the social determinants of health
Rediscovering public purpose

55

UK Spend on Consultancies annually• 1979 M. Thatcher elected£6 million• 2011 M. Thatcher ousted£246 million• 2021 Total spend by public bodies £ 2.5 billion• Billions more by business56

THE HEALTH EQUITY SYSTEM IN NORWAY
E.16 Five principles for moving anchor institution work towards equity

Whole of society action required• Action on the social determinants requires an effective health equity systemcomprising the whole of society• the voluntary sector• communities,• health care
• business and the economic sector,• public services• national and local government.

Taking practical steps

Marmot Localities• Coventry• Greater Manchester• Cheshire and Merseyside• Lancashire and Cumbria• Luton• Waltham Forest• Gwent• South west region• 2023 – tbc• Leeds• North of Tyne
• Kent/Medway

Work with different sectors• Business• Voluntary and community sector –Barnardo’s• ICS• Marmot Trusts• Local Government• Other public sector organisations

How businesses shape health: the IHE Framework

Targeted

ELFT’s Marmot Mountain: Potential actions in line with our vision

Promote access to employment &apprenticeships at ELFT for SUs
and other disadvantaged groups byaddressing potential barriers in ourrecruitment processes

Monitor and increase thenumber of SUs supported
into good employment
Improve SU satisfaction withemployment support services
provided by ELFT

UniversalProvide training/a skills academy
for local people for jobs in healthand social careEngage with young people toraise aspiration and promote
access to healthcare careers

Engage with public & private sector
employers to advocate for good quality
work, mentally healthy workplaces &equitable access to volunteering andemployment opportunities

Bring meaningful employment &apprenticeship opportunities tolocal people
ELFT as a training& employment
providerPartner with VCS
organisations to conduct
community outreach for
employment support tovulnerable groups

Our service users

The wider Luton
community

Establishing good working relationships with community partners & employers

MARMOT PRINCIPLES• Give every child the best start inlife• Create and develop healthy andsustainable places and communities• Enable all children, young
people and adults to maximise
their capabilities and havecontrol over their lives• Strengthen the role and impact of ill
health prevention• Create fair employment andgood work for all• Ensure healthy standard of living
for all• Tackle discrimination, racism andtheir outcomes• Pursue environmental sustainabilityand health equity together

66