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J Epidemiol Community Health doi:10.1136/jech-2012-201525
  • Research report

Are health inequalities really not the smallest in the Nordic welfare states? A comparison of mortality inequality in 37 countries

  1. Clare Bambra3
  1. 1MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
  2. 2School of Geography and Geosciences, University of St Andrews, St Andrews, UK
  3. 3Department of Geography, Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton on Tees, UK
  1. Correspondence to Dr Frank Popham, MRC/CSO Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow G12 8RZ, UK; f.popham{at}sphsu.mrc.ac.uk
  • Received 15 May 2012
  • Revised 21 November 2012
  • Accepted 3 December 2012
  • Published Online First 5 February 2013

Abstract

Background Research comparing mortality by socioeconomic status has found that inequalities are not the smallest in the Nordic countries. This is in contrast to expectations given these countries’ policy focus on equity. An alternative way of studying inequality has been little used to compare inequalities across welfare states and may yield a different conclusion.

Methods We used average life expectancy lost per death as a measure of total inequality in mortality derived from death rates from the Human Mortality Database for 37 countries in 2006 that we grouped by welfare state type. We constructed a theoretical ‘lowest mortality comparator country’ to study, by age, why countries were not achieving the smallest inequality and the highest life expectancy. We also studied life expectancy as there is an important correlation between it and inequality.

Results On average, Nordic countries had the highest life expectancy and smallest inequalities for men but not women. For both men and women, Nordic countries had particularly low younger age mortality contributing to smaller inequality and higher life expectancy. Although older age mortality in the Nordic countries is not the smallest. There was variation within Nordic countries with Sweden, Iceland and Norway having higher life expectancy and smaller inequalities than Denmark and Finland (for men).

Conclusions Our analysis suggests that the Nordic countries do have the smallest inequalities in mortality for men and for younger age groups. However, this is not the case for women. Reducing premature mortality among older age groups would increase life expectancy and reduce inequality further in Nordic countries.

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