Prevention to reduce inequality

Prevention: Multidisease will be one of the biggest challenges for the healthcare system in the coming years and is likely to further increase health inequalities. This is according to a new analysis from SDU/Danish Regions. The report also shows a link between obesity and multiple diseases. Nutrition professionals therefore have an important role to play in prevention.

Arne' is one step closer to his senior pension. Not because he has reached retirement age, but because after a long and hard working life he can no longer do his job as a brewery worker. He is worn out. And the government assures us that it will deliver on its election campaign promise to introduce a senior pension for Arne and other 'particularly worn-out' people in 2020.

So far, so good. The challenge is that Arne - according to the statistics - also has the prospect of having his retirement spiced with up to several diseases. Arne belongs to the group of people with a low level of education who, according to the statistics, have the highest frequency of illness and risk of dying earlier than others with a high level of education. The same is true for Arne's children, as there is - also statistically speaking - an increased risk of developing a number of diseases as a child of parents with a low level of education.

Inequalities in health

Arne is therefore not only a symbol of the need for early retirement, but also of the health inequalities that exist in the Danish welfare society. The least educated - i.e. those with primary school as their highest level of education - die on average ten years earlier than those with a long or medium level of higher education. They live more unhealthy lives, get sicker and even receive poorer treatment from the health service. This is according to extracts from 'The National Health Profile' from 2017 and the National Board of Health's analysis 'Inequality in health' from 2011, which also examined the causes of inequality and found that people with a low level of education are challenged in all KRAM factors: they smoke and drink more, eat less healthily and exercise less.

Health inequalities show that even within a short geographical radius, life expectancy can vary. One of the examples most often repeated in the media is from Aalborg, where there is a 13-year difference in average life expectancy between citizens living in Aalborg East and those living seven kilometers away at the other end of the city, where education levels and average income are higher.

We are living longer and getting sicker

Life expectancy is steadily increasing, and has been doing so largely since 1990, although it is still not on a par with the other Nordic countries. Increasing life expectancy is seen as positive for Danish society, but it is also a challenge as it means that more people can look forward to more years of illness. There is no evidence to suggest that we generally become healthier or suffer fewer illnesses as we age. On the contrary. If we live longer, more people can expect to develop not one, but a number of chronic diseases.

This is according to the report 'Risk of multimorbidity', carried out by the National Institute of Public Health for Danish Regions. The analysis shows that multimorbidity also has a socially unequal impact. The least educated are four times more likely to have a multimorbidity than those with a long education. The analysis also identifies obesity as the main cause of the development of all types of multimorbidity. Stronger than smoking.

Multidisease is characterized by two, three or more chronic diseases - such as osteoporosis, COPD, diabetes, heart disease, stroke, osteoarthritis and persistent mental illness - diseases that will greatly affect the quality of life and diseases that can be avoided if 'prevention is intensified and a framework is created that makes it easy to make healthy choices', writes Danish Regions in its proposal for a health reform.

Inequality is not consistent with well-being

The social inequality in health, as evidenced by the reports, is simply unacceptable in a welfare society such as Denmark's. So says Minister for Health Magnus Heunicke, and the view is echoed by Danish Regions and Local Government Denmark. Combating social inequality in health is therefore high on the agenda when the long-awaited health reform is negotiated.

How do we tackle health inequalities? How to ensure that the ever-increasing number of older people with chronic diseases receive the treatment that will give them the best possible quality of life? What structural changes will work? And how to harness the skills of nutrition professionals to prevent the development of multiple diseases in future generations?

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