1. Health in an egalitarian society Espen Dahl Professor Oslo and Akershus University College Harvard Club of New York, April 22th 2015

2. Mandate - to analyze social inequalities in health and in the consequences of ill-health; and examine trends and comparisons with other countries

3. Social inequalities in health exist…. …and form a gradient ….appear in all phases of life … for men and women ….for most socioeconomic indicators ….for most, but not all indicators of health ….and persist over time; increase for some health outcomes and decline for others ….and are not necessarily smaller in Norway and in Nordic countries than in other countries in Western-Europe

8. The social determinants of health “Health inequities arise from the societal conditions in which people are born, grow, live, work and age, referred to as social determinants of health. These include early years' experiences, education, economic status, employment and decent work, housing and environment, and effective systems of preventing and treating ill health.” Source: The Rio Declaration on Social determinants of health

9. Three challenges to existing knowledge Challenge 1: Persistent social inequalities in health in Norway Challenge 2: Increasing educational inequalities in mortality and longevity - in all Nordic countries Challenge 3: Not smaller social inequalities in health in Norway and the other Nordic countries than in other Western European nations and populations

10. Persisting social inequalities in Norway 1.Early year’s experience and learning conditions 2.Distribution of economic resources 3.Work environment 4.Health-related behaviour

11. Child poverty has increased Percentages of poor children

14. Wealth, income and earnings Wealth Norway: Rich: 472,8. Super-rich 63,6 persons per million inhabitants. USA : Rich 124,6. Super-rich 36,5 persons per million inhabitants. Income Income poverty: Stable around 8 per cent Household disposable income: Gini 1986 = 0.21, 2011 = 0.24 Market incomes: Gini: Norway =0.38. OECD average = 0,41 Earnings Since late 1990s have montly wages among lower educated groups been lagging behind the higher educated (from 90 Per cent to 80 per cent of the average of all groups). The same development is seen among different occupational groups: low status occupations are lagging behind Sources: Dahl et al 2014, Moene 2014, Pedersen 2013 Rich > 30 million dollar. Super-rich > 100 million dollar.

15. Work environment: Control

17. Health-related behaviour: smoking  Educational inequalities in smoking are particularily large in Norway  Estimated that they account for 25 per cent of educational inequalites in over-all mortality  The increase in educational inequalities in mortality is largely due to smoke-related causes of mortality, i.e. COPD and lung cancer.  The smoking epidemic seems to follow the pattern of «diffusion of innovations». Now, at the end of the epidemic, the educational inequalities in smoking are about to decline.

18. The three challenges revisited 1. An «infrastructure» of inequalities in material and immaterial goods, resources and exposures + 2. Large (and growing) inequalities in smoking between educational groups. = 3. Explain the three challenges

19. Thank you for your attention www.hioa.no/helseulikhet