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Increasing life expectancy through prevention

Country: 
Dänemark
Partner Institute: 
University of Southern Denmark, Odense
Survey no: 
(13) 2009
Author(s): 
Seested Nielsen, Jytte
Health Policy Issues: 
Prävention
Reform formerly reported in: 
Reducing inequality in health through prevention
Current Process Stages
Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? nein nein ja nein nein nein nein

Abstract

The Danish liberal-conservative government has set itself the target to increase the average Danish life expectancy by three years over the coming decade. An independent commission was set by the government to come up with recommendations for preventive activities with documented cost-effectiveness. The commission came up with 52 suggestions which combined would increase life expectancy by three years over the coming decade [1].

Purpose of health policy or idea

The Danish liberal-conservative government has set itself the target to increase the average Danish life expectancy by three years over the coming decade. This is slightly above the increase in life expectancy in the decade from 1995-2005 which was 2.5 years. An independent commission was appointed by the current government to come up with recommendations for preventive activities with documented cost-effectiveness which combined would increase life expectancy by three years over the coming decade [1]. The commision includes a chairman and nine members who have been appointed by the Minster of Health and Prevention, Danish Regions and the Danish Association of Municipalities. The commission began its work in 2008. 

The current situation in Denmark

The commission argues that the reason why the current life expectancy in Denmark is relatively low compared to other OECD countries (Denmark is only ranked 20 on the list of OECD countries in terms of life expectancy) among other things can be found in the Danish life-style with respect to smoking, alcohol, nutrition and excercise (the so-called four "KRAM factors", acronym corresponding to the first letter in each of the four risk factors in Danish: nutrition, smoking, alcohol and excersice).

The main problem in Denmark in terms of risk factors is smoking. On average, a smoker lives approximately 10 years less than an individual who has never been smoking and if nobody smoked today the average life expectancy in Denmark would be three years longer.

Compared to other OECD countries the intake of alcohol is very high in Denmark (only exceeded by five OECD countries in 2004) and in particular young people have a large intake of alcohol. Compared with the other OECD countries, the consumption of fat and sugar is very high in Denmark as well. However, the intake of fruit and vegetables has increased noticeable in the later decades (from a very low starting point).

40% of the Danish population is employed in jobs that do not require any physical activity at all and the number of obese individuals has doubled within the last two decades. 

How could we increase life expectancy in Denmark through prevention?

The independent commission for prevention has come up with 52 suggestions within eight different focus areas which combined would increase life expectancy with three years over the coming decade. In addition to the four KRAM factors already mentioned the remaining four focus areas are: focus on early discovery, efforts at workplaces, efforts aimed at younger people and children and finally knowledge and research in prevention. Some of the suggestions with regards to the four "KRAM factors" will briefly be mentioned here. 

The suggestions from the commission with regards to prevention of premature death from smoking are among other things that the taxes on tobacco should be doubled resulting in a price of DKK 50 per cigarette package (about 7 Euros). In addition, the current smoking ban should be expanded to incorporate all indoor locations (with the exception of ones private home). All cigarette packages should contain pictures warning about the effects from smoking and courses in smoking cessation should be provided with a special effort to attract the young and socioeconomically disadvantaged.

With regard to the consumption of alcohol the proposal is among other things to raise the age limit for buying alcohol from 16 to 18 years and a ban against advertising for alcohol in all medias.

In terms of exercise and physical activity, children should be more active physically in schools (at least one hour per day) and the overall potential for physical activity should be promoted in district plans (i.e. establishing bicycle paths) etc.

A proposed tax increase on chocolate and sweets would decrease the intake of unhealthy food and is recommended in order to reduce the number of premature obesity-related deaths. A decrease in VAT is not warranted since according to the commsion this would only lead to a marginal increase in the intake of fruits and vegetables whereas the loss in state income from a VAT decrease would be substantial. Instead fruits should be offered for free in schools

The main focus from the commsion has been on prevention relating to the four KRAM factors since these - according to the commision - account for 40% of all deaths. Moreover, according to Vallgårda [7] there is a general tendency in Denmark that solutions to health problems stress the importance of behavioural factors and individual responsibility. This is by contrast to Norway and Sweden in which for example social relations and living conditions are more stressed when it comes to solution to health problems.

In addition to the suggestions relating to the four "KRAM factors" the commission's suggestions range from recommending greater priority to research within the area of prevention and health promotion to suggestions of different health promoting initiatives at the workplace.

Main points

Main objectives

Increase life expecancy over the coming decade by three years through prevention

Type of incentives

Non-financial

Groups affected

Individuals, healthcare sector

 Suchhilfe

Characteristics of this policy

Innovationsgrad traditionell traditionell innovativ
Kontroversität unumstritten recht kontrovers kontrovers
Strukturelle Wirkung marginal recht marginal fundamental
Medienpräsenz sehr gering recht hoch sehr hoch
Übertragbarkeit sehr systemabhängig systemneutral systemneutral

 

Political and economic background

As a reult of the public sector reform of  January 1, 2007, prevention and health promotion now are the responsibility of municipalities. The background to this is that prevention should be based in the everyday life of the citizens and according to this the municipality is the obvious choice to place responsibility [1]. The liberal-conservative government has set the aim that life expectancy should increase by three years over the coming decade.

Change based on an overall national health policy statement

Purpose and process analysis

Current Process Stages

Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? nein nein ja nein nein nein nein

Origins of health policy idea

The initiatives to settle on prevention of poor health can be seen as a continuation of a long-standing policy by the former governments to promote health through prevention.

Initiators of idea/main actors

  • Regierung: After reading the report, the MoH has rejected raising the age limit for buying alcohol from 16 to 18, increasing the taxes on cigarettes to DKK 50 and rejected the proposal of extending the smoking ban to all indoor locations [5]. After reading the report the Prime Minister has rejected the tax increase on cigarettes based on the risk for cross-border shopping [3].
  • Leistungserbringer: The Danish Medical Association has expressed very positive views towards the suggested initiatives [2]
  • Bürgergesellschaft: The Danish Heart Foundation has expressed very positive views towards the suggested initiatives [2]
  • Politische Parteien: The Social-Liberal party supports increased taxes on chocolate and sweets [4]. The Social Democrats support increased taxes on unhealthy food [6]. The Liberals have suggested different prevention initiatives which according to [6] all are based on voluntariness and a change of behaviour without the use of economic instruments, eg. construction of interactive playgrounds, more physical activity in schools and more bicycle paths, or

Approach of idea

The approach of the idea is described as:
renewed:

Stakeholder positions

In the parliament there seems to be consensus about the aim to focus on prevention yet there seems to be some disagreements in the parliament on the appropriateness of the specific initiatives suggested by the commission. The disagreement is partly based on different opinions as to the extent to which the political parties find it acceptable to regulate people's behaviour by use of economic incentives like for example increased taxes on cigarettes. Another aspect of this discussion is how much you can increase taxes on for example cigarettes without increasing the cross-border shopping of tobacco (see also comments from main actors). Furthermore, it has been claimed by the MoH that increasing the age limit for buying alcohol is associated with a risk of rejection of the whole idea by the population.

The Danish Heart Foundation and the Danish Medical Association have expressed very positive views towards the mentioned initiatives.

Actors and positions

Description of actors and their positions
Regierung
MoHsehr unterstützendunterstützend stark dagegen
Prime Ministersehr unterstützendunterstützend stark dagegen
Leistungserbringer
Danish Medical Associationsehr unterstützendsehr unterstützend stark dagegen
Bürgergesellschaft
The Danish Heart Foundationsehr unterstützendsehr unterstützend stark dagegen
Politische Parteien
Social-Liberalsehr unterstützendsehr unterstützend stark dagegen
The Social Democratssehr unterstützendsehr unterstützend stark dagegen
The Liberalssehr unterstützendneutral stark dagegen

Influences in policy making and legislation

Some of the preventive and health promoting measures could be taken within the existing frames of the new organisation of the public sector after the recent structural reform and some would require a formal legislative process. 

Legislative outcome

success

Actors and influence

Description of actors and their influence

Regierung
MoHsehr großsehr groß kein
Prime Ministersehr großsehr groß kein
Leistungserbringer
Danish Medical Associationsehr großneutral kein
Bürgergesellschaft
The Danish Heart Foundationsehr großneutral kein
Politische Parteien
Social-Liberalsehr großgering kein
The Social Democratssehr großgroß kein
The Liberalssehr großsehr groß kein
Social-LiberalDanish Medical Association, The Danish Heart FoundationThe Social DemocratsMoH, Prime MinisterThe Liberals

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

The main actors in prevention closely related to citizens would be the health promoting personnel in municipalities and regions. On the state level the Minstry of Health along with other relevant ministries would have to coordinate and develop the prevention effort as well as take responsibility for relevant legislation.

Monitoring and evaluation

 

Review mechanisms

keine Angaben

Dimensions of evaluation

Ergebnis

Results of evaluation

 

Expected outcome

The aim of the proposed policy is to increase average life expectancy in Denmark with three years over the coming decade. This is slightly above the increase in life expectancy from 1995-2005 which was 2.5 years.

Impact of this policy

Qualität kaum Einfluss neutral starker Einfluss
Gerechtigkeit System weniger gerecht neutral System gerechter
Kosteneffizienz sehr gering high sehr hoch

According to the commission mandate all suggestions should have a documented effect and be cost-effective. Yet in the report from the commission some initiatives for which it is not possible to do a cost-effectiveness analysis (like for example research in prevention) have also been included. The Danish Institute for Health Services Research has carried out the cost-effectiveness analyses focusing on smoking (smoking ban in all indoor locations and pictures on cigarette packages warning about the effect) and alcohol initiatives (age limit for buying alcohol increased from 16 to 18 years old, ban against advertising in all medias and limited accessibility to alcohol). In addition, the commission has included international experiences in its work.

References

Sources of Information

  • [1] Forebyggelseskommissionen: Vi kan leve længere og sundere. Forebyggelseskommissionens anbefalinger til en styrket forebyggende indsats, 2009. (Also available online at http://rapport.forebyggelseskommissionen.dk/
    Forebyggelseskommissionen__rapport.pdf
  • [2] Kraft, Signe Juul: "Læger: Ny rapport godkendt, men..." Dagens Medicin (available online at   www.dagensmedicin.dk/nyheder/2009/04/21/voxpop/index.xml , accessed  April 21, 2009)
  • [3 Ritzaus Bureau: "Løkke afviser nye afgifter på tobak". Berlingske Tidende (available online at www.berlingske.dk/article/20090421/politik/904210360/ , accessed April 21, 2009)
  • [4] Tang, Uffe: "R: Markant højere afgift på usund mad". Berlingske Tidende,  April 20,  2009.
  • [5] Nielsen, Hanne Fall: "Sundhedsministeren: "Forbud er ikke vejen til bedre sundhed"". JyllandsPosten, April 21, 2009.
  • [6] Mylenberg, Troels: "V: Forebyggelse skal sikre længere levetid". Berlingske Tidende, April 11, 2009.
  • [7] Vallgårda,S: Public health policies: A Scandinavian model?, Scandinavian Journal of Public Health, p.1-7, 2006.

Reform formerly reported in

Reducing inequality in health through prevention
Process Stages: none

Author/s and/or contributors to this survey

Seested Nielsen, Jytte

www.sdu.dk/ansat/jsn.aspx

University of Southern Denmark; www.sdu.dk

Empfohlene Zitierweise für diesen Online-Artikel:

Seested Nielsen, Jytte. "Increasing life expectancy through prevention". Health Policy Monitor, April 2009. Available at http://www.hpm.org/survey/dk/a13/2