|Reducing inequality in health through prevention|
|Implemented in this survey?|
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 .
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 . 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 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.
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  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.
Increase life expecancy over the coming decade by three years through prevention
Individuals, healthcare sector
|Medienpräsenz||sehr gering||sehr hoch|
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 . The liberal-conservative government has set the aim that life expectancy should increase by three years over the coming decade.
|Implemented in this survey?|
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.
The approach of the idea is described as:
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.
|MoH||sehr unterstützend||stark dagegen|
|Prime Minister||sehr unterstützend||stark dagegen|
|Danish Medical Association||sehr unterstützend||stark dagegen|
|The Danish Heart Foundation||sehr unterstützend||stark dagegen|
|Social-Liberal||sehr unterstützend||stark dagegen|
|The Social Democrats||sehr unterstützend||stark dagegen|
|The Liberals||sehr unterstützend||stark dagegen|
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.
|Prime Minister||sehr groß||kein|
|Danish Medical Association||sehr groß||kein|
|The Danish Heart Foundation||sehr groß||kein|
|The Social Democrats||sehr groß||kein|
|The Liberals||sehr groß||kein|
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.
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.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||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.
|Reducing inequality in health through prevention|
Process Stages: none
Seested Nielsen, Jytte
University of Southern Denmark; www.sdu.dk