Culture and experience Health

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1 48 Culture and experience Health Health The health of a population reflects both the lives of citizens and the health system's ability to prevent and cure diseases. With regard to health and welfare, there are many similarities between Denmark and Sweden. In both countries, health spending is about 4,030 EUR per year per capita, which corresponds to the average for OECD and EU countries of about 10 per cent of GDP (OECD). There are significant differences, however, between the two countries in terms of health, treatment and lifestyle. Sweden is number five and Denmark number 25 on the list of the 34 OECD countries. In Denmark, life expectancy is two and a half years shorter than in Sweden and is thus one of the lowest in Europe. This difference also applies to the Øresund, where life expectancy in Scania is 81 years, while in the Capital and it is around 78 years. In addition, there is a difference for life expectancy between the sexes. The life expectancy for men living on both sides of the Øresund is four or five years lower than it is for women; and the difference in gender life expectancy is highest on the Danish side. In the Danish part of the Øresund, men in Copenhagen have a life expectancy of 74 years compared to 77 in North, where men have the highest life expectancy. In Scania, the lowest life expectancy is found for men in Perstorp (77 years) and Malmö (78 years). For a man to have a longer life, he needs to settle in Båstad, where male life expectancy reaches 82 years on average. An Øresund citizen has a life span of 79 years on average with a range from 77 in Copenhagen and to 84 in Båstad. In general, average life expectancy is rising rapidly. In just four years (from 2006 to 2011), the average life expectancy on both sides of the Øresund has increased by 0.8 years slightly faster on the Danish side and slightly faster for men. Average life expectancy for a 0-year-old, born between Scania Øresund Men Women Total Source: Statistics Denmark and Statistics Sweden.

2 Øresund Trends Causes of death per 100,000 inhabitants (2009) The most frequent causes of death In general, the two major causes of death on both sides of the Øresund are cancer and cardiovascular diseases. The shorter lifetime of the Danes is due in part to a higher incidence of cancer earlier in life, while the Swedes die at a slightly later age and thus more often of cardiovascular diseases. But if, for example, the year old age group is compared on the two sides of the Øresund, the risk of death associated with cancer and cardiovascular diseases is significantly higher west than east of it. The risk of dying of cancer is per cent higher, of lung cancer up to 50 per cent higher and cardiovascular disease 20 per cent higher. Traffic accidents are a slightly more frequent cause of death on the side Scania Øresund Men Cancer Cardiovascular diseases Suicide Traffic accidents Accidents in general Women Cancer Cardiovascular diseases Suicide Traffic accidents Accidents in general Source: Statistics Denmark and Social Services Sweden. of the Øresund, while the incidence of suicide and accidents in general is slightly higher on the Scanian side. Obesity Of the Øresund 's adult population, 13 per cent are obese. This is particularly high in and is lowest in the Capital. There are roughly equal numbers of obese men and women, with most aged years.

3 50 Culture and experience Health Obese (BMI = 30 and over) among the adult population in percentage Scania Øresund Men Women Total Source: National Institute of Public Health, The National Health Profile 2010 and Scania, Public Health Scania Note: In Denmark, adults comprise citizens aged 16 and over; in Sweden, adults comprise citizens aged 18 and 84. The Danish data is from Smoking Every fifth Øresund citizen has one or more cigarettes daily. Danes smoke more than Swedes and there are generally more male smokers than female. Most smokers are in the age group. 23 per cent of citizens in smoke on a daily basis, while only 15 per cent of citizens in Scania do. Within the regions, however, the smoking patterns are essentially different. In, most smokers are in the more outlying areas, for example Lolland and Odsherred; and also in the west lying municipalities such as Brøndby, where more than 25 per cent smoke on a daily basis. North of Copenhagen, there are several municipalities, such as Furesø, Allerød and Hørsholm, where there are fewer than 15 per cent who smoke on a daily basis. In Scania, most of the smokers (about 20 per cent) are in Åstorp and Östra Göinge, while the fewest are in Lund and Lomma (below 10 per cent). The Danes rarely take snuff, while 17 per cent of Scanian men use it daily. In general, women use no snuff. Use of health services When comparing health system resources and the use of health services in the two parts of the Øresund, there are certain caveats to be aware of for example, people s behaviour is affected by the availability of health services and the extent to which they are free. (See text box). Doctor capacity is roughly similar in the two parts of the region, but there are a few more doctors per capita east of the Øresund than west of it. In, there are 2.5 doctors per 1,000 inhabitants, while in Scania there are

4 Øresund Trends Daily smokers among the adult population, in per cent Scania Øresund Men Women Total Source: National Institute of Public Health, The National Health Profile 2010 and Scania, Public Health Scania Note: In Denmark, adults comprise citizens aged 16 and over; in Sweden, adults comprise citizens aged 18 and 84. The Danish data is from 2010, Scanian from 2008 and for Sweden as a whole, the data is from Number of doctors and hospital beds per 1,000 inhabitants (2010) Scania Øresund Doctors Hospital beds Source: Danish Health and Medicines Authority and Sweden s municipalities and Landsting (regional facts) Number of doctor and dentist visits, hospital admissions and bed days (2010) Scania Øresund Per 1,000 inhabitants Visits to the doctor Visits to the dentist Per 1,000 inhabitants Hospital admissions Bed days Per admission Bed days Source: Statistics Denmark, Danish s and Social Services (SE) and Öresund Committee calculations. Note: Health consultations comprise most health services, apart from visits to the dentist (see text box).

5 52 Culture and experience Health 3.4. The opposite is true for the number of hospital beds. In the Capital, there are 3.4 beds per 1,000 inhabitants, compared to 2.8 in Scania, which is slightly higher than the national average in Sweden. On average, the inhabitants of the Øresund visit the doctor 6.1 times per year. This figure conceals, however, a marked difference in frequency when the two parts of the Øresund are compared. Danes go to the doctor more than twice as often as the Swedes, although the comparison is associated with some uncertainty; see text box. The comparison suffers from the fact that the Swedish figures for visits to the doctor are not as comprehensive as the Danish. Data for health consultations is therefore more comprehensive and comparable. Overall, there are 7.3 health consultations annually per capita in the Øresund, with most on the Danish side. Visits to the dentist are also a more frequent occurrence on the Danish side than on the Swedish, with the Danish Øresund citizens going to the dentist twice as often as the Scanians. In both countries, citizens pay a significant proportion of their dental costs themselves. All in all, dental care is significantly more expensive in Denmark than it is in Sweden. (See text box). The number of hospital admissions is much higher in Denmark than in Sweden. In the Øresund, the inhabitants of accounted for the most admissions: there were 287 admissions per 1,000 inhabitants in 2010, compared with only 158 in Scania. By contrast, admissions were of a shorter duration in the Capital and than in Scania: on average these were 4.4, 3.9 and 5.6 days, respectively. In terms of bed days per capita, use of hospitals was a little higher west of the Øresund.

6 Øresund Trends About health systems Treatment resources, structure and registration are very different in Denmark and Sweden. Therefore, there are a number of difficulties and caveats about comparisons across the Øresund in terms of number of doctors and hospital beds, consultations and admissions to hospital. See also Nomesco: Both countries' health systems are essentially built around the same welfare ideals and have many similarities. In Denmark, however, a system of private practitioners and medical centres is used, while doctors in Sweden are usually associated with hospitals and health centres. Nearly all contacts with the public health system in Denmark are registered as doctor consultations because of the billing system. In Sweden, some consultations are recorded as contacts with other health professionals other than a doctor; this is the case, for example, for health care. A better comparison is for health consultations, which include registration for all types of health services, including psychiatric treatment (but excluding dentists). In the Danish health system, there is much outpatient care and patients are discharged very quickly. Hospital breakdown by speciality affects how patients are treated. A number of patients are admitted to a local hospital for diagnosis, then sent to a larger hospital for treatment and finally back to the local hospital. This allows multiple admissions of a relatively short duration. In addition, rapid discharges in Denmark can mean slightly more short-term readmissions. In Sweden, there is a tendency for patients to have slightly longer courses of treatment at the same hospital. The figures for the Capital include patients from the rest of the country admitted for specialist treatments at Rigshospitalet, the national hospital of Denmark. Medical care in Denmark is free, while in Sweden patients pay for medical consultations and hospitalisation. Payment in Sweden is determined regionally and is typically a few hundred kroner. In both Denmark and Sweden, citizens pay in general for dentistry. In Denmark, standard treatment such as dental examinations, are supported by a small subsidy, while the more expensive treatments are not subsidised. On the other hand, many citizens have private health insurance, which reduces the cost of dental treatment to some extent. In Sweden, citizens have a lower basic subsidy but also 50 per cent or more in subsidies for expensive treatments. In addition, dental care is generally cheaper on the Swedish side than the Danish. On both sides of the Øresund, health and lifestyle are comprehensively and continuously surveyed. For a number of parameters, data is not directly comparable for example, alcohol habits.

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