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- Andersen, Ronald, et al.
(författare)
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Cost containment, solidarity and cautious experimentation : Swedish dilemmas
- 2001
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Ingår i: Social Science and Medicine. - 0277-9536 .- 1873-5347. ; 52, s. 1195-1204
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Tidskriftsartikel (refereegranskat)abstract
- This paper uses secondary data analysis and a literature review to explore a “Swedish Dilemma”: Can Sweden continue to provide a high level of comprehensive health services for all regardless of ability to pay — a policy emphasizing “solidarity” — or must it decide to impose increasing constraints on health services spending and service delivery — a policy emphasizing “cost containment?” It examines recent policies and longer term trends including: changes in health personnel and facilities; integration of health and social services for older persons; introduction of competition among providers; cost sharing for patients; dismantling of dental insurance; decentralization of government responsibility; priority settings for treatment; and encouragement of the private sector. It is apparent that the Swedes have had considerable success in attaining cost containment — not primarily through “market mechanisms” but through government budget controls and service reduction. Further, it appears that equal access to care, or solidarity, may be adversely affected by some of the system changes.
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| 4. |
- Leinsalu, Mall, et al.
(författare)
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Estonia 1989-2000 : enormous increase in mortality differences by education
- 2003
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Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 32, s. 1081-1087
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Tidskriftsartikel (refereegranskat)abstract
- Social disruption and increasing inequalities in wealth can be considered main recent determinants; however, causal processes, shaped decades before recent reforms, also contribute to this widening gap.
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| 6. |
- Leinsalu, Mall, 1958-
(författare)
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Troubled transitions : Social variation and long-term trends in health and mortality in Estonia
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is about social variation and long-term trends in health and mortality in Estonia. After five decades of Soviet occupation Estonia’s independence was re-established in 1991 on the basis of the historical continuity of its statehood. Estonian independence changed political, economic and social realities; it was accompanied by a sharp decline in living standards. By 1994/1995 the socioeconomic and political situation had started to stabilize. Both transitions, the Sovietization and the return to independence, were particularly hard on the population. Life expectancy had improved little or not at all from the 1960s. At the beginning of the 1990s there was an unprecedented fall. From 1995, life expectancy started to rise again. Cause-specific mortality for 1965–2000 was examined in order to understand both the recent and the earlier long-term health crises in Estonia; educational and ethnic differences in cause-specific mortality were analysed for 1987–1990 and 1999–2000. Self-rated health was examined for 1996/1997. The cause-of-death data come from the national mortality database, and the self-rated health data come from the Estonian Health Interview Survey. Circulatory diseases, neoplasms, and injuries and poisonings account for over 80% of all deaths in Estonia. Circulatory disease mortality started to decline considerably later than in Western countries, is very high by international standards and was sensitive to sudden social changes in the 1980s and 1990s. Cancer mortality rates among men increased, mostly because of lung cancer mortality. Mortality from injuries and poisonings is extremely high, has increasingly been contributing to Estonia’s long-term mortality stagnation and was the major contributor to the decline in life expectancy in the 1990s. Educational and ethnic differences in mortality increased sharply in 1989–2000. In 2000, male graduates aged 25 could expect to live 13.1 years longer than corresponding men with the lowest education; among women the difference was 8.6 years. Estonian men could expect to live 6.1 years longer than Russian men in 2000; among women this difference was 3.5 years. Injuries and poisonings were mainly responsible for the lagging behind of the lower educated and of Russians; in terms of total mortality the ethnic differences were small and not significant in 1989. Generally low living standards (particularly a poor diet), and the increasing gap with Western countries, may have contributed to the long-term mortality stagnation from the mid-1960s. In the 1990s, the increasing differentiation of wealth and opportunity, as well as perceived social exclusion and poor adaptation to the social and economic changes, in particular among the low educated and among ethnic Russians, are important determinants of the growing mortality divide in Estonia. Alcohol consumption, in particular binge drinking, has to be seen as a main cause of increasing mortality among middle aged men from the mid-1960s, most evident in those causes of death that can be directly linked to alcohol. It accounts for a considerable part of circulatory disease mortality as well. Alcohol also contributes to educational and ethnic differences in mortality and their widening over the 1990s. Tobacco smoking, similarly, has contributed to long-term mortality stagnation and the widening of educational, but not ethnic, differences in mortality. Adverse living conditions in childhood may also have contributed to the educational and ethnic differences in mortality and to the long-term mortality development in Estonia. Estonia needs to think hard about policies to remedy this situation.
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| 7. |
- Ringbäck Weitoft, Gunilla, 1958-
(författare)
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Lone parenting, socioeconomic conditions and severe ill-health : longitudinal register-based studies
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aims of this dissertation are to analyse how family situation, and especially lone parenting, influence health and life chances in Sweden and the extent to which possible relations are influenced by socioeconomic circumstances and health selection. In two population-based cohort studies we analysed overall and cause-specific mortality (1991-95), and also severe morbidity (1991-94) from different causes among lone mothers in comparison with mothers with partners. Information on the mothers was obtained from the Swedish Population and Housing censuses of 1985 and 1990. The outcomes considered were death or utilisation of (overnight) hospital care, with data taken from population-based national health registers. In the analyses we adjusted for socioeconomic and demographic circumstances, such as socioeconomic status, country of birth, receipt of social-welfare benefit, and housing situation. To take health-selection effects into account, we adjusted for previous inpatient history (1987-90). Our findings suggest that lone motherhood entails health disadvantages with regard to mortality, severe morbidity and injury. Socioeconomic circumstances were found to play a major role in accounting for increased risks, but the risks are partly independent of both socioeconomic conditions and health selection into lone motherhood. In two further studies we analysed mortality (1991-98), severe morbidity and injury (1991-99), and also educational achievement (in 1998 at ages 24-25 of offspring), of children who had lived in lone-parent families in comparison with children in two-parent families. We mainly used data from the Swedish censuses and national health-data registers. Living in a lone parent family was found to be associated with increased risks of a variety of unfavourable outcomes: psychiatric disease, suicide/suicide attempt, injury, addiction, and low educational attainment. Relatively poor educational performance and also health disadvantages are explicable to a large extent by socioeconomic conditions, especially a lack of economic resources (as measured here by receipt of social-welfare benefit and having rented accommodation). Educational achievement among children varies with cause of lone parenthood, with the best prospects found among the children of widows/widowers. In a fifth study we analysed mortality from different causes (1991-2000) among lone fathers (fathers with and without custody of their children) and childless men (with and without partners) in comparison with cohabiting fathers with children in the household. For this purpose we linked information from the Swedish censuses of 1985 and 1990 to Sweden’s Multi-Generation Register (which contains information about all known biological relations between children and parents). Lone non-custodial fathers and lone childless men suffer from the most pronounced elevated risks, especially of death from injury or addiction, but also from all-cause mortality and death from ischaemic heart disease. Being a lone custodial father also seems to entail an increased mortality risk, although generally to a much lesser degree, and not for all outcomes studied. The elevated risks for all subgroups fell when variables assumed to control health selection and socioeconomic circumstances were introduced into the initial regression model employed. However, even following adjustments, significantly increased risks, albeit greatly attenuated, remained in all the subgroups investigated. Key Words: Single parent, single mother, single father, children, risk factor, socio-economic status, mortality, morbidity, injury, psychiatric disease, education, epidemiology, longitudinal
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| 10. |
- Sparén, Pär, et al.
(författare)
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Long term mortality after severe starvation during the siege of Leningrad : prospective cohort study
- 2004
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Ingår i: The BMJ. - 1756-1833. ; 328:7430, s. 11-14A
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To determine whether starvation during periods of increased growth after birth have long term health consequences.Design Analysis of cardiovascular risk factors and mortality in a longitudinal follow up after the 1941-4 siege of Leningrad. Mortality measured from 1975 up to the end of 1999.Setting St Petersburg, Russia (formerly Leningrad).Participants 5000 men born 1916-35 who lived in Leningrad, randomly selected to take part in health examinations in 1975-7. Of the 3905 men who participated, a third had experienced the siege.Main outcome measures Relative risk of ischaemic heart disease and mortality from stroke by siege exposure. Odds ratios and means for several cardiovascular risk factors.Results Three to six decades after the siege, in men who experienced the siege around the age of puberty blood pressure was raised (mean difference in systolic 3.3 mm Hg, in diastolic 1.3 mm Hg) as was mortality from ischaemic heart disease (relative risk 1.39, 95% confidence interval 1.07 to 1.79) and stroke (1.67, 1.15 to 2.43), including haemorrhagic stroke (1.71, 0.90 to 3.22). The effect on mortality was partly mediated via blood pressure but not by any other measured biological, behavioural, or social factor.Conclusions Starvation, or accompanying chronic stress, particularly at the onset of or during puberty, may increase vulnerability to later cardiovascular disease.
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