Maria Danielsson

Health in Sweden : the National Public Health Report 2005.

Health in Sweden – The National Public Health Report 2005 : Scandinavian Journal of Public Health

Sexual and reproductive health

Summary In many ways our sexual and reproductive health reflects our way of life and living conditions. In a long-term perspective, advances in welfare combined with a well-developed health and medical care system, have meant that by international standards it is now rare for mothers to die during delivery and infant mortality continues to decline to new record lows. Pregnancy and childbirth, however, continue to be a time in a woman’s life associated with many health problems, and absence from work due to illness is common. The age of parents at the birth of their first child is

Young people’s health : Health in Sweden: The National Public Health Report 2012. Chapter 3

Summary Over 18 per cent of Sweden’s population – approximately 1.8 million people – are 65 years of age or older. The proportion of elderly people in the population has been growing for more than a century and is expected to continue to rise given the gains in average life expec tancy and the fact that large age cohorts are reaching retirement age. The average remaining life expectancy among those who had reached the age of 65 in 2011 was 21 years for women and 18 years for men. The most common causes of death among elderly people are cardiovascular diseases and cancer. The risk of suffering a stroke or heart attack has declined and morbidity has shifted to the upper age groups. On the other hand, the cancer incidence has increased, while cancer mortality has declined, owing to earlier detection and more effective treatment. The most common forms of cancer among elderly people are prostate cancer, breast cancer, colorectal cancer, and lung cancer. There has been a rise in the proportion of elderly people who perceive their general state of health as good. In the case of women, however, the increase is mainly noticeable among younger pensioners, while in men, it is spread across all age groups, according to the Statistics Sweden’s Survey of Living Conditions (ULF). The percentage of elderly people reporting long-term illness has risen, while the proportion with illnesses or complaints that interfere with daily life activities has declined. The percentage of people suffering from impaired mobility has fallen since the 1980s, while pain issues have remained at about the same level. Reports of nervousness, anxiety and sleeping

Psychosocial stress and health problems: Health in Sweden: The National Public Health Report 2012. Chapter 6.

Stress can be defined as an imbalance between demands placed on us and our ability to manage them. The body’s stress system is adapted to confront sudden physical threats. Today, however, we are in ...

Sexual and reproductive health Health in Sweden: The National Public Health Report 2012. Chapter 9.

Summary In many ways our sexual and reproductive health reflects our way of life and living conditions. In a long-term perspective, advances in welfare combined with a well-developed health and medical care system, have meant that by international standards it is now rare for mothers to die during delivery and infant mortality continues to decline to new record lows. Pregnancy and childbirth, however, continue to be a time in a woman’s life associated with many health problems, and absence from work due to illness is common. The age of parents at the birth of their first child is

Overweight, cardiovascular diseases and diabetes: Health in Sweden: The National Public Health Report 2012. Chapter 7.

Overweight, cardiovascular diseases and diabetes : health in Sweden: the National Public Health Report 2012. Chapter 7

Public health: An overview Health in Sweden: The National Public Health Report 2012. Chapter 1.

Average life expectancy is one of the most widely used measures of the health of a population. It is often used to compare health status across countries. In 2011, the average life expectancy of women in Sweden was 83.7 years and that of men was 79.8. By international standards, average life expectancy in Sweden is high, as shown in Table I, which lists the ten countries with the highest average life expectancy for women and men in 2007. In particular, men in Sweden live longer than men in almost every other country; only men in Switzerland, Iceland, Japan and Australia had a higher average life expectancy. Swedish women only share ninth and tenth place with Canadian women. Average life expectancy among women is higher than in Sweden in a number of countries in southern Europe, as well as in Japan, Australia, and Finland. Swedish women thus rank lower than Swedish men in international comparisons. As Table II shows, mortality is higher in Sweden than in several other European countries in the table, particularly for women aged 60–74. However, the mortality rate among younger women in Sweden is among the lowest. One important reason is that Swedish women who are now middle-aged or elderly smoked to a greater extent than women in most other countries. This is because smoking among women became common relatively early on in Sweden. Swedish women today smoke to about the same extent as women in most other European countries, while men smoke significantly less than the European average. The proportion of female smokers in Sweden is now declining, while smoking has become more widespread among women in other European countries. In the coming years, therefore, average life expectancy among Swedish women may increase more than that of women in many other European countries. Public health: An overview Health in Sweden: The National Public Health Report 2012. Chapter 1.

Violence: Health in Sweden: The National Public Health Report 2012. Chapter 12.

In Sweden and in other countries, it has become increasingly common to view violence from a public health perspective. This chapter presents a description of interpersonal violence with an emphasis on violence in close relations, particularly in partner relationships. According to the Swedish Crime Survey 2010, approximately one in ten inhabitants was exposed to violence, threats or harassment of some kind in 2009. Young people and single mothers with small children are particularly vulnerable to violence. According to Statistics Swedens ULF surveys (Survey on Living Conditions) for 2004-2005, 17 per cent of men and 12 per cent of women aged 16-24 years reported having been subjected to violence or serious threats at some time in the previous 12 months. Boys and men are more frequently subjected to lethal violence and to violence resulting in hospitalisation than girls and women. Similarly, men also make up a majority of the victims of assaults reported to the police. On the other hand, domestic violence and work-related violence more often involve women than men, and sexual violence is chiefly directed at girls and women. Most women and children who are subjected to assault are acquainted with the perpetrator, while this only applies to a minority of male victims. Women are four to five times as likely to be killed by a partner as men. Partner assaults against women, rapes, and gross violations of a womans integrity account for a fifth of all reported crimes of violence (against women and men combined). Violence in partner relationships has significant consequences for physical and mental health; between 12,000 and 14,000 women seek outpatient care each year as a result of violence committed by a partner. Violence can also have serious social repercussions: isolation, financial difficulties, sick leave from work, unemployment, etc., and women subjected to this form of violence can be prevented from seeking medical or other assistance. Children are often involved. Approximately 10 per cent of all children have experienced violence in the home and 5 per cent have experienced it frequently. Many children who witness violence are also beaten themselves. In 2006, the Swedish National Board of Health and Welfare estimated the annual socioeconomic cost of violence against women to be between SEK 2.7 and 3.3 billion, SEK 38 million of which were direct medical costs. Factors affecting the risk of violence in partner relationships are related both to the social structure and individual character of the perpetrator. Trends in violence have moved in different directions. Today, more people in all age groups, with the exception of the most elderly (aged 65-84), report that they have been exposed to threats or violence than in the 1980s. In recent years, however, the increase has halted; there has even been a decline among young people aged 16-24. Crimes of violence reported to the police are growing in number, and the number of reports of work-related violence, for example, has more than doubled since the mid 1970s. The number of rapes reported to the police has also risen significantly in recent year, and the victims are on average becoming younger. Furthermore, rape and gross violation of a womans integrity (combined) are now almost as common as robbery. This increase is probably due to a combination of greater willingness to report crimes, a lower tolerance threshold for violence, legislative changes and an increase in the number of violent acts committed. The rise in violence represented by crime statistics is not reflected in the proportion of people who have suffered serious physical injuries as a result of violence. Over the past ten years, the number of deaths resulting from violence has declined among women and men. Hospital statistics also show that although the percentage of people receiving treatment has remained relatively stable, more people are now seeking hospital treatment following a sexual assault.

Tobacco habits and tobacco-related diseases Health in Sweden: The National Public Health Report 2012. Chapter 10.

In Sweden just under a million people still smoke despite a decline in smoking in the last few decades. In 2010, 15 per cent of women and 13 per cent of men are smokers, compared to around 25 and 50 per cent for women and men respectively in the 1960s. Since the beginning of the 1990s, smoking has been more common among women. Increasingly few women smoke while pregnant but 6 per cent of expecting mothers continue to do so. Smoking among men began to decline 30-40 years ago and the percentage of smokers fell significantly in all age groups. As a result, lung cancer mortality in men has been falling since as far back as the early 1980s. The simultaneous decline in cardiovascular mortality has had a decisive influence on the rapid rise in men’s life expectancy over the last decades (see Chapter 1, Public Health – An Overview). Lung cancer is relatively frequent among women in Sweden compared to other European countries. The long upward trend in lung cancer mortality among women has halted at last, still, the number of total lung cancer deaths was the highest ever in the latest report (2010). The proportion of younger women smokers, has fallen steadily in recent decades, and lung cancer mortality in the 40–54 age group has declined since 1997. The proportion of smokers in the 65–84 age group has remained unchanged for the last twenty years. Cardiovascular mortality in women has steadily declined since the 1950s despite the higher number of women smokers (see Chapter 7, Overweight, Cardiovascular Diseases and Diabetes). Smoking cessation lowers the risk of cardiovascular diseases relatively quickly. The risk of lung cancer is also reduced but considerably more slowly than with cardiovascular diseases. A far more common consequence of smoking than cancer is impaired lung function resulting from chronic obstructive pulmonary disease (COPD). This disease is incurable but its course can be arrested if the sufferer stops smoking. Use of ‘snus’ tobacco1 has increased since the beginning of the 1970s. Its health effects are not as well explained as those of smoking, but using ‘snus’ does increase the risk of contracting several forms of cancer, among them cancer of the pancreas. Significantly more men than women use snus, 19 and 4 per cent, respectively. Differences in smoking habits have a significant impact on gender disparities in life expectancy and across social groups. Gender disparities have diminished, particularly in terms of causes of mortality associated with smoking. Sweden has the lowest percentage of male smokers in Europe and the lowest lung cancer mortality. It may be assumed that the comparatively low proportion of men who smoke – now and in the past – is partly responsible for fact that the life expectancy of Swedish men is among the highest in the world. The smoking habits of Swedish women, however, have been more of an EU average. On the other hand, the number of Swedish women smokers is historically higher than in other countries. Tobacco habits and tobacco-related diseases Health in Sweden: The National Public Health Report 2012. Chapter 10.

Chapter 6: Reproductive health

N The birth rate in Sweden during the twentieth century varied more than the birth rate in any other European country. Childbirth tends to be high during times of economic growth and low during hard times. The average number of children women have during their lives, however, has remained surprisingly constant at around two per woman. N During the recession of the 1990s, childbirth declined chiefly among women poorly established in the labour market. Employed work for women seems to be a condition for high childbearing. During the 2000s, childbirth has been on the rise again.