Health in Norway, with its early history of poverty and infectious diseases along with famines and epidemics, was poor for most of the population at least into the 1800s. The country eventually changed from a peasant society to an industrial one and established a public health system in 1860. Due to the high life expectancy at birth, the low Child mortality rate and the fertility rate in Norway, it is fair to say that the overall health status in the country is generally good.
Population data Norway has a birth-, death-, cancer-, and population register, which enables the authorities to have an overview of the health situation in Norway. The total population in Norway as of 2018, was 5,295,619. The life expectancy at birth was 81 years for males and 84 years for females (2016). The under five mortality per 1000 live births in 2016 were three cases and the probability of dying between 15 and 60 years for males was 66 and 42 for females per 1000 in population. The total expenditure on health per capita was $6,347 in 2014. Total expenditure on health as percentage of GDP was 9,7% Gross national income per capita was $81,807 (2018).
Fertility The total fertility rate per women in 2018 was 1,62, while the regional average was 1,6 and global average was 2,44. Prevalence of tuberculosis was 10 per 100 000 in population and the regional average was 56 while global average was 169. In Norway today, there are 5371 HIV positive people, 3618 men and 1753 women. In 2008 the incidence of HIV positive people had a peak and the highest incidence of HIV positive. Since that, there have been a decrease in new cases.
Human Development Index Norway was awarded first place according to the United Nations Human Development Index (HDI) for 2018 .
A new measure of expected human capital calculated for 195 countries from 1990 to 2016 and defined for each birth cohort as the expected years lived from age 20 to 64 years and adjusted for educational attainment, learning or education quality, and functional health status was published by the Lancet in September 2018. Norway had the seventh highest level of expected human capital with 25 health, education, and learning-adjusted expected years lived between age 20 and 64 years.
Demographic measures for Norway: Total population (2018) 5,295,619 Gross national income per capita (PPP international $, 2018) 81,807 Life expectancy at birth m/f (years, 2017) 81/84 Probability of dying before the age of five (per 1 000 live births, 2017) 3 Probability of dying between 15 and 60 years m/f (per 1 000 population, 2016) 66/42 Total expenditure on health per capita (Intl $, 2014) 6,347 Total expenditure on health as % of GDP (2014) 9.7
History In the early Norway faced major challenges. The differences between rich and poor were large, living conditions poor and infant mortality high. Economic conditions in the country improved, but some social groups still lived under constrained conditions. The nutritional status was poor as well as hygiene and living conditions. The conditions and class differences were worse in the cities than in the countryside.
Immunization against smallpox was introduced in the first decade of the 19th century. In 1855, Gaustad Hospital opened as the first mental asylum in the country and was the start of an expansion in treating people with such disorders. After 1900 living standards and health conditions improved and the nutritional status improved as poverty decreased. Improvement in public health occurred during development in several areas such as social and living conditions, changes in disease and medical outbreaks, establishment of the health care system and emphasis on public health matters. Vaccination and increased treatment opportunities with antibiotics resulted in great improvements. Average income increased as did improvements in hygiene. Nutrition became better and more effective also improving general health.
In the 1900s the situation improved in Norway and, as a result of decreased poverty, nutritional status improved. Within 100 years Norway became a wealthy nation. Even though Norway experienced a setback during World War II, the country achieved steady development. Improved hygiene led to fewer infectious diseases and scientific discoveries led to breakthroughs in many fields including health.
However, an economic downturn in the 1920s exacerbated the nutritional situation within the country. Nutrition therefore became an important part of social policies. In periods there were high rates of unemployment, and poverty affected women and children most. Children often had to walk long distances to get work as shepherds during the summer in order to help their families with income. In mining towns as Røros, children also had to work in the mines. Living conditions improved during the 1900s. From being a poor country, Norway developed within 100 years to become a wealthy nation. Even though the country experienced a setback under the Second World War, the country achieved steady development. From 1975 Norway was self-sufficient in petroleum products and oil became an important part of the Norwegian economy. Improved hygiene led to fewer infectious diseases and scientific discoveries led to breakthroughs in many fields including health.
After 1945, smoking became a relevant factor. While infectious diseases decreased, chronic diseases such as cardiovascular disease were blooming. From 2000, life expectancy was still on the increase. There are, however, still social differences when it comes to health. While globalization increases the demand for infectious control and knowledge, the Norwegian population demands more from the government in regard to health and treatment.
Infant mortality Early on, there were no statistics kept for the whole country on infant mortality, but in Asker and Bærum in 1809 infant mortality was 40 percent for all live births.Fure E. Spedbarnsdødeligheten i Asker og Bærum på 1700- og 1800 tallet. Tidsskr Nor Lægeforen 2005; 125: 3468-71. In 1900, infant mortality was higher in Norway than in any other European country. Development of the welfare state has contributed to a great decrease in infant mortality rates. This can be attributed to better nutrition and living conditions, better education and economy, better treatment possibilities and preventive health care (especially immunization). The infant mortality rate increased again between the 1970 and 1980 due to sudden infant death syndrome (SIDS). SIDS was unknown from earlier, but the increase was dramatic. The trend was reversed when Norwegian parents were encouraged to lay their children on their backs and not their stomachs when sleeping.
Population At the beginning of the 19th century the total population was just under 1 million, however it doubled within the next hundred years even though many decided to emigrate. Industrialization resulted in many people emigrating from the countryside to the major cities for work. At the beginning of the 1900s the population was 2.2 million and increased to about 4.5 million through the 1900s. 15 percent of the country's population lived in Oslo and Akershus. The proportion of people associated with agriculture, forestry and fishing declined while the percentage affiliated with industries increased.
Communicable diseases The Norwegian government recognized that the population needed to improve its health if the country was to become a nation with strong economic development.
Cholera and typhoid fever were common communicable diseases in the 1800s. Norway experienced several epidemics; cholera was the worst. The last epidemic outbreaks were around the 1840s. Even though these were not as severe as the Black Death in the 1300s, mortality rates were high. Sexually transmitted diseases also caused widespread problems. These were, however, not defined and divided into gonorrhea and syphilis until later. Smallpox was the most serious disease in the years around 1800; legislation for vaccination against smallpox was introduced in 1810. At first, the law was not strictly enforced but when people were commanded to show their vaccination cards at confirmations and weddings, there was an increase in the vaccinating of children and Norway finally gained some control over this disease. Leprosy, also known as Hansen's disease, ravaged the west coast of Norway. Patients were isolated in leprosy hospitals with room for up to 1000 patients. Gerhard Armauer Hansen (1841–1912), working in Bergen, discovered the leprosy bacillus. He revealed the association between hospitalization for infected patients and a decrease in the number of new cases. Tuberculosis caused many deaths in the late 1800s while leprosy rates declined. Mortality of tuberculosis was high around 1900, but decreased steadily for the next fifty years. The greatest decrease in tuberculosis happened before vaccinations and medical treatments were available; the decrease was caused by improved living conditions, nutrition, and hygiene. The Spanish flu of 1918 affected the country. This influenza pandemic took many lives, especially those of young people who lacked immunity to the new flu virus. Diphtheria, a common childhood disease, raged during the early years of World War II, but with new vaccines available, the country experienced an immediate positive response. Polio had its last major outbreak in 1951 when 2100 cases were registered. In 1956 immunization of polio started.
Discovery of microbes In the late 1800s microbes were discovered and prevention of diseases were now possible. Until now, spreading of infections had only been debated. With new discoveries within the field and greater understanding on how bacteria and viruses transfer and spread among humans it was possible to make significant changes in treatment and care of patients. One example was to isolate people with leprosy and tuberculosis in order to stop spreading.
Antibiotics In the 1900s many vaccines were developed and the first antibiotic, penicillin, came about in the 1940s. These introductions were very powerful tools in preventing and treatment of childhood diseases.
Vaccines More vaccines became available and the child-vaccination-program was growing rapidly. Almost all feared childhood diseases were going extinct. Vaccines against measles (rubella) were introduced to the childhood immunization program in 1978. Rubella is dangerous to the fetus if the mother is affected during pregnancy. Today, all children are offered free vaccines and the offer is voluntary. The coverage for most vaccines is high.
HIV/AIDS In the early 1980s AIDS came as an unknown disease. Norway was early in preventing it in high-risk groups, through information campaigns. The HIV virus was later discovered and HIV tests became available from 1985.
Cardiovascular diseases Incidences of tuberculosis became fewer and an increase in cases and mortality of chronic diseases appeared, especially cardiovascular disease. Tobacco is one of the most important causes of cardiovascular and cancer diseases. During World War 2, the tobacco use in Norway was limited because of strict rationing. After the war, sale of tobacco bloomed and so did the implications from consuming it. In the late 1900s, chronic diseases were dominating and because of increased life expectancy, people lived longer with these chronic diseases. Around millennium new treatment and prevention for cardiovascular diseases ensured a decrease in mortality, however, these diseases are still one of the greatest public challenges in the country. The incidence of coronary heart disease in Norway reduced significantly between 1995 and 2010, with about 66% of the reduction due to changes in modifiable risk factors like activity levels, blood pressure, and cholesterol. Mortality reduced from 137 per 100,000 person-years to 65.
Lifestyle diseases