This article is an excerpt from the magazine Nordic Health 2030, which represents a shared agenda on sustainable health inspired by leading decision makers across the Nordic region.
The Shift from Sick Care to Health Care
Demographics and the end of ‘sick care’
The healthcare systems of the Nordic countries, as well as the welfare models that underpin them, are subject to significant and increasing pressure on a number of fronts. This pressure has been created in large part by a combination of demographic trends, posing a challenge to the ‘sick care’ logic that has dominated Nordic healthcare systems for ages.
The population is ageing, with life expectancy now above 80 years of age across the Nordics and an ever-growing proportion of the population aged over 65 (already making up over 20% of the population of the Nordic countries today). Paradoxically, longevity and quality of life can be attributed to the very system now under pressure, as treatment, education, and prevention have served to reduce many incidences of communicable diseases.
It must also be noted that a longer average lifespan does not necessarily equate with good overall health. In fact, with age comes increased susceptibility to non-communicable and lifestyle diseases. Indeed, the rise in non-communicable diseases has been notable in the Nordic countries, accounting for around 90% of disability-adjusted life years (DALYs) in 2016, according to the World Health Organization (WHO).
The number of people working and contributing taxes that feed the welfare system has also shrunk. This can be attributed not only to retirement, but also to health factors like long-term illness and disabilities, as well as to people working fewer hours than in the past and spending more time in formal education and training.
Finally, birth rates in the Nordic nations have either stagnated or fallen, which will have long-term implications for the tax-dependent redistribution systems that are favoured in the region.
While the Nordic healthcare and welfare systems are among the best performing in the world today, each of these trends highlight how their viability could be challenged in the future. Reforms that can both accommodate these developments and mitigate their effects are necessary.
The need for prevention
To ensure the health of Nordic citizens and the sustainability of our healthcare system over the long term, we need to carry out a fundamental shift from services centred on sick care to one that promotes preventive health. By investing in the latter, the potential for return on investment is substantial as costs for treatment should – ideally – decrease in parallel with the reduced number of people requiring treatment. Yet, according to figures collected in 2017 across Denmark, Finland, Iceland, Norway, and Sweden, the total public expenditure on preventive health in the Nordics as a percentage of GDP was only about 0.3%. This contrasted starkly with the 2017 figures for sick care, which amounted to 9.8% of GDP on average.
Today, we are witnessing innovative forms of treatment and the construction of high-tech super hospitals designed for the effective treatment of diseases, but we see little innovation in terms of preventive services. Of course, this is not to say that the super hospital does not have a place in the healthcare system of the future, but it is symptomatic of the long-established tendency to invest in treatment rather than developing preventive health capabilities and awareness among institutions and citizens.
The much-needed transition towards preventive health can enable well-informed citizens, supported by access to tools, data, and relevant information, to remain healthy over a longer period of time, and thereby reduce the growing burden on healthcare systems. While not a panacea for every challenge facing the Nordic welfare states, supporting a transition from sick care to preventive health may provide the best opportunity for creating a healthy, productive, resourceful, and equitable society that enjoys an improved quality of life.
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