Reading and writing difficulties in adolescence and later risk of welfare dependence. A ten year follow-up, the HUNT Study, Norway

Background: Welfare dependence and low work participation among young people have raised concern in many European countries. Reading and writing difficulties (RWD) might make young people vulnerable to work integration problems and welfare dependence through negative influences on education and health. Our main objective of this study was to examine if RWD in adolescence affected the risk of welfare dependence in young adulthood. Methods: Baseline information on self-reported RWD, health and family was obtained for 8950 school-attending adolescents in Nord-Trøndelag County, Norway, participating in the Young-HUNT1 survey, 1995-97. All individuals were linked to biological parents to identify siblings and parental education from national registers. Welfare dependence was assessed by the reception of social benefits (medical and economic) from the national social insurance database (1998-2007). Only long-term benefits (> 180 days) were included. Results: The adolescents who reported RWD at baseline were more likely to receive medical or social benefits during follow-up compared with those who did not report RWD. In girls with RWD, the adjusted 5-year risk (at age 24 to 28) for receiving medical benefits was 0.20 (95% confidence interval 0.14-0.26), compared with 0.11 (0.09- 0.12) in girls without RWD. In boys the corresponding risks were 0.13 (0.09-0.17) and 0.08 (0.07-0.09). Conclusions: The associations between RWD in adolescence and welfare dependence later in life suggest that increased attention should be paid to these problems when discussing the public health aspects of work integration, since there might be a potential for prevention

Epidemiology and health policy: How to avoid becoming prisoner of the proximate

It goes without saying, epidemiology –the science of distribution of diseases and risk factors in popula-tions–isthebasisforallsoundandrationalhealthpolicy.Politiciansandpeopleinchargeof healthservices will always be looking for data on the needs for health care in the population, particularly in a welfare state where health services are supposed to be provided according to medical needs and not according to wealth, or “demands” in the market. However, there are two obvious challenges for epidemiology in this respect: 1. It must provide evidence relevant to population health and health policy, and 2. Since health policy is also about health promotion and the prevention of disease, knowledge derived from epidemiology needs some extra concerns and considerations: Epidemiological knowledge is based on data from individuals, while sound preventive measures require strategies for populations. This shift in perspective calls for a good understanding of “causes of the causes”, the social determinants for health. There is a risk of being seduced by “the inverse evidence law”, suggesting that the best evidence we have is about the simplest but poten-tially least effective interventions. We have less, or weaker evidence about complex interventions –such as policies. This paradox may lead to the false conclusions that lack of evidence means that there is evidence against an intervention. A true challenge for epidemiology, when providing evidence for health policy, is how to avoid becoming “prisoners of the proximate”

Disability in society--medical and non-medical determinants for disability pension in a Norwegian total county population study

The objective of this study was to describe sociomedical determinants and developments for the medically based disability pension in Norway by linking individual based data from a county health survey to data on disability from the National Insurance Administration. Two cross-sectional total population health surveys with an approximate 10-year interval were conducted in Nord-Trøndelag county, HUNT I (1984-86) and HUNT II (1995-97), which allows for analyses of changes over time, supplied with official incidence data on disability pension. The large-scale variations and overall increasing incidence rates of disability pension in Norway during the last 20 years also applied to the county of Nord-Trøndelag. The prevalence of disability pension generally increased in the population from the mid-1980s to the mid-1990s. A striking finding was a consistent pattern of increasing prevalence of disability pension with decreasing socio-economic status and education. A geographic pattern for disability pension prevalence on a municipality level suggested that structural and cultural factors were important in determining the level of disability in society. Medical determinants alone cannot explain either the dramatic variations or the overall increased incidence rates of disability pension in the last two decades in Norway. The results demonstrate the importance of social, non-medical and contextual determinants for disability pension, how these determinants result in important prevalence differences by socio-economic status, and their impact on the level of disability in society.Disability pension Epidemiology Socio-economic status Cross-sectional studies Social security medicine Norway

Evaluation of National Insurance Advisory Scheme. Subproject 5: Careers of Those Whose Application of Support was Declined, 1994

This project is a part of the project “Evaluation of the Social Security System Counselling”. The aim of this project was to look at what happens next to those who get their application for disability pension declined, considering the main sources of livelihood

Socioeconomic inequalities in health care utilisation in Norway: the population-based HUNT3 survey

Background In this study we investigated the distribution of self-reported health care utilisation by education and household income in a county population in Norway, in a universal public health care system based on ideals of equal access for all according to need, and not according to wealth. Methods The study included 24,147 women and 20,608 men aged 20 years and above in the third Nord-Trøndelag Health Survey (HUNT 3) of 2006–2008. Income-related horizontal inequity was estimated through concentration indexes, and inequity by both education and income was estimated as risk ratios through conventional regression. Results We found no overall pro-rich or pro-educated socioeconomic gradient in needs-adjusted utilisation of general practitioner or inpatient care. However, we found overall pro-rich and pro-educated inequity in utilisation of both private medical specialists and hospital outpatient care. For these services there were large differences in levels of inequity between younger and older men and women. Conclusion In contrast with recent studies from Norway, we found pro-rich and pro-educated social inequalities in utilisation of hospital outpatient services and not only private medical specialists. Utilisation of general practitioner and inpatient services, which have low access threshold or are free of charge, we found to be equitable