Prerequisites of health 2021
The coronavirus pandemic has impacts on people's overall wellbeing, alongside morbidity

The most common diseases in the population include cardiovascular diseases, musculoskeletal disorders and cancers. An increase in problems related to work ability and the disability of the ageing population of working age reflect the development during the previous decade. Nutrition is a more significant risk factor for non-communicable diseases than inactivity, alcohol and smoking combined.

The share of Finns aged 20 or over who perceive their quality of life as good has decreased

The FinSote National survey of health, wellbeing and service use describes Finnish people’s wellbeing and experiences of healthcare and social welfare services by region and population group. The indicator is clearly linked to the theme of equal opportunities for wellbeing, whose aim is to reduce inequality in health and guarantee everyone with equal and necessary services. While change or development in this area cannot yet be fully assessed by means of this indicator, it will be possible to monitor this development in the future.

Finland’s current situation

There are major health and wellbeing disparities between regions and population groups in Finland. Between 2018 and 2020, the share of those who perceive their quality of life as good decreased by 4 per cent to 56 per cent. For women, the figure fell by 5 per cent and for men by 2 per cent compared to the previous survey round. This has helped level out the wellbeing gap between women and men, but it is worrying that this has happened at the expense of women's wellbeing.  According to many objective indicators, such as the Finnish Institute for Health and Welfare's morbidity index and some indicators of standard of living, there are significant differences between regions and municipalities; however, self-rated wellbeing has been found to vary relatively little between regions (Karvonen 2018). Nevertheless, people in Uusimaa have rated their wellbeing clearly higher compared to the country average. Significant differences have been detected in the comparison of large cities, especially in the areas of self-rated health, lifestyles and work ability. Major differences in health and work ability have also been found between people with different educational backgrounds in large cities. 

Finland’s recent development

Between 2013 and 2018, the share of those who perceived their quality of life as good increased particularly among women. In general, the share of men who perceived their quality of life as good increased as well. In the 2020 measurement, the experienced quality of life deteriorated for both men and women. A contributing factor to the negative development could be the coronavirus pandemic. In 2020, the FinSote survey was made to include a section on the impacts of the coronavirus epidemic on everyday life and the use of services. A decrease in social interactions and an increase in the experience of loneliness was visible everywhere in Finland. However, loneliness has increased most in Helsinki, where approximately 44 per cent of respondents reported feeling increasingly lonely, which is clearly more than in the whole country (32%).

Correspondingly, there are major regional differences in the increase in telework: the average increase in telework in Helsinki during the coronavirus epidemic has been 74 per cent, compared with 48 per cent in the whole country. Many wellbeing problems are more common among people with disabilities compared to the rest of the population. The coronavirus epidemic and the related restrictive measures have further impaired their situation. A larger share of people with disabilities (29%) compared to the rest of the population (22%) reported that their care appointment had been postponed or cancelled since the beginning of March 2020.  Similarly, the coronavirus pandemic has increased a feeling of loneliness among people with disabilities and has impaired their financial situation more compared to the rest of the population. Older people were more likely than other population groups to report that they experienced sleep difficulties and nightmares, and were more likely to have reduced their daily physical activity.

Other observations related to the indicator

Quality of life refers to an individual’s own assessment of their life in the cultural environment in which they live and its specific values, and in relation to their own goals, expectations, values and other things that are meaningful to them. The indicator is based on the WHO8-EUROHIS scale, which is a concise yet multidimensional quality of life indicator covering four dimensions of the quality of life: physical, mental, social and environmental.

Forming a comprehensive picture of the wellbeing of the population requires taking different dimensions and perspectives into account. Objective indicators of living conditions (e.g., unemployment) describe important factors of wellbeing. However, they do not suffice on their own; instead, we also need information on how citizens feel about their lives and social situation. If this aggregating quality of life indicator scores low in some area in relation to the whole country, for instance, it would be a good idea to try and identify the underlying factors behind the phenomenon.

Overweight is becoming more prevalent in all population groups, most among young men

The overweight and obesity data on children and young people are based on height and weight data measured in child health clinics and school health care. The data are transferred to the Finnish Institute for Health and Welfare  as part of the Avohilmo data collection. Children's growth and development are monitored using growth curves.

Overweight and obesity data on adults are based on the height and weight data measured in the FinHealth study.  In adults, overweight and obesity is determined by the body mass index (body mass index BMI >= weight kg/height- m2) (%), i.e., the ratio of measured weight to height with BMI>25 indicating overweight and BMI>30 obesity. Research has shown connections between overweight and the prerequisites of human health. However, weight does not tell everything about someone's health but is a part of the whole.

Finland’s current situation and recent development

Although Finnish people’s health has generally improved for several decades, the increasing overweight and obesity rates are worrying, as obesity is a risk factor for many diseases and reduces quality of life and functional capacity. 

The development of overweight and obesity in children should be monitored and addressed, as childhood obesity is a risk factor for cardiovascular diseases and diabetes, but it is not an independent risk factor. In other words, if an obese or overweight child is not obese as an adult, the risk of illness is the same as for those who have never been obese. The obesity epidemic is made problematic by the continuation of obesity to adulthood. The majority of overweight children are also overweight or obese as adults. An estimated 20 per cent of obese adults were also obese during their childhood.

17 per cent of Finnish girls aged between 2 and 6 and 27 per cent of boys are at least overweight. 4 per cent of girls of the same age and 8 per cent of boys are obese.

Of young adults, i.e., those aged 18–29, at least 35 per cent of women and almost half, or 47 per cent, of men are at least overweight. 19 per cent of women and 17 per cent of men in the age group are obese.

Of Finnish adults aged over 30, 63 per cent of women and 72 per cent of men are at least overweight. 28 per cent of women and 26 per cent of men are obese. Nearly one in two (46%) men and women are abdominally obese.

Other observations related to the indicator

Obesity increases the risk of developing multiple diseases, such as type 2 diabetes, cardiovascular diseases, asthma, musculoskeletal disorders, dementia, depression, sleep apnoea, gout, diseases of the gallbladder and the pancreas, and many cancers.

In addition, obesity may cause menstrual disorders, infertility and complications during pregnancy and childbirth.

The risk of diseases is particularly increased by fat accumulated in the abdominal area and obesity starting early in life. Abdominal obesity is particularly characteristic of metabolic syndrome, i.e., a condition in which one person has several disorders threatening his or her health at the same time.

Obesity and related illnesses reduce a person's quality of life as physical functional capacity and work ability deteriorate.

Morbidity index indicates that the health of Finns will improve throughout the country, but regional differences will become more pronounced

THL’s morbidity index has been prepared as an indicator of regional variation in morbidity and changes in the morbidity of individual regions. As the prevalence of most diseases is considerably different in different age groups, the age structure of the area has a major impact on the level of morbidity. The age-standardised index describes the proportion of differences between regions not resulting from differences in age structures. The previous morbidity index, covering data from 2014 to 2016, was published in 2019.

Finland’s current situation

In a comparison of cities with over 50,000 inhabitants across the country (100 points), the healthiest inhabitants are in Espoo (73 points), Helsinki (81 points) and Vantaa (83 points). The highest morbidity rate is found in Kuopio (129 points), Oulu (115 points), Joensuu (114 points) and Kotka (113 points).

When comparing regions to the whole country (100 points), the population is healthier in Åland (65 points), Uusimaa (83 points) and Ostrobothnia (89 points). The disease rate is highest in North Savo (130 points), North Karelia (122 points), North Ostrobothnia (122 points), Kainuu (118 points) and Lapland (115 points).

Coronary artery disease, musculoskeletal disorders and mental health disorders are the most common in Eastern and Northern Finland. Cancers are slightly more common in the south than in Central and Northern Finland.

Accident rates were highest in Lapland and North Karelia. Cerebral vascular diseases are distributed fairly evenly throughout the country.

Finland’s recent development

“The morbidity rate grows as we move from the south and west to the northeast, and this has been a key feature of Finland’s regional health disparities for over a century by now. Although health has improved throughout the country, regional differences have remained considerable and even become more pronounced”, says Research Professor Seppo Koskinen.

“In the 2000s, morbidity has decreased by 16 per cent in the whole country, by 36 per cent in the ten healthiest municipalities, but only by 5 per cent in the ten municipalities with the highest morbidity rates”, Koskinen continues.

The differences in morbidity are based on reasons related to living conditions, lifestyles, hereditary factors and health care activities. The figures presented are age-standardised, which means that the different age structures of municipalities do not affect the results.

Other observations related to the indicator

THL’s morbidity index brings together data on the prevalence of key national diseases from several national registers. The statistical data are updated annually from the national registers of the Finnish Institute for Health and Welfare, Statistics Finland, Finnish Centre for Pensions, the Cancer Register and the Social Insurance Institution of Finland.

In order to ensure an adequate number of cases, data for three consecutive years have been used to calculate the index for the smallest regional levels. For example, data concerning the period 2008–2010 have been used to calculate the 2010 index. Despite this, random fluctuations in the smallest municipalities have a significant impact on the results. As a result, indices per disease group are only presented for municipalities with more than 2,000 inhabitants. Error margins (confidence intervals) have also been calculated for index values to assess the impact of random fluctuations on index values. Taking error margins into account is necessary when interpreting the results of small municipalities. The disease group-specific indices of all municipalities are available with confidence intervals in the Terveytemme.fi online service.

The results of the dementia index have not been updated for this publication, which covers the period 2014–2016. In 2016, there was a change in the rights for special reimbursement for medicines used for the treatment of Alzheimer's disease, which would make the results incomparable with previous results. Therefore, the results of the dementia index for the period 2013–2015 have been used to calculate the results of the THL morbidity index for the period 2014–2016.

Prevalence of mental strain; mental strain most common among women of working age, least common among men aged over 65

Mental strain affects people's wellbeing and participation, especially when it reserves resources to unused potential and prevents the potential for activities from turning into agency. Mental strain reduces people’s faith in their own opportunities for exerting influence and takes up energy from social engagement. Persons under a lot of stress are also easily excluded from other social life as they spend their resources on primary survival.

Finland’s current situation

Based on the FinSote2020 survey, 17.6 per cent of working-age population aged 20–54 were experiencing significant mental strain, while the corresponding figure for those aged between 55 and 74 was 10 per cent. Mental strain was reported most by women aged 20–54 (18.6%). Around one in four respondents believed that they would not be able to work until retirement age. Work ability has been found to deteriorate with age. Differences between men and women were fairly minor.

Based on the Social inclusion and wellbeing among people outside the working life survey, experiencing strain is considerably more prevalent in this group than the rest of the population. In the survey focusing on mood and anxiety, the share of people with mental strain was 34.5 per cent. Based on a survey with more emphasis on coping with current concerns and tasks, mental strain affected as many as 39.5 per cent of the respondents. The scores of over one third of the respondents in the survey indicated fairly severe mental strain. This share is up to three times higher than the average score of the rest of Finland’s population.

The prevalence of mental strain was nearly 40 per cent in a survey describing topical concerns and coping with everyday tasks. This figure is twice as high as in the FinHealth 2017 survey representing the entire population, in which around 20 per cent of the working-age population reported experiencing mental strain (Suvisaari et al. 2018).

Finland’s recent development

Compared to the previous FinSote 2018 survey, mental strain has increased both at the level of the whole population and people with different educational backgrounds, and between men and women. One reason for the increase in mental strain between two monitoring periods may be the coronavirus, issues related to which were discussed above. Positive mental health had increased slightly among people aged 50–69, whereas it had deteriorated to some extent in the younger age groups.

Threats and acts of violence more likely to be committed by family members than strangers

Domestic violence is described by examining its occurrence in population surveys, the number of clients who have contacted the authorities because of domestic violence, those who have been referred to mediation in criminal and civil cases, and the clients who have used special services intended for the victims of domestic violence, and by the operating models developed for identifying domestic violence. The respondents in the survey included 2,758–3,461 men, 3,354–4,285 women, in total 6,141–7,746 respondents. 

The data in the indicator figure have been obtained from the annual National Crime Victim Survey carried out in Finland. In 2017, a total of 6,222 people between the ages of 15 and 74 who were permanent residents of Finland responded to the National Crime Victim Survey.

Finland’s current situation

According to a crime victim survey, 2.5 per cent of men aged 15–74 and 4.8 per cent of women had been subjected to threats and violence in a relationship.

In the National Crime Victim Survey, a slightly higher share of men than women reported having experienced violence committed by some other person who the victim was more familiar with, taking into account all the forms of violence examined. An exception to this can be found in sexual violence or a threat of it: women reported that they had been subjected to this more often than men, when the perpetrator was someone the victim knew better. There was no difference between women and men in violence by a stranger or a distant acquaintance, considering all forms of violence in total. (Danielsson & Näsi 2018.)

A substantial difference observed between the genders was that women had been the target of violence or threats more often than men in situations where the offender was their current or former partner. With regard to perpetrator groups excluding domestic violence, there were no discernible difference between the genders. It seems that incidents of violence and threats experienced by both men and women in situations in which the offender is their current or former partners have decreased between 2012 and 2017, while violence and threats from strangers has increased.

Finland’s recent development

The prevalence of experiences of violence and threats has remained relatively stable in the period 2012–2017. In nearly all forms of violence, the relative stability of the prevalence of acts over time is a key result. For example, the prevalence of threats has remained at the same level for both men and women during the period under review. The prevalence of physical violence experienced by men decreased between 2012 and 2014 but has remained stable since then. While women have reported less severe forms of physical violence than men, such as grabbing and pushing, there has been no difference between the sexes in experiencing more serious physical violence. There is a clear gender gap in sexual violence: around two per cent of women and less than one per cent of men have reported that they have been subjected to sexual violence or its attempt.

Respondents were asked to share their experiences of violence both during the previous year and of three incidences of violence they have experienced after turning 15 in a study on violence against women carried out in 2012. In the past year, five per cent of Finnish women who responded to the survey had experienced physical or sexual violence committed by their current or former partner and seven per cent by some other person. 31 per cent of Finnish women aged 15 or over had experienced physical or sexual violence during their lives by their current or former partner and 33 per cent by another person.

The coronavirus pandemic, which began in 2020, has probably had an impact on the increase in domestic violence.

“Domestic violence during the coronavirus pandemic among the parents of families with babies and in discussions on the Nollalinja helpline” survey states that 12.3 per cent of all parents with babies who responded by 1 September 2020 reported having experienced intimate partner violence. According to the interim results, there was a link between the impacts of the coronavirus pandemic, which had affected coping, reduced the feeling of intimacy between the spouses and increased the amount of disagreements and conflicts, and the increased occurrence of intimate partner violence. The number of calls made to Nollalinja fell in the spring and has increased significantly since the summer. The number of callers to Nollalinja who had experienced violence for the first time and the number of those who reported physical violence increased during the enforcement of the Emergency Powers Act. In addition, after the state of emergency was lifted, the number of callers who had experienced violence in previous partnerships or other relationships increased. During the coronavirus pandemic, the role of spouses and dating partners as perpetrators of acts of violence became emphasised.