Prerequisites of health 2020
The mortality rate of working-age people has decreased, but multimorbidity, obesity and mental health issues have increased

12.4.2021 9.59
The mortality rate of working-age people has decreased, but multimorbidity, obesity and mental health issues have increased

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. Unhealthy nutrition is a more significant risk factor for non-communicable diseases than inactivity, alcohol and smoking combined. In 2020, the COVID-19 pandemic, which is not included in the indicators for monitoring sustainable development, also significantly influenced the prerequisites of health. A separate section on the effects of coronavirus on the prerequisites of health has been included in this monitoring text.

Share of Finnish men and women aged over 20 who perceive their quality of life as good has grown in the last decade

Figure: The share of people who rate their quality of life as good. (Source: Finnish Institute for Health and Welfare)

The FinSote National survey of health, wellbeing and service use describes Finnish people’s wellbeing and experiences of social welfare and health care services by region and population group. The survey was carried out for the first time in 2018 and will be implemented at least once every four years in the future. The sample size will be increased to enable monitoring changes at a rough level by county (sample size 3,300/county). FinSote replaces the Regional Health and Well-being Study (ATH) previously carried out by the Finnish Institute for Health and Welfare, which produced data on the general development of the wellbeing of and services for the adult population in the period 2010–2017 by region and population group. However, changes occurring in this phenomenon cannot be investigated in great detail, as the used question has changed compared to the one used in the ATH study.

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.

Figure: Share of people who rate their quality of life as good by region. (Source: Finnish Institute for Health and Welfare)

Finland's current situation

There are major health and wellbeing disparities between regions and population groups in Finland. While there was previously no difference between men and women, women have perceived their quality of life as better than men in the previous five years. 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 education groups in large cities (Kaikkonen et al. 2013). 

Finland's recent development

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. The respondents are aged 20 or over, and the sample of respondents filling out the coronavirus section was 48,400 (2,200/wellbeing services county). The data collection of the section of coronavirus began in September 2020 and will continue until February 2021. The results are based on responses received by the end of November. A decrease in social interactions and an increase in the experience of loneliness is 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 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 factors that influence the background underlying the phenomenon.

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

Figure: Share of overweight men and women per age group. (Source: Finnish Institute for Health and Welfare)

Overweight and obesity data 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.

Figure: Overweight of children and young people by age group and level of education. (Source: Finnish Institute for Health and Welfare)

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 THL as part of the Avohilmo data collection. Children's growth and development are monitored using growth curves.

Finland's current situation

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 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.

Finland’s recent development

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 years old, 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

Figure: THL's age-standardised morbidity index (Source: THL Graphs downloaded from image bank: https://aineistopankki.thl.fi/l/r-nNgmtMkXVx)

THL's morbidity index describes the morbidity of the population in municipalities and regions in relation to the national level. The index is updated annually. The index takes into account seven different groups of illnesses and four different weighting perspectives, which are used to assess the significance of illnesses. The disease groups included in the index are cancer, coronary artery disease, cerebral vascular diseases, musculoskeletal disorders, mental health problems, accidents and dementia. In the index, each disease group is weighted on the basis of its significance for mortality, disability, quality of life and health care costs in the population. Further information about the weight factors. The area index is the weighted sum of sub-indices by disease group. The higher the morbidity in an area, the higher the value of the index. The index value is 100 points in the last year of the time series in the whole country. 

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. 

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

Figure: Share of significant mental strain by age group in the Finnish adult population. (Source: THL FinSote 2018 and Report on FinSote survey results)

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 FinHealth2017 and FinSote2018 surveys, 14 per cent of young people aged 20–54 were experiencing significant mental strain, while the corresponding figure for those aged between 55 and 74 was 8 per cent. Mental strain was reported most by women aged 20–54 (15%). 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. However, according to the FinHealth 2017 survey, more than half of those aged 60–69 still find themselves fully capable of work (Koskinen and Sainio 2018). Differences between men and women were fairly minor. On the other hand, reduced work ability was nearly twice as high in the group with the lowest level of education compared to those with the highest level of education (33% vs. 14 %). 

Based on the Social inclusion and well-being 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.

In the national FinHealth 2017 survey targeting the working-age population, the prevalence of psychological strain was less than 15 per cent. In the Regional Health and Wellbeing Study (ATH) aimed at the adult population, the share was about 10 per cent (Sotkanet 2018, ind. 4355).
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

The Project to co-ordinate the promotion of social inclusion (Sokra) funded by the European Social Fund focused on the most vulnerable working-age people. The aim was to collect data on the inclusion and wellbeing of those not in working life. There is a considerable need for this data, as this is a population group that has not been reached well by other population surveys. The labour market status of the respondents was poor in multiple ways. More than 70 per cent of the unemployed respondents had been unemployed for more than one year and more than 50 per cent of them for more than two years. More than one third of the respondents were employed through rehabilitative work activities, work try-outs or work supported by a pay subsidy.  16.5 per cent were on a disability pension, received rehabilitation allowance or had a long-term illness.

The respondents found it fairly difficult to cope financially and difficulties in meeting basic needs were common. Nearly 60 per cent found it difficult to cover household expenses. This share is high and nearly double of that in the population as a whole. Anticipation of income and future planning were also considered difficult. Only one in three respondents said they knew what their earnings would be in the following year. The majority of the respondents lived in financial uncertainty and were unable to make far-reaching life plans.

The respondents felt that their health was rather poor and long-term morbidity was common. Their perceived health was considerably lower than in other studies covering the entire population. 55 per cent of those who responded to the survey rated their health as average or worse, while the share of the total population was nearly half as low at 28 per cent. Women rated their health as considerably poorer compared to men.

Nearly one in four respondents felt constantly or fairly often lonely. Compared to the entire population, this share is up to three times higher. According to researcher Lars Leemann, feeling constantly or recurrently lonely has been interpreted as one of the most significant signs of exclusion. Loneliness is also linked to diseases that impair functional capacity.

Other observations related to the indicator

The Finnish Institute for Health and Welfare has the main, and the Diaconia University of Applied Sciences partial, responsibility for implementing the Sokra project. The survey was carried out before the activation model for unemployed people entered into force. The questionnaire was filled out by 789 representatives of the target group. The survey is used to develop, among other things, an inclusion indicator to measure the connection between people’s experience of inclusion and their wellbeing. The indicator is needed for purposes such as measuring the effectiveness of services implemented under the Social Welfare Act.

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

Figure: Persons subjected to threats and violence by gender and by the relationship between the perpetrator and victim, 2012–2017, %. (Source: THL statistical report 40/2018 Domestic violence)

The statistical report is the first statistics on domestic violence published by the Finnish Institute for Health and Welfare. The statistics on domestic violence join together previously published statistics on domestic violence. 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 an 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 2017 Gender Equality Barometer (N = 1,678) asked respondents about their experiences of sexual harassment in the previous two years. 38 per cent of women and 17 per cent of men reported having experienced sexual harassment. Those who had experienced sexual harassment mostly reported that the perpetrator was a person they were unfamiliar with (46% of women, 35% of men) or an acquaintance (32% of women, 32% of men). Around one fifth reported that the harasser was a co-worker (20% of women, 21% of men) or a person in their circle of friends (17% of women, 17% of men). A smaller proportion of those who had experienced sexual harassment reported that the perpetrator had been their former spouse or dating partner (6% of women, 4% of men) or current spouse or dating partner (2% of women, 2% of men). When comparing the figures, it should be noted that the same respondent may have experienced various forms of harassment and may have been harassed by more than one person. 

Impacts of the coronavirus pandemic on the prerequisites of health among Finns

The coronavirus epidemic and the related restrictive measures and recommendations have had significant impacts on the wellbeing and living conditions of the population, the service system and the use of services as well as on the national economy. Many of the adverse effects were most pronounced during the emergency conditions in spring 2020, and the situation showed many signs of calming down in the following summer. However, the second wave of the epidemic in autumn 2020 brought along uncertainty, which is reflected in the wellbeing, services and finances of the population. During the epidemic, the mood of Finns does not seem to have changed significantly compared to previous years. However, more mental symptoms have been observed in some groups, such as students, older people and health care staff. The epidemic has affected people’s everyday lives and lifestyles in many ways. E-services and telework have become more prevalent. Social interactions have decreased and many people feel that their loneliness has increased. Sleep difficulties have also been common. Both positive and negative changes have been visible in recreational physical activity and nutrition.

The impacts of the coronavirus epidemic on the daily lives and lifestyles of the population were most pronounced in the spring, when the restrictive measures of the first wave of the epidemic were in force. As a result of the lifting of restrictions, the situation has somewhat stabilised and has been more positive in the autumn compared to the spring. However, if the epidemic situation gets worse and prolonged, there may be an increase in negative effects on people’s everyday lives and the lifestyles harmful to health. The increasingly difficult economic situation in Europe will also be reflected in Finland and, as the epidemic is becomes more difficult and prolonged, the financial problems of the population and related concerns will probably increase at the end of the year.  

The effects of the first wave of the epidemic were more visible as lay-offs than as an increase in unemployment. The lay-offs and unemployment have increased financial problems, and concerns about the sufficiency of earnings have been common. An increase in the need for basic social assistance also indicates financial problems. It appears that the epidemic has particularly weakened the situation of people and families who already struggled with their livelihood before the epidemic. According to social workers, financial problems have been visible in municipalities, for example, as an increase in the need for food aid. Overall, the coronavirus epidemic has had a significant impact on the livelihood and well-being of those whose social situations have already been difficult in various ways before the epidemic. These include people in need of social assistance, mental health and substance abuse rehabilitees, homeless people and working-age people with a foreign background. Many risk groups were excluded from services in the spring or left without services when personal services and group activities were restricted.

From the perspective of the restrictive measures, older people have been in a particularly challenging situation. Restrictions on social contacts have caused loneliness and reduced functional capacity in addition to the interruptions in physical activity and recreational activities. The measures have also hampered the social relationships and interactions of groups such as people with disabilities living alone. Both positive and negative developments have been observed in the wellbeing of children and families. For some, the emergency conditions have led to spending more time together and a less busy lifestyle, but many have faced more mental strain and conflicts. In families with small children, reconciliation of work and family has become more difficult and financial uncertainty has increased. During the restrictive measures, there was a decrease in the use of services by shelters and helplines for the victims of domestic violence. This led to a backlog in service needs, which was reflected in a significant increase in the use of helplines after the spring. Services intended for those experiencing violence have indicated that controlling violence has increased. Victims were more active in seeking assistance for situations of violence using chat services. (Source: THL report 14/2020 Laura Kestilä, Vuokko Härmä and Pekka Rissanen (ed.) Impact of the covid-19 epidemic on wellbeing, the service system and the national economy. Specialist assessment, autumn 2020)

Heli Kuusipalo, Finnish Institute for Health and Welfare