This report encompasses health inequalities between socioeconomic groups over the last 25 years in Finland. The data cover time trends in socioeconomic differences in mortality, self-rated health, morbidity, functional capacity, mental health, healthy life expectancy, health behaviours and biological risk factors as well as disparities in the use of health services. Results from earlier studies have been supplemented with unpublished data and new analyses specifically done for this report. The report starts with a review on the causes and explanatory models of health inequalities. After describing the time trends in health inequalities and their determinants, health and social policy measures tackling health inequalities are discussed. The main indicator of socioeconomic position  in this report is education, but social class based on occupation, as well as income and employment status are also used. Information on the workingaged population is most extensive but also children, adolescents and the elderly  have been covered when possible.

Various indicators show that the health of the Finnish population has  improved but socioeconomic health inequalities have generally remained or even widened. It appears increasingly difficult to reach the Health 2015 Public Health Programme goals for reducing differences in mortality by a fifth by 2015. Long-term illnesses are about 50% more common among the lowest educational and other socioeconomic groups than in the highest groups. These differences have slightly decreased among the working-aged but increased among those aged 65 or over. Differences in self-rated health have remained clear during the study period. Differences in functional capacity and self-reported work ability have also remained quite stable over the past two decades. Information  on trends in mental health problems by population groups is scarce, but severe mental disorders continue to be more common in the lower socioeconomic groups. Healthy life expectancy varies according to education even more strongly than life expectancy.

Health related behaviours show large socioeconomic differences especially  among the working-aged, whereas differences in health behaviours among the retired are smaller. Socioeconomic differences in smoking in the workingaged population have widened. Heavy alcohol use and binge drinking are more common in the lower socioeconomic groups. The proportion of adolescents who smoke and get drunk is much higher among students in vocational schools than among students in high schools. Persons in higher socioeconomic groups follow dietary recommendations more often than those in lower socioeconomic groups, although differences in fat and vegetable use have decreased. Physical  activity among the working-aged men has continuously been the most common in the highest socioeconomic groups. Socioeconomic differences in biological risk factors, such as high blood pressure, serum cholesterol and obesity, have remained large.

There are socioeconomic differences in the use of health services that do not fully correspond to the estimated need for care. When need for care is taken into account, people with high income use more occupational health and private practice services than those with lower income. Visits to municipal health centres, however, are more common among those with low income. There are similar differences in the use of dental services, although these have diminished along with dental care system reforms. Little is known about the differences in the use of mental outpatient care by population groups. Hospital  treatment for severe diseases also varies: bypass surgery and angioplasty of coronary arteries, endoprosthesis surgery of knee and hip, and cataract surgery are more frequent in those with high income than those with low income after considering the need for care. The increase in coronary artery procedures in the 1990s levelled out but did not abolish the socioeconomic inequalities.

Reducing health inequalities has been an objective in the Finnish health policy programmes since 1986. In recent years, health inequalities have been increasingly viewed as larger socio-political problems than just a problem of traditional health policy (e.g. in the Government Programmes of 2003 and 2007). However, the evidence on the tools that work in reducing health inequalities is limited. Health impact assessment of political and social measures, required by the Health 2015 public health programme, is only in its first stages and the development of methods for this assessment is on the way. Finnish research on health inequalities, based on population surveys and  registers, is of high quality but scattered, and in need of better co-ordination. Furthermore, it is vital to establish a monitoring system that would serve planning and implementation of health policies and assessment of their goal attainment. Policies should incorporate measures that aim to even out social inequalities, as well as measures that strengthen the prerequisites for a healthy life and facilitate the adoption of healthy lifestyles so that lower socioeconomic groups will approach the levels acquired by the higher groups. The needs of the lower socioeconomic groups should be addressed in all health and welfare policies including planning and provision of services.

Hannele Palosuo, Seppo Koskinen, Eero Lahelma, Elisa Kostiainen, Ritva Prättälä,
Tuija Martelin, Aini Ostamo, Ilmo Keskimäki, Marita Sihto and Eila Linnanmäki (eds.). Health inequalities in Finland. Trends in socioeconomic health differences 1980–2005. Helsinki 2009, 240pp.
Publications of the Ministry of Social Affairs and Health 2009:9
ISSN 1236-2050 (print), ISSN 1797-9854 (online),
ISBN 978-952-00-2804-6 (pb.), ISBN 978-952-00-2805-3 (PDF)