Reducing health and wellbeing inequalities supports societal resilience

The strengths of Finnish society have included a high level of trust and relatively small differences in health and well-being. Current developments are overshadowed by an increase in mental health problems among young people, declining work ability among the working-age population, and a growing number of low-income families with children. Preventing and narrowing these differences is important both from a human perspective and for ensuring societal stability and crisis resilience.

“Living in a society with a high level of inequality is unpleasant. The strength of Finnish society has been its high level of trust and sense of community. If these are lost, it will be a loss for everyone,” says Sakari Karvonen, Research Professor at THL.

In Finland, differences in wellbeing and health are still small by many indicators. Life expectancy is high in international comparison, and health differences between low- and high-income groups are relatively small.

However, the overall picture is not very encouraging. There are concerns related, among other things, to young people’s mental health and the decline in the work ability of the working-age population. Loneliness among older people has increased, as has the number of low-income families with children. Reducing homelessness has been a success story, but this positive trend has now stalled.

“The situation of people in vulnerable positions seems to be worsening all the time. It feels as though people are increasingly unable to put themselves in others’ shoes, and individuals are blamed for their own difficult circumstances,” Karvonen says.

Differences in wellbeing and health are persistent and easily transmitted across generations

Internationally, differences in wellbeing and health in Finland may be small, but when viewed internally, they are quite clear and very persistent. For example, differences in mortality between Eastern and Western Finland have been observed for centuries. There is no single comprehensive explanation for these differences. Over time, factors such as migration, agricultural conditions and trade have influenced mortality.

Today, the most significant factor affecting wellbeing and health is a person’s socioeconomic position: the lower the level of education, occupational status and income, the poorer the health.

“World-renowned researcher on health inequalities Michael Marmot has noted that the lower a person’s social position, the higher the risk of, among other things, heart disease, stroke, diseases of the digestive system and HIV infection. The risk of suicide, accidents and violent death also increases,” Karvonen explains.

When it comes to differences in wellbeing, discussions often focus on living conditions, inclusion or participation, sense of community and identity. Stable differences are also evident in all of these.

Education and income affect opportunities for activity and participation as well as social relationships. People with higher levels of education often have different kinds of networks that they can draw on when needed.

“For example, people with a migrant background may have social relationships only within their own community, which can make it more difficult to find employment and integrate into society.”

Poorer wellbeing and health are easily passed on from one generation to the next. Poverty experienced in childhood has long-term effects extending into adulthood, and some studies suggest that infancy is a particularly critical period in this respect.

“Even young children show differences in health. These are linked to living conditions and the resources available to parents. In addition, for example, the use of social assistance is known to be intergenerational. If a family has needed social assistance, their children often need it as well when they reach adulthood.”

Primary health care should be strengthened

Much can be done to reduce differences in health and wellbeing. THL has emphasised that public primary health care should be strengthened. Access to care should be easy regardless of place of residence, and health problems should be treated before they have time to worsen.

“If local services disappear and become fully digitalised, part of the population risks being left outside them,” Karvonen says.

In the long term, reducing inequality between different population groups is more challenging.

In Karvonen’s view, the most important thing would be to halt negative trends.

“The availability of alcohol should not be increased in any way. In addition, the income of low-income groups should not be further weakened, nor should housing arrangements be made more difficult.”

An unstable society is vulnerable in times of crisis

For decades, efforts have been made in Finland to reduce differences in health and wellbeing. The issue has been considered important regardless of the government in power.

Poor health places a burden not only on individuals themselves but also on the health care system. Preventing diseases would make it possible to allocate resources elsewhere.

“There is also a risk that if inequality increases, trust will erode and society will become unstable.”

An unstable society is vulnerable when a crisis occurs.

“Trust strengthens societal resilience. It enables us to cope with different kinds of crises. People need to feel that it is important to defend society. A more hard-nosed reality is that national defence requires healthy soldiers.”