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      Socioeconomic characteristics and health outcomes in Sami speaking municipalities and a control group in northern Norway

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          Abstract

          Objectives

          The Sami people constitute an ethnic minority in northern Norway. The objectives of this study were to compare municipalities with a majority of Sami in the population and a control group with regard to socioeconomic factors and health outcome.

          Methods

          Original data from Statistics Norway and Directorate of health on socioeconomic factors (education, unemployment, disability, poverty) and health outcomes [total mortality, cancer specific mortality, cardiovascular disease (CVD) specific mortality] were imported from the “Health Atlas” at the Northern Norway Regional Health Authority (NNRHA) trust. The 8 municipalities in the administration area of the Sami language law (Sami-majority group – 18,868 inhabitants) was compared with a control group consisting of 11 municipalities where the Sami constitute a small minority in the population (18,931 inhabitants). Most data were from 2005 and 2008.

          Results

          There was no significant difference in socioeconomic factors. Overall, cancer- and CVD-specific mortality rates were similar in both groups. The life expectancy was significantly longer among women in the Sami-majority area (81.3 vs. 79.5 years, p=0.035) and males (74.5 vs. 72.0 years, p=0.037).

          Conclusion

          Socioeconomic factors and cause-specific mortality rate were similar in the Sami-majority group and the control group. Residents of both sexes in Sami-majority areas enjoyed longer life expectancy.

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          Most cited references23

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          Income inequality, trust, and population health in 33 countries.

          I examined the association between income inequality and population health and tested whether this association was mediated by interpersonal trust or public expenditures on health. Individual data on trust were collected from 48 641 adults in 33 countries. These data were linked to country data on income inequality, public health expenditures, healthy life expectancy, and adult mortality. Regression analyses tested for statistical mediation of the association between income inequality and population health outcomes by country differences in trust and health expenditures. Income inequality correlated with country differences in trust (r = -0.51), health expenditures (r = -0.45), life expectancy (r = -0.74), and mortality (r = 0.55). Trust correlated with life expectancy (r = 0.48) and mortality (r = -0.47) and partly mediated their relations to income inequality. Health expenditures did not correlate with life expectancy and mortality, and health expenditures did not mediate links between inequality and health. Income inequality might contribute to short life expectancy and adult mortality in part because of societal differences in trust. Societies with low levels of trust may lack the capacity to create the kind of social supports and connections that promote health and successful aging.
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            Decomposition of socio-economic differences in life expectancy at birth by age and cause of death among 4 million South Korean public servants and their dependents.

            Differences in life expectancy at birth across social classes can be more easily interpreted as a measure of absolute inequalities in survival. This study quantified age- and cause-specific contributions to life expectancy differences by income among 4 million public servants and their dependents in South Korea (9.1% of the total Korean population). Using 9-year mortality follow-up data (208,612 deaths) on 4,055,150 men and women aged 0-94 years, with national health insurance premiums imposed proportionally based on monthly salary as a measure of income, differences in life expectancy at birth by income were estimated by age- and cause-specific mortality differences using Arriaga's decomposition method. Life expectancy at birth gradually increased with income. Differences in life expectancy at birth between the highest and the lowest income quartile were 6.22 years in men and 1.74 years in women. Mortality differentials by income among those aged ≥50 years contributed most substantially (80.4% in men and 85.6% in women) to the socio-economic differences in life expectancy at birth. In men, cancers (stomach, liver and lung), cardiovascular diseases (stroke), digestive diseases (liver cirrhosis) and external causes (transport accidents and suicide) were important contributors to the life expectancy differences. In women, the contribution of ill-defined causes was most important. Cardiovascular diseases (stroke and hypertensive disease) and external causes (transport accidents and suicide) also contributed to the life expectancy differences in women while the contributions of cancers and digestive diseases were minimal. Reductions in socio-economic differentials in mortality from stroke and external causes (transport accidents and suicide) among middle-aged and older men and women would significantly contribute to equalizing life expectancy among income groups. Policy efforts to reduce mortality differentials in major cancers (stomach, liver and lung) and liver cirrhosis are also important for eliminating Korean men's socio-economic inequalities in life expectancy.
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              What is known about the health and living conditions of the indigenous people of northern Scandinavia, the Sami?

              Background The Sami are the indigenous ethnic population of northern Scandinavia. Their health condition is poorly known, although the knowledge has improved over the last decade. Objectives The aim was to review the current information on mortality, diseases, and risk factor exposure in the Swedish Sami population. Design Health-related research on Sami cohorts published in scientific journals and anthologies was used to compare the health condition among the Sami and the majority non-Sami population. When relevant, data from the Sami populations in Swedish were compared with corresponding data from Norwegian and Finnish Sami populations. Results Life expectancy and mortality patterns of the Sami are similar to those of the majority population. Small differences in incidences of cancer and cardiovascular diseases have been reported. The traditional Sami lifestyle seems to contain elements that reduce the risk to develop cancer and cardiovascular diseases, e.g. physical activity, diet rich in antioxidants and unsaturated fatty acids, and a strong cultural identity. Reindeer herding is an important cultural activity among the Sami and is associated with high risks for accidents. Pain in the lower back, neck, shoulders, elbows, and hands are frequent among both men and women in reindeer-herding families. For men, these symptoms are related to high exposure to terrain vehicles, particularly snowmobile, whereas for women psychosocial risk factors seem to more important, e.g. poor social support, high effort, low reward, and high economical responsibilities. Conclusions Although the health condition of the Sami population appears to be rather similar to that of the general Swedish population, a number of specific health problems have been identified, especially among the reindeer-herding Sami. Most of these problems have their origin in marginalization and poor knowledge of the reindeer husbandry and the Sami culture in the majority population. It is suggested that the most sustainable measure to improve the health among the reindeer-herding Sami would be to improve the conditions of the reindeer husbandry and the Sami culture.
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                Author and article information

                Journal
                Int J Circumpolar Health
                Int J Circumpolar Health
                IJCH
                International Journal of Circumpolar Health
                Co-Action Publishing
                1239-9736
                2242-3982
                20 August 2012
                2012
                : 71
                : 10.3402/ijch.v71i0.19127
                Affiliations
                [1 ]Northern Norway Regional Health Authority, Bodø, Norway
                [2 ]Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
                [3 ]Department of Oncology, University Hospital of North Norway, Tromsø, Norway
                [4 ]Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
                Author notes
                [* ] Jan Norum, Northern Norwegian Regional Health Authority, N-8038 Bodø, Norway. Email: jan.norum@ 123456helse-nord.no
                Article
                IJCH-71-19127
                10.3402/ijch.v71i0.19127
                3424492
                22901291
                8f362413-6e99-4c6b-9572-5e78b582888d
                © 2012 Jan Norum and Carsten Nieder

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 February 2012
                : 30 May 2012
                : 21 June 2012
                Categories
                Original Research Article

                Medicine
                referral,specialist health care,ethnic minority,sami
                Medicine
                referral, specialist health care, ethnic minority, sami

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