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9 $"%& '()* (++# $"!*%& B<9.8.4E756954<-I?9A32> K9/1./<-324>7E9.E9>/4<F!/8-58E;5>/954:964=45>7 7::750758P <46;922754<-5+:4575:P1.7//E7/495/ <5-83/ E.3?29:3=07//:-29/1.7//-/81.67E.3?29:9/8953:7//:754E;29.769?43:964=45>7 :9>754:9.57FF32> /99//.9E7.7/4</E9.E9>/4<9229.9//4564<46;922/E9.E9>/4<F " 5575:75<7.948AB.>7/ ;/9.48/42246O9.3:<-.6<72+<-.6AB.1> E.4<7/7 2B54587.?B.:75/7/ /422<42>7A7>/3.9.3:?9/1::9.0;.A.4>95?9A32> :?42/.75E3./ D7:7.>5769.<42>9/>754559?1.7/9C57??:7// /0;. ; ;56.7-.E9.436/D69.E-7//69557>7507<7.7/AB.012A/95 ;/? </ /7:/?9>7//54587</3?7>3=072>30323=07<<47 >723.4/1/7AB631: D849595<7.957<8B.7569AB.;/1//5458AB.695?1//.9A32>012753=024< B>7690D849595AB.;/1//9.?-699//156.7/?9/ ?9A32> /9C7///<1// :953=>->3229>/4<7457/9.4A3.:7<7<23EE3= <9.>3=0/ /422A.4>/<7//957:/?1//.9?3/ ? <46;92273=0>3229>/4<7457/9. ;569.<42>7<422>3.6929<9.3=00;.7:01229/E-<9.>7.4564< //29<7-587A.4> AB E-8.;567<A7>/3.9.3:AB.24/98.B57>9.4>3/953=0AD4>457>/4<4/9/9229.AB. & 10 Munthe. C. (2009) Etik grundfrågor och konfliktområden. Ur Folkhälsan som tvärvetenskap möten mellan ämnen. red Andersson. I & Eljertsson. G. Studentlitteratur. 11 Stefan Ackerby. Vad får vi för pengarna? Sveriges kommuner och landsting Socialstyrelsen (2009) Folkhälsorapport Stockholm. 13 Hjärtinfarkter samt utskrivna efter vård för akut hjärtinfarkt Socialstyrelsen

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olkhälsorapport Socialstyrelsen 15 Førebyggelsekommissionen (2009), Vi kan leve længere og sundere. Forebyggelsekommissionens anbefallningar til en styrket förebyggande insats. Ministeriet for sundhet og forebyggelse, Köpenhamn 16 Fair Society, Healthy Lives. The Marmot Review Strategic review of health inequalities in England post Folkhälsorapport Socialstyrelsen. 18 Marmot. M. (2004) Statsusyndromet- hur vår sociala position påverkar hälsan och livslängden. 10

11 /.764/4359.'( ( )95/D>9.4>> :7.=> //3=472AB.1>.458E.38.7:AB.7//?9:B/73=4724/9.57;EE<458 75AB.92389//45AB.75697<9//3?2487/3.4>/@;>AB.1>.458D/9:+3:.B/769A.7: 3:0769;/A3.:7/7<9>353:95Q 42247:9<9.4689@;><-.695A :96>7//9.3=0 AB.<72/7697<23>727:D564809/9. <9.489<72699//3AA95/248/@;><-.6D/9:95248/9<9.4689: E.4<7/E.7>/ A1.6/7/9545A2D/7569B< /.1=>9.489:9229./ // @;>< >75/9CA <42>95;//.1=>5458A7:42@9E324/4>95/D.01275)<95>7A3.>7.93=0 9CE9./9.E-<12A1.6E324/4>+89.AB2@7569AB.> /422> : > /81229.?7.53=087:270127(F&;8959.B7.9/B69/1./422/<-AB.B.@7.A7:42@9.+69/ E16?7.56B624809/9//77:?7561./D6248/3=>-6-<4> AB.> : ><4553.AB.<1.<692/ =07.?9/2B09/F9189.<467.97//F!/B<9. :B6.7<-.695+AB <-.6953=0?7.57< /-1<95A7:42@9E324/4>95+3=0?7.5A7:42@ :96?1//.9AB.:-877//@12<7A-45>3:/9.E-7.?9/:7.>57695+<4>/48AB. <9.489:D=>9/2-87E16?7.56B624809/F " 7/54587.E-?7.5;EE<1C/<422> /422?1// / B624809/4<1/ /9/954E95435D/9:9/8.;56692 IA32>E K7<?9/D6929AB.126.9B<9.29<576FB@678.;56E :96"E.3=95/.96;=9.7.B<9.6B624809/95?275669:B<9.-.:96"+E.3=95/F /; /1.722/-:-587A7>/3.9.3:AB.>27.7.?9A32> /9?7.7@;><-.6+45/9?7.70;. :D=>9/:75@12<45<9/ :96:3/4353=0?.7>3/9A32> /9.E9827. E324/4>7< =00;.:D=>9/<4>/: <4624</42A7>/3.9.+E-<9.>75A.-5 AB <47895;EE1// =472/7.<4AB /4227>/;92277:0122A7>/ A1.6/7/ ? / / 1. 9// >15/ 7// 45>3:/> / >7 <12A1.6/7/ /7? // 45>3:/> E-<9.>7.AB <0127* $ # " ) 95 > : :45/ 4 D69;.3E7 B.> // 95 3=472/.D8809/ 3=0/ /422 3AA95/248 9.<4=9 1. 5B6<156487:95 45/9 /422.1=>2487 <422>3. AB. 7// 5-@1:5 AB < 0127 // A1..9 ><4553..B>9. 4 D69;.3E ;.3E <4>/48 AB.> /422 7// <12A1.6/7/ ;.3E7 45/9 :9. ;/@1:57. > /A =>E16?7.56B624809/ >756457< Palier. B Hälso- och sjukvårdens reformer En internationell jämförelse. SKL Lundberg. O, Åberg Yngwe. M, Kölegård Stjärne. M, Fritzell, J, Vågerö, D & Palme, J. DN-debatt 18 oktober Ibid. 22 Eikemo T. A., Bambra. C. Joyce K. & Dahl.E. Welfare state regimes and income-related health inequalities: a comparison of 23 European countries. The European Journal of Public Health Mackenbach. J.P, Stirbu I, Albert-Jan R. Roskam, A-J. R, Schaap.M.M, Menvielle. G, Leinsalu,M & Anton E. Kunst. A.E. Socioeconomic Inequalities in Health in 22 European Countries. The New England Journal of Medicine

12 24<21586A :?7567:/4648/<9/<47//69/A4559///7.>/7:?756:92275 D921// =06B624809/42;58=75=9. % 3::96AB.B>76>35;:/4357</3?7>3=072>3032AB./7.69E34/4<79AA9>/9.571.>< ?9/7.3=0B<9./7.:15.4>?9/99569-AB.1: E34/4<79AA9>/9.577<7// 69.7/7/;3=045>3:/9.B>7/;EE<187<9//F:75248/F?9/99569 $".--'%1/2 $"."!*#/2%1 %+- <95> AB./ //69/4220B.95A.4>7.9?9A32> /07.<7.4/95.4>/48AB.9/ :954@1:AB.929: A.7:/-.<445/ :-A.4>7.'"<7.695AB.<15/769-/9./ < AB.9//5DAB//?7.5+6<:969224< '%+'-.4< :7/>3: :96'+'-..""'1.:969224< < : ; ::7:969224<21586 B.7//:1/ <1563=>-:-//9/F-/81.6?7.6B624809/F6<6B624809/3:>75E-<9.>7 7<75/45895A32>0123E324/4>9229.7<@;>< /81.6?7.6B624809/15<9.489B6/7295E9."""""4?9A32> <9.489:3/>.458'" :95""475:7.>3=0"4! <9.489;54>7E34/ /81229.?9A32> /-AB.<787/ $"."$1 2'#)-/2% &1:AB./:96: <95>7@;>< '"A-// B>54587<457.9;.9.9/3/727;/84A/9.57AB.0123<-.63:756927<B>769:96+ E.3=95/9509/9.:3/%+H+E.3=95/9509/9.B>54584A ;/3:;/<9=>2769 < ::7.99A/9.'" //B<9.0927E '"H""' 07.?795AB.@;><-.695A <E.36;>/43595< AB.<787/4<9.489 < '"950B ?9A32> 'E.3=95/<7.B<9.-.:3/4 8953:54//"+E.3=95/4H ""'< <9.489'+%E.3=95/:3/ %+'E.3=95/43:8953:54//1.69/81229.AB <1C/:9.4 < :7.>3=03.89:9547::7/7>/3:4H :8953:54// 7::75A7//5458<407.<9.4894AB / B <?9A32> :1.B<9.-.+: :54// <9>353:453:8-./422@;>< ?927/ B8.9AB.<95>@;><-.67::75/789/>7569/07>9//95 ;5675/ <695<-.63:69D58.9A-. 24 Lundberg. O, Monica Åberg Yngwe. M Kölegård Stjärne. M, Björk. L & Fritzell. J. The Nordic Experience: Welfare States and Public Health. Health Equity Studies No 12 - August

13 =0:9. <-.6>.1<7569 >;229 >;557;EE<187 7< 7// /422 <-.6&1:AB.929. >9.:92275 ' : >7 46 7< < AB /422'21569.A-.<9.489+E =0.75>.4>9?1/.9;2/7/1:/.9;2/7/ 07.!+75:7.>+3./;8723=0/3.?.4/ :755324>/?9B>/75:7.>+? >7.A29.7-.>3./7.924<21586 <9.>24895E-1:.9@;><-.6) /9C457/9.AB.45>3:/AB =0A7:42@9E324/4>3=069/3:>722724</427.75>7. 6.4=>9.:9.3=0.B>9.:9.? E-95:9.24?9.72E324/4> 2;/7/ // 69/ 45/ >27./ 7// < :3/1.69/;EE95?7./7//69507.: ;.9.154A !5D// ;/7/1.7//6B624809/95?9.3.E-0;.24?9.72E324/4> >77< /4<:45>54587<@;>< ;.9.4>3:?457/435:96950B : ?;.4/95;5675/ <D58.94@;><-.6953:>;229>;557AB.> AB.1: /9.57/ E34/43595< $"0)*% $"0"!/2% #2*- > B7 9A29/7<9/7//>< <9.A :15:9569/1.3=>-6.7:7/4>7> /9./ <21586AB.4564<469.:96324>7;/? " > "+-. :92275><4553.:969A/9.8D:57472;/? =0:15:968.;56>327 7:/4648/< >7/4359.7//>< /4</:1507.AB.1:.7/; /9 69= //AB./7/9=>95E-69557AB.1: < ;/<9=> /9./ < <46" B>7.:D=>9/2-587::7.9AB.>< AB.:1537<9// ;/? ;EE:951.>42/AB.><4553.:96>3./;/? <21586B>7.;569. E /422""'?7.7:96"+'-.@1:AB./:9695B>5458:96+-.AB.:15:967::7 ;/? //7557/:-//E ><724/9/@;/ < >7.907.>3:?459.7/ B<9.29<576H3=00123/7/4/4>AB.E "PH'95AB.<15/76924< B>769 :96+-.AB.5DAB667E3@>7.:95?7.7:96+'-.AB.A24=>3.::75.1>57.3:69/4<72;/7+ <42>9/9>353:9.8B.+3=0< //><724/9/@;/9.7/-./422"""""63227.<755E3@>7.""" 3=0A24=>3.57AB """ '!587>< AB / Molin. R &Persson- Cavalieri A. Svensk sjukvård i internationell jämförelse Sveriges kommuner och landsting Førebyggelsekommissionen (2009), Vi kan leve længere og sundere. Forebyggelsekommissionens anbefallningar til en styrket förebyggande insats. Ministeriet for sundhet og forebyggelse, Köpenhamn 27 Burström.K. Johannesson. M & Diderichsen.F.The value of the change in health in Sweden 1980/81 to 1996/97. Health Economics

14 9/1.3=>-/3.7> :92275:153=0><4553.;EE29< E.3=95/7<7227 /D6248/.9675?2756;587:153=0>< D8/E.3=95/7<;587:15.7EE3./ :3/;EE9:3/0927E.3=95/7<>< ,$< <9/?9/-.9//012387E:92275>< =0:15/.3/>< <21586 <4553.3< "H%"E.3=95/7<>< AB.<1.<7>/4< B:5?9<1.9/1.95B>5458:96H8-589.A.-5"P-.54<-9/ A455?-69>B5H3=0>27> /81229.B:5?9< /:9/;EE95? /3.7B> <B:5?9<1.95; /9/<-69= // "3= :01228.;EE9.29.3<9.1:.9 <472756/ <4228B.7? >35/ <6CB*B:6B!DDE$EE4 mmol per 6,1 liter 5,9 5,7 5,5 5,3 5,1 4,9 4,7 4, Kvinnor Män 12273=472/D.9295I""K32>0123.7EE3./""/3=>032: 478.7::9/59675<47.7//?236/.D=>9/:45>7.4?9A32> /9.?3//95:95:9.AB.:15 15AB.><4553.3=07//:45>545895AB.?-67>B595E2757.;/3=0/4223=0:96/489.9/1.%"H+ "H3=0"H-.487:153=0><4553.3:;569.B>/4 1/9.?3//959/1.? / B.697? >35/ >5769.9;2/7/A455AB.?9A32>545895>329/9.32< => :15AB.?1//.4587./B..915><4553. #// //:-//3:>7575<1567AB.7//?9>.4<7;/<9=> <0127B<9./ AB.?-67>B595+:9675>< E324/4>/-/81.6?7.76B624809/B>7.3=0: /7859.7/5-83/53.7>/ /4<7/.95695AB.>< ;58=75=9.5;/<9=>2458 " A3.>545895F!569.'"H3=0"H/7295-/9.A75595>27.B<9.6B624809/4-/81.6? Källa: SCB, Undersökningarna av levnadsförhållanden (ULF) SCB (2008) Levnadsnivåundersökningen. 30 Hälso- och sjukvårdsrapport 2009 Socialstyrelsen. 14

15 69/45/9>9//5-8.7AB.?1// E324/4>/-/81.6?7.76B624809/95;5675/789/:15:96 0B8.9E9>/4<9: ;/? B.:15:962-8;/? =0AB.>< :/2487 ;/? ;EE9./D=>/.95695/<1./3:<7.795AB.1:.458F 6FB /9.57/435922@1:AB.929<7.<95>7>< ?1// :54//9/AB.H //9/1.75/729/6B6A722E9."""""4?9A32>545895AB.><4553."H'%-.3=0@1:AB.929 >9.:96456;/ :@1:AB.1.'P3=0""P"B.< /46E //-.>3./7.9(""P".95""P"<7.695-/81.6?7.76B624809/95AB.><4553.4<9.489+"3=0695/3/727 6B624809/95+'E9."""""45<-57.9< :5769E--//3569E27/ AB. 6B624809/953=0E-/.96@9E27/AB.695-/81.6?7.76B624809/95 /7/4/4>95>759E-A29.71//3:7//><4553.+A-.95?1// = /?1//.9: :54//9/AB.69.4> /32> //<95>7>< AB.?1//.7E-/78248/2-587::7.9@1:AB./:96>< (7B6 5/B ;587>< <1569-<12.9=9E/? :.9=9E/A.47:1.// >9:9692+@1:AB./:96:3/< ?2756;587:15I.9=9E/?927867(E.3=95/AB. >< E9>/4<9AB.:15J.9=9E/A.47('.9E9>/4<9%E.3=95/K9/<7.A9: <75248/ 7//;587>< ?9B>/95;5863::3// @1:AB./:960;.3A/7: @3./ 69/I.9E9>/4<9E.3=95/K//07?9<1.7< /<7.51/756;??92/- <75248/?2756;587><4553.+@1:AB./:96:15595I%.9E9>/4<9E.3=95/K9;587>< B8.9;//.1=> ?9< :54//9/7<>< ?9A32> % %6B6 //>12/4227// > AB.23.7/4//2967.>7E1.;/<9=>245895AB >42/ :1.>?7./1.7//126.9A.75>7+E75>7+4/72495>7:951.>42/@7E75>7>< // B / F?1/7F :<9.4893=02756 <9.489:45> ;EE95H% :965967//AB.:-87/7.>/:92275"3=0 2;/9/7<"H/729/AB.7//9675-/9./4879// ?-69:153=0>< / /-015/9675"H/729/:4//4<9.489< <422>3.95AB E34/4<D51.7// 31 Westerling. R. Åtgärdbar dödlighet som en indikator i den folkhälsopolitiska uppföljningen. En undersökning av regionala skillnader i Sverige Statens folkhälsoinstitut R 2008:03 32 Hälso -och sjukvårdsrapport Socialstyrelsen. 33 Nolte E.& McKee. M. The Health Of Nations: Updating An Earlier Analysis. Health Affairs.2008; 27: 34 Resultat från Nationella folkhälsoenkäten Regionala och nationella resultat. Unga personers hälsa Lundberg. O, Monica Åberg Yngwe. M Kölegård Stjärne. M, Björk. L & Fritzell. J. The Nordic Experience: Welfare States and Public Health. Health Equity Studies No 12 - August

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