Is Something Rotten in the State of Denmark?

A view of Copenhagen from atop Vor Frelsers Kirke (Our Savior's Church). (Photo by Michael Yudell)

As far as I could tell from three days in beautiful Copenhagen, nothing—to paraphrase Shakespeare—is rotten in the state of Denmark. Well, almost nothing.

With a population of approximately 1.8 million, Copenhagen is a beautiful, immaculately clean city just a tad larger than Philadelphia. It is the largest city in Scandinavia and the capital of one of the richest nations in the world. Yet somehow Copenhagen feels small—its people are welcoming, it has few tall buildings, and its mix of wide avenues and narrow, timeworn streets gives this city a small-town feel.

With low crime and ingrained notions of civic trust (there are no turnstiles and nobody checks for tickets on the Metro) and civic participation (almost 87% of registered voters turned out in the 2007 parliamentary elections), it seems an idyllic place. One of my favorite things about Copenhagen is that well-behaved dogs are welcome on the city’s Metro, you just have to front a child’s fare to get them on.

Another amazing thing about Copenhagen are the bike lanes. There are 217 miles of bike tracks (paved and separated by a curb from the roadway) in Copenhagen, and more than half of Copenhageners ride their bikes to work or school everyday. Oh, yea, and health care is universal, free and considered to be of high-quality.

Yet, for all its successes, Denmark is surprisingly low for Western industrialized nations in life expectancy at birth. Denmark is 48th on the list, at 78.63 years. The United States, also considered low, is right behind at 50th with 78.37 years. For comparison, the tiny country of Monaco is number 1 at 89.73 years, Japan is 5th at 82.25 years, and our friends to our north in Canada are 12th at 81.38 years.

Why, with all of its seeming public health successes—universal health care, exercise as transportation as a norm, and significant wealth—does Denmark find itself struggling in this key health indicator?

Over the past 20 years the Danes’ health status has steadily declined. Danish life expectancy is lower than almost all European nations as a result, in part, of a rise in premature mortality (death at middle age). Causes for this include persistently high smoking rates, a high-fat diet, physical inactivity, and high alcohol consumption.

A recent study authored by scientists at the Danish National Institute of Public Health points to trends in social inequality as playing a significant role in this change. Despite a decrease in overall social inequality in Denmark, the study notes that those at the bottom are increasingly “marginalized to unemployment and less attractive employments.” Furthermore, tobacco may be a cause of increased mortality rates among Danish women with low education, who have shown a dramatic increase in smoking rates since the 1980s.

Health policy makers in Denmark, and in other countries afflicted by such poor health outcomes, have their work cut out for them. The Danish example shows that that even when medical care is high quality and free, disparities in health can persist, and calls attention to the ways in which a medical approach is just not enough. Integrating public health, medicine, and social justice (to redress social inequalities) into policy would be a wise place to start.

I’ll close on a really depressing note: for all of Denmark’s problems in closing its social inequality gap, Philadelphia has a life expectancy of barely 72 years and an ever-widening inequality gap, which has an awful impact on health in our city.

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