Large health differences between population groups in Norway

New report

There are large health differences between groups of immigrants in Oslo. Compared with Norwegians, the differences are also great. The differences are seen for risk factors and actual diseases. This is shown in a new report from the Norwegian Institute of Public Health. Five of the largest immigrant groups were compared with each other and the ethnic Norwegian population. The report was commissioned in order to target health care better.

The five immigrant groups in this study come from Pakistan, Turkey, Iran, Vietnam and Sri Lanka. There are large differences within the individual groups - in the same way there are large differences in the Norwegian population. Among others, people with a higher education level generally have better health than those with a lower level of education – regardless of birth country.

Here is a selection of the findings:

• Among immigrant groups, men were generally older than the women from same country.
• The age of the immigrants reflects migration history from low and middle income countries to Norway; Pakistanis had the highest average age and Sri Lankans the lowest.
• Men had a higher education than women, particularly among immigrants from Turkey and Pakistan. Iranians, Norwegians and Sri Lankans had a higher education than those from Vietnam, Pakistan and Turkey.
• More men had full time employment than women, and Norwegian men had the highest proportion of full time employment. At the other end of the scale, Pakistani women had the lowest proportion of full time employees.
• More men than women live alone, particularly Iranians and those born in Norway. Among Sri Lankans and Pakistanis there are fewer who live alone.
• Over 90 percent of the immigrants in our study live in Oslo East.

• Those born in Norway reported good health more frequently compared to the immigrant groups.
• Regardless of country of origin, those with the highest education reported good health more frequently than those with little education. This is illustrated by men from Sri Lanka and Turkey with higher education reporting better health than Norwegians with lower education. A similar pattern was observed among Sri Lankan women with high education compared to Norwegian women with little education.
• Women reported musculoskeletal disorders more often than men.
• Diabetes was most common among Pakistanis and Sri Lankans.
• In general, immigrant groups reported more chronic diseases and conditions compared to Norwegians.

• Vietnamese men had the lowest consumption of fruit and vegetables, while Turkish women had the highest consumption. Norwegians were at neither end of the spectrum.
• Men consumed more soft drinks than women, the highest was seen in Turkish men.
• The consumption of full-fat milk was higher in men than women, the highest consumption was observed among Pakistanis and the lowest in Norwegians.
• Immigrants were not as active as Norwegians.
• Smoking habits varied enormously across the immigrant groups. Generally, men smoked more than women, except among Norwegians where women smoked the most.
• Most smokers were observed among men from Turkey and Iran (53 and 42 percent), while fewest smokers were observed among Sri Lankan women (0 percent), Vietnamese and Pakistani women (4 percent), and Sri Lankan men (19 percent).
• Norwegians had the highest alcohol consumption. Over 90 percent of women from Turkey, Sri Lanka and Pakistan consumed no alcohol, or less than once a month. Pakistani men's consumption was low and similar to that of Pakistani women, whereas the consumption was higher in men from Sri Lanka, Vietnam, Iran and Turkey. However, all the immigrant men reported a much lower consumption of alcohol than Norwegian men.
• Obesity is a challenge for Turkish and Pakistani women, as around 50 percent were obese (Body Mass Index >30).
• At the other end of the scale we found Vietnamese men and women with almost no obesity (3-4 percent). Among all immigrant groups general obesity was more frequent in women than in men, but the opposite was seen in Norwegians.
• Abdominal obesity (Waist Hip Ratio >1 for men and >0.9 for women) was most frequently seen in women from Sri Lanka and Pakistan, which fits with their higher prevalence of diabetes.
• Greater proportions of those with high blood pressure were observed among Norwegians and lowest among those from Iran.
• The favourable HDL (high density lipid) cholesterol levels were highest in Norwegians but lowest in Pakistanis and Sri Lankans.

• Women reported more mental distress than men. Turkish and Iranian women (40 percent) reported the most mental distress. The lowest scores were found among Norwegians, especially men. Among the immigrant groups, Sri Lankans had the lowest score, with women in the same range as Norwegian women.
• In all groups, except immigrants from Pakistan and Sri Lanka, mental distress decreased with increasing education.

• Immigrants made a greater number of visits to the general practitioner (GP) and specialists compared to Norwegians.
• Turkish and Iranians visited the psychiatrist/psychologist most frequently.
• Emergency services were used most frequently by those from Turkey and least by the Norwegians.

Our findings show positive aspects for some risk factors among immigrants.

• In all immigrants the low alcohol consumption compared with Norwegians indicates the risk due to this factor will be considerably lowered.
• With the exception of one group the extremely low prevalence of smoking in women will play a great role in reducing the risk for both overall cardiovascular risk and cancer.
• In most immigrants the prevalence of high blood pressure was low compared to Norwegians and this will contribute to a favourable cardiovascular risk profile.
• In some of the immigrant groups their traditional food habits promote a higher consumption of fruit and vegetables and this could contribute to a reduced risk for several chronic diseases.

The data are based on two population based cross-sectional studies carried out in Oslo, Norway.

• Oslo Health Study (HUBRO), 2000 – 2001 by the National Health Screening Service (now the Norwegian Institute of Public Health, NIPH) in collaboration with Oslo Municipality and the University of Oslo.
• Oslo Immigrant Health Study (Innvandrer-HUBRO), was conducted in 2002 by the NIPH and the University of Oslo.