Heterogeneity and diversity in active and healthy ageing
As illustrated in the previous section, the core of this analysis has placed emphasis on the key statistical differences between the Nordic countries. To a certain extent, examining and understanding gender differences, age group differences, and any gaps uncovered in urban-rural geographies and socio-economic groups have also been considered in order to better grasp the diversity of older adults. In the following, some of the key observations from the analysis are discussed more closely.
When focusing on health and wellbeing, one of the indicators that was examined was self-perceived health, showing how older adults in the Nordic countries rate their own health. Older adults are highly diverse in terms of health status, and perhaps unsurprisingly, self-perceived health tends to decrease as one enters older age. Interestingly, older men rate their health slightly higher than women, while, at the same time, statistics show that women generally live two to three years longer than men in all the Nordic countries. Similarly, as in the rest of Europe, there is a clear connection between health and socio-economic status in the Nordic countries, where older adults with a higher socio-economic standing are generally healthier. Based on our analysis, there is no clear distinction that can be made between urban and rural areas that is common to all the Nordic countries. Rather, opposite tendencies can be seen for instance, when comparing Finland and Norway, where older Finnish adults in cities generally rate their health higher than in rural areas, while the opposite can be observed in Norway.
Another indicator also worth highlighting in the context of health and well-being is the one reflecting how much physical activity is performed outside working time in a typical week, by educational attainment and according to gender and age group. In Europe, for instance, on average 44.5 per cent of people aged 65–74 years spend at least three hours per week on physical activity – perhaps reflecting the additional free time that is available to pensioners (Eurostat, 2020). Denmark and Sweden reported the highest levels of physical activity per week in 2017, with women being more active than men in Sweden, whereas Finland reported a lower percentage with approximately 60 per cent of people aged 65–74 spending at least three hours per week. Data are unavailable for Iceland, but among the four Nordic countries, Norway has the lowest percentage of its older population reporting weekly physical activity, with a slightly higher participation among men. While briefly considered here, it would be relevant to discuss further correlations with socio-economic standing because it is likely that higher levels of education are associated with more time spent on physical activities outside of work.
From the perspective of progress in healthy ageing, several of the indicators examined in the analysis show a positive development over time. For instance, life expectancies have increased in all the Nordic countries and progress can also be seen in terms of improvements in self-perceived heath and long-standing health limitations over the past two decades. To this end, it should be acknowledged that the Nordic countries generally rank relatively high in international and European comparisons for many indicators measuring health status and wellbeing. However, the wealth of indicators available in this domain suggest that active and healthy ageing in the Nordic region is a complex landscape to interpret when it comes to the different countries and the varying regions within them. Aspects such as nutrition, mental health, and social belonging also need to be taken into greater consideration to draw a more complete picture of health and well-being.
Evidently, while additional heterogenous perspectives are needed, socio-economic status remains an important determinant of active and health ageing. Looking at the educational attainment levels among older people in the Nordic countries still provides the fundamental knowledge that there are noticeable differences. Norway, Sweden, and Finland have the highest proportions of older adults who have completed a tertiary degree. Beyond this, there are certain common patterns that can be observed across the countries. First, a trend in the Nordic countries is that women generally have higher educational levels than men. Second, a general pattern that can be observed is that educational levels are higher in urban than in rural areas. This difference is most evident in Iceland where the proportion of older adults who have completed tertiary education is more than twice as high in urban areas than in rural areas. Another indicator used for examining socio-economic status in this study was the at-risk-of-poverty rate. This measure shows noticeable gender differences that can be seen throughout the Nordics, where women in all five countries face a greater risk of poverty than men. Related to this, housing and living conditions show that older adults who live alone generally also face a heightened risk of poverty and social exclusion (Eurostat, 2020). While there are country-specific differences between the Nordic countries, the general trend shows that in most cases those older adults who live alone generally have lower incomes.
In the WHO (2002) framework for active ageing, “active” refers to continued participation in society in different ways, and different indicators measuring social activity, engagement, and participation were analysed as such. The primary intention here was to examine digital literacy in different ways. While the Nordic countries are generally among the top-ranked countries in Europe and the world on several measures of digital literacy in older age groups, cross-Nordic comparisons show great variation among older adults in this regard. One of the aspects influencing digital capabilities is socio-economic status. For instance, the general trend in all the Nordic countries is that older adults with higher educational levels are more frequent internet users than those with lower formal education. Gender differences are also apparent here as women are generally more active internet users than men in the five Nordic countries.
Another measure of activity and participation that was examined, and where a distinction between women and men could be made, is participation in formal or informal voluntary activities as well as in cultural and/or sporting events. Here, men engage more actively than women in all types of voluntary activities in each of the Nordic countries. Yet, when it comes to cultural and/or sporting events, the opposite is seen among women. Observing these trends, what still needs to be elaborated is who these people are and what the main barriers are that prevent some sub-groups of the older population from participating compared to others. Similarly, as reflected across many other indicators, engagement in all types of voluntary and cultural and/or sporting activities decreases with age in all Nordic countries. And, again, educational attainment level is an important determinant influencing how actively one participates in voluntary activities, highlighting the importance of socio-economic factors in understanding the preconditions for active and healthy ageing.
Based on our analysis, we can identify which age and gender groups are advantaged and disadvantaged, but the data for understanding key social determinants for a given indicator or the domain at large will require a next phase. As mentioned, the selection of indicators in addition to those that are available at the national level suggest that there is much to say about how active and healthy ageing in the Nordic region will be constituted as we proceed through the Decade of Healthy Ageing that has been mapped out at the global level.
This study therefore calls for the need to enhance and strengthen a heterogenous approach to using indicators and available data. However, there are challenges in using intersectional analysis as a tool in this context because the application of understandings and perspectives in active and healthy ageing is relatively new to the field. Further intersectional analysis based on cross comparing the data could therefore be followed up in a next phase of these reports. Here, one would for instance be using more detailed classifications of sex and other identity variables to create an intersectional identity matrix that crosses each variable, so that each subgroup can be uniquely classified. In a simplified example, if studying gender and ethnic background, four groups could be created: ethnicity 1 women, ethnicity 1 men, ethnicity 2 women, ethnicity 2 men. What follows is that other variables such as educational attainment, income level, and degree of urbanisation could also be added to the matrix. However, from an analytical standpoint doing so presents considerable complexities for, at least, two reasons. First, the data required to examine these intersections are rarely available at the macro level. Second, the more variables added to the matrix, the smaller the sample of individuals would become because the subgroups created would also be smaller. For example, it can be challenging to find a representative sample of individuals matching many characteristics in rural areas where, due to smaller populations, diversity is smaller. In short, it often requires survey data and more detailed classifications of not just age and gender, but other identity variables. For example, out of the subgroup formed by gender, age can be divided. In the case of active and healthy ageing, the indicators observed in this report suggest highly correlated variables, which makes it difficult to separate the effects of certain variables, which is to say the true effect of a single measure. Another consideration is that it would also be necessary to apply both quantitative and qualitative methods to explore and describe the ageing population from an intersectional perspective. Exploring lived experience through a qualitative lens would add the voices of older adults, in addition to the analysis of the statistical variables.
These limitations of using intersectional perspectives have also been reflected in dialogue with different Nordic actors (see Appendix). Here, it could be observed that while the actors acknowledge the importance of considering heterogeneity in practice, there were no specific actions that targeted an intersectional approach in policy mainstreaming or national level programmes and activities. Based on the inputs provided, intersectionality and heterogeneity in general are considered relevant as an analytic tool, yet there are noticeable variations in how different stakeholders view and understand this analytical framework and its applicability in supporting policy action in the field of active and healthy ageing. Overall, though, the possible contribution of intersectionality remains relevant for policy and practitioners to meet the objectives set forth in the Nordic countries’ national policies and strategies targeting health and welfare in the ageing population.
Next steps for Nordic indicator analysis for Our Vision 2030
As observed, it is not straightforward to determine the main barriers for active and healthy ageing with the currently available data. However, it can be observed that various socio-economic factors are central determinants of active and healthy ageing across the Nordic countries, and there are also noticeable differences according to gender and other background characteristics on several of the indicators examined in this study.
There are a range of institutions from the international level to the municipal that offer indicators spanning topics such as health, pensions, living conditions, and active ageing, among others, and understanding the most important determinants influencing the preconditions for active and healthy ageing is still at an early stage. In line with the challenges addressed in the previous section, this type of analysis would require the availability of Nordic data that can be broken down even further to disentangle the interrelations of different variables, and how different background characteristics intersect. Subsequently, there are several challenges and tools that need to be addressed to obtain a clearer picture for conducting these analyses. These aspects have been covered in the report Indicators for Active and Healthy Ageing in the Nordic Region (2022) and are therefore abbreviated for the purposes here. The findings concluded that the indicators produced by the OECD, ESS, Eurostat, and UNECE show various inconsistencies in terms of geographic and time coverage. Overcoming this is a precondition for successful comparisons, but the gaps in these data pose a great challenge to studying changes over time, and for making comparisons between countries (note that this is not a challenge posed only by Nordic databases, and other indicators produced by other institutions are also outdated). Closer Nordic collaboration and coordination of relevant data at least at the national level will be needed, while also underscoring that data rapidly become obsolete.
In parallel, the coverage of subnational territories (regions and/or municipalities) remains another challenge. It is very seldom that supranational institutions produce indicators that are relevant for active and healthy ageing at the subnational level, except for Eurostat. This is a barrier for making comparisons across regions in different countries because this means that national institutions have the responsibility to produce these indicators and, as such, these indicators differ from country to country.
It is also worth noting that the selected indicators here correspond with many of those set forth by the Nordic Council of Ministers in Our Vision 2030 (Nordic Council of Ministers, 2020). Under the area covering the objectives for a socially sustainable Nordic region, the indicators, while not addressing the ageing population specifically, include Self-rated health, Mortality before the age of 75 from diseases that can be prevented and cured, Proportion of people living at risk of poverty and social exclusion, Social trust and electoral turnout in general elections, and Household cultural expenditure. Alignment between the suggested list of common Nordic indicators alongside those set forth in Our Vision 2030 can strengthen Nordic efforts targeting measures to promote active and healthy ageing across the region. To do so multilaterally but also in the domestic context, cross-sectoral competencies will be needed to use, manage, and apply the indicators. Applying intersectionality and heterogenous approaches will also have to be strategically mainstreamed at the political level.