An outlook on Nordic indicators

In this chapter we list a range of institutions at different territorial levels that produce useful indicators for the measurement and definition of active and healthy ageing. The findings show 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.

Statistical indicators and variables focusing on seniors constitute a cornerstone for assessing the current situation, and the change over time, of three relevant domains for this segment of the population across the Nordic region, namely active and healthy ageing, age-friendly cities and communities, and welfare technology. Hence, we have examined and collected indicators from diverse institutions at the international, European, Nordic, national, regional, and municipal level. All the indicators listed in this report offer data disaggregated by age, which helps to identify pressing issues for different age groups of older adults. Age in these indicators is mostly delimited in 5-year intervals, but some of the indicators also offer the possibility to examine age on a 1-year interval.

The reason for listing statistical indicators to examine active and healthy ageing is twofold. First, active and healthy ageing has become a responsibility at all policy-making levels, and therefore, it is important to provide the most comprehensive overview for all actors involved in the topic, ranging from international to municipal policymakers. A second reason is that we aim to establish a comparative perspective not only on what indicators are available for policymakers, but also what indicators are not available. Often, as we will show later, some international or European indicators are not available in all Nordic countries. This, therefore, is an important aspect to highlight if efforts in the Nordic region are to converge around active and healthy ageing.

What are indicators?

When working with conceptual objects, for example, active and healthy ageing, it is necessary to delimit, measure, and operationalise those objects. This is done by using indicators, which are direct or indirect measures of concepts (Bryman, 2012). Indicators can also be used to develop variables such as the old-age dependency ratio, mental wellbeing, or social connectedness, which reflect different characteristics of the concepts under investigation. Indicators not only allow measuring the baseline level of active and healthy ageing and changes over time but can also help stakeholders form a common understanding about what key dimensions should be emphasised in policies and to set objectives in relation to these goals.

International institutions

At the international level, we have found relevant indicators from the OECD, the WHO, and the Institute for Health Metrics and Evaluation (IHME).

Organization for Economic Cooperation and Development

The OECD publishes a biennial report on the pension systems across OECD and G20 countries (OECD, 2019a) and a biennial report on health systems and indicators of health status in the OECD region (OECD, 2019b). In addition, their datasets on health status and health expenditure and financing offer relevant indicators such as life expectancy, causes of mortality, premature and available mortality, perceived health status (broken down also by age and gender and by socio-economic status, communicable diseases, cancer, injuries, and absence from work due to illness) (OECD, 2021).

Table 6 in the Appendix shows these indicators, their demographic breakdowns (age and gender), most recent year of update, and what they exactly measure. There are three important aspects to highlight in relation to these indicators. First, as can be seen in the table, not all the indicators are up to date, and the OECD lacks data for some of the indicators in some countries. For example, Denmark and Finland are the only Nordic countries with at least four OECD indicators available for 2020 (the most recent year of data availability at the time of writing). Iceland has three, and Norway and Sweden only have two. Second, although most indicators are disaggregated by sex, some others, communicable diseases, injuries, and absence from work due to illness are not. Third, most of the indicators do not offer age grouping and therefore they do not properly address the target group of active and healthy ageing. Therefore, the only three indicators that provide age grouping are life expectancy (which is available for the age groups 40, 60, 65, and 80 years old), premature mortality (age group of 75 years old or younger), and perceived health status by age (which offers a range from 45 to 64 years old and an open-ended interval for 65 or older).

World Health Organization

The WHO has published flagship reports on active and healthy ageing such as Decade of Healthy Ageing (World Health Organization, 2020) and Age-friendly environments in Europe (World Health Organization, 2018). In addition, it manages the database Maternal, Newborn, Child and Adolescent Health and Ageing that provides data on morbidity, mortality, integrated care for older people, age-friendly cities and communities, risk factors, healthy life expectancy, healthy ageing, ageism, and long-term care for older people. Among these, the relevant indicators are the incidence rate of falls among older people and the mean body mass index. Falls are a major concern for seniors due to the severe consequences that they might have in their health. Body mass index is relevant to measure the health status of the older population because old people at the extremes of the spectrum have a higher risk of morbidity and mortality due to the consequences of risk factors for non-communicable diseases, malnutrition, and frailty (McKee & Morley, 2021). The WHO data thus offer data on both the incidence rate of falls among older adults and body mass index covering the period 2000–2017 for all five Nordic countries. In addition, the data are broken down by sex and by the following age groups: 60–64, 65–69, 70–74, 75–79, 80–84, 85–89, 90–94, and 95+ years old. Even though the data are comprehensive, they have two notable limitations, namely the obsolescence of the data and the lack of data at the sub-national level.

Institute for Health Metrics and Evaluation

Another relevant source of indicators and publications related to active and healthy ageing is the IHME. The institute is a health research organisation based at the University of Washington School of Medicine and works “to develop timely, relevant, and scientifically valid evidence that illuminates the state of health everywhere” (Institute for Health Metrics and Evaluation, 2021). They conduct the Global Burden of Disease study (GBD), which is “the most comprehensive worldwide observational epidemiological study to date” (The Lancet, 2021). The study examines trends in diseases and risk factors across 204 countries since 1990 and, as such, it “provides an important tool to inform clinicians, researchers, and policy makers, and to promote accountability, and improve lives worldwide” (The Lancet, 2021).

The GBD constitutes a good tool to address many relevant aspects related to health in the Nordics given the good coverage that it provides. For example, all Nordic countries have been part of the study since its inception in 1990 to the last edition in 2019. In addition, it offers data disaggregated by demographic variables such as sex and age groups (55–59, 60–64, 65–69, 70–74, 75–79, 80–84, 85–89, 90–94, and 95+) and it covers the following diseases by showing their prevalence and incidence:

Cardiovascular diseases (strokes, hypertensive heart disease, myocarditis, etcetera.)
Chronic respiratory diseases
Diabetes and kidney diseases
Digestive diseases
Mental disorders (depressive, bipolar, anxiety, etcetera)
Neoplasms
Neurological disorders
Sense organ diseases
Skin and subcutaneous diseases
Substance use disorders (alcohol use, drug use disorders, etcetera)

In addition, the GBD offers the dataset Dietary Risk Exposure Estimates 1990–2019 that provides estimates of 15 dietary risks and the burden attributable to these (Global Health Data Exchange, 2021). All five Nordic countries are represented in those estimates, and data are also disaggregated by sex and gender. The 15 dietary risks are measured as daily individual intake of the following nutrients: calcium, fibre, fruits, legumes, milk, nuts, seafood (omega-3 fatty acids), processed meat, polyunsaturated fatty acids, red meat, sodium, sugar-sweetened beverages, trans fatty acids, vegetables, and whole grains (Institute for Health Metrics and Evaluation, 2021).

Furthermore, in the promotion of active and healthy ageing at local levels, important action is being taken in the form of creating more age-friendly cities and communities. In relation to this, a relevant initiative is the Age-friendly Environments in Europe (AFEE) project. This project was initiated jointly by the European Commission and the WHO Regional Office for Europe to support cities and communities in taking action towards creating more age-friendly environments in Europe (WHO, 2019a). The purpose of the project is to develop tools that allow local and regional authorities to take strong commitments towards becoming more age-friendly and to measure their progress towards this objective. The report Age-Friendly Environments in Europe: Indicators, monitoring and assessments (WHO, 2018), published as part of the AFEE project, describes various tools that cities and communities can use for the tasks of self-assessment, target-setting and monitoring, and recommendations for selecting indicators for monitoring changes over time. The report provides a synthesis of emerging national, European, and international guidance in the field of age-friendly indicators and age-related statistics, from which local governments can draw inspiration to design their own toolbox of indicators, assessment instruments, and information systems.

For example, the list below shows some of the key indicators presented in the AFEE report (WHO, 2018) for measuring the eight domains of age-friendliness.

Outdoor environments
1. Proportion of streets in the neighbourhood with pedestrian paths that meet locally accepted standards (administrative data + field survey)
2. Proportion of public spaces and buildings that are fully accessible by wheelchair (administrative data + field surveys)
Transport and mobility
1. Proportion of people aged 65 years and older who have access to and use public transportation (survey of older residents)
2. Proportion of priority parking spaces at new and existing public facilities designated for older people or people with disabilities (administrative data)
Housing
1. Availability of affordable multipurpose and ageing in place housing options (survey)
2. Proportion of people aged 65 years and older who report feeling safe home alone at night (survey)
Social participation
1. Proportion of older people who report participating in group physical activities in their leisure time (survey)
2. Proportion of older people who enrolled in education or training, either formal or non-formal, in the past year (administrative data)
Social inclusion and non-discrimination
1. Proportion of older people who report feeling respected and socially included in their communities (survey + participation assessment)
2. Age structure of elected community assembly (administrative data)
Civic engagement and participation
1. Proportion of older people who are currently employed (employment statistics)
2. Proportion of older people providing care to children and grandchildren (at least once a week) (local adaptation of European Quality of Life survey)
Communication and information
1. Proportion of older people who report that they know who to call if they need information about health concerns and relevant services in their communities (survey)
2. Proportion of older people living in a household with Internet access at home (administrative data)
Community and health services
1. Proportion of people aged 55 years and older who report no unmet need for medical and dental examination or treatment during the 12 months preceding the survey (Local adaptation of EU-SILC)
2. Availability of low-cost food programmes (e.g., meals on wheels, wheels to meals, food bank) (administrative data + programme information)

These indicators are based on a variety of data sources such as general statistics at the local level, other administrative data, survey data, and participatory assessment methods. These indicators can be used for measuring how age-friendly a city or neighbourhood is, for instance, in relation to aspects such as neighbourhood walkability, accessibility of public transport, safety at home, influence in the local community, and availability of home and community-based services.

European institutions

At the European level, UNECE, Eurostat, and the European Social Survey (ESS) provide a large range of indicators relevant to active and healthy ageing.

United Nations Economic Commission for Europe

UNECE, for example, has developed the Active Ageing Index (AAI), which:

“Is a multidimensional concept referring to a situation where people continue to participate in the formal labour market, engage in unpaid productive activities, and live healthy, independent and secure lives as they age” (UNECE, 2019a: 1)

UNECE’s Active Ageing Index comprises twenty-two indicators grouped in the following four categories:

Capacity and enabling environment for active ageing

Remaining life expectancy (RLE) achievement of 50 years at age 55: RLE at 55 divided by 50 to calculate the proportion of life expectancy achievement in the target of 105 years of life expectancy
Share of healthy life years (HLY) in the remaining life expectancy at age 55: HLY measures the remaining number of years spent free of activity limitation
Mental well-being for older population aged 55+
Use of ICT: share of people aged 55–74 using the internet at least once a week
Social connectedness: share of people aged 55 or more that meet socially with friends, relatives, or colleagues several times a week or every day
Educational attainment: percentage of older persons aged 55-74 with upper secondary or tertiary educational attainment

Employment

Employment rate for the age group 55–59
Employment rate for the age group 60–64
Employment rate for the age group 65–69
Employment rate for the age group 70–74

Independent, healthy, and secure living

Physical exercise: percentage of people aged 55 years and older undertaking physical exercise or sport at least 5 times a week
Access to health and dental care: percentage of people aged 55 years and older who report no unmet need for medical and dental examination or treatment during the last 12 months preceding the survey
Independent living arrangements: percentage of people aged 75 years and older who live in a single household alone or in a couple household
Relative median income: the ratio of the median equivalised disposable income of people aged above 65 to the median equivalised disposable income of those aged below 65
No poverty risk: percentage of people aged 65 years and older who are not at risk of poverty
No severe material deprivation: percentage of people aged 65 years and older who are not severely materially deprived
Physical safety: percentage of people aged 55 years and older who are not worried about becoming a victim of violent crime

Lifelong learning: percentage of people aged 55 to 74 who stated that they received education or training in the four weeks preceding the survey

Participation in society

Voluntary activities: percentage of older population aged 55+ providing unpaid voluntary work through different organisations
Care to children, grandchildren: percentage of older population aged 55+ providing care to their children or grandchildren (at least once a week)
Care to infirm and disabled: percentage of older population aged 55+ providing care to elderly or disabled relatives (at least once a week)
Political participation: percentage of older population aged 55+ taking part in the activities of meeting of a trade union, a political party or a political action group

The rationale behind these groups is that “while the first three domains aim to capture experiences and achievements, the fourth tries to quantify the contextual conditions enabling or hindering active ageing” (UNECE, 2019a). Based on these indicators, UNECE builds its Active Ageing Index from four sources of indicators. These sources are:

the European Union Survey on Income and Living Conditions (EU-SILC),
the European Union Labour Force Survey (EU-LFS),
Eurofound’s European Quality of Life Survey (EQLS), and
the Generations and Gender Programme’s Generations and Gender Survey (GGS)

Although the micro-data of the three first sources is available for researchers, such data are not available for the public and therefore it may be difficult to access the latest versions of the data. However, aggregated data are accessible through Eurostat and Eurofound, and this allowed us to fetch the metadata on these indicators. The AAI has been published biannually since 2010, and Denmark, Finland, and Sweden have participated in all editions. This represents an obvious shortcoming for the purpose of our study because Iceland and Norway are not included in the index and thus the comparability of the indicators is not the most accurate through the Nordics. Nonetheless, we have tried to replicate the AAI using both Eurostat and other sources of indicators at the national level in order to offer a Nordic perspective. The table below summarises the indicators available for each country in these five domains.

Table 1. Indicators in the Nordics by UNECE's domains of Active and Healthy Ageing

Country	Capacity	Employment	Independence	Participation	Total
Denmark	29	4	28	5	66
Finland	25	4	48	10	87
Iceland	17	2	33	4	56
Norway	19	2	30	5	56
Sweden	21	1	46	9	77

We have categorised the indicators based on UNECE’s methodology, and because we are also interested in indicators related to welfare technology, we also address those (note that welfare technology is not included in UNECE’s framework). However, not all countries provide indicators on welfare technology. Therefore, we list below the welfare technology indicators for Sweden and Norway.

In Sweden, Socialstyrelsen (National Board of Health and Welfare) is the source of the indicators, and these are organised around the following five topics:

Welfare technology in municipal health care
Welfare technology in ordinary housing, disabled
Welfare technology in ordinary housing, seniors
Welfare technology in support and service housing
Welfare technology in special housing for the elderly

These indicators are available for municipalities and counties and have been produced for 2021 so far. Socialstyrelsen, commissioned by the government, has been tasked to conduct an annual follow-up of the development of e-health, welfare technology, and digitalisation in social services (Socialstyrelsen, 2021, p. 11). The data stem from a questionnaire distributed by Socialstyrelsen (Sweden) to all 290 Swedish municipalities, and one significant result is that “a relatively large percentage of the welfare technology available to municipalities is in pilot projects (…), aproximately 28 per cent of municipalities report that they have welfare technology in pilot projects for those still living at home” (Socialstyrelsen, 2021: 14). Despite the apparent slow adoption of welfare technology, the questionnarie and the subsequent indicators produced are, to a large extent, comprehensive. Indicators measure the extent to which municipal healthcare has adopted different types of welfare technology. For example, the survey asks if municipalities have adopted digital medical signatures, epilepsy alarms, keyless locks for patients, digital support for physical exercise, or digital medicine cabinets among others.

Helsedirektoratet in Norway also provides indicators for welfare technology through the national patient register (Kommunalt pasient- og brukerregister – Helse- og omsorgstjenester). These indicators comprise the following four topics:

Safety alarms
Mobile safety alarms
Medicine dispensers
Digital visits

These indicators have been available since 2017, and they are available at the municipal, regional, and national level. They measure the number and demographics for each of these four services. For example, data are available for the total number of users, percentage of users by the level of assistance required, by gender, and by age groups comprising 0–17, 18–49, 50–66, 67–79, 80–89, and 90+ years old. In addition, Helsedirektoratet’s national quality indicators (NKI, nasjonale kvalitetsindikatorer) include location technology for people with dementia who live at home. This indicator is available also at the municipal, regional, and national level, but it is not disaggregated by gender or age.

Eurostat

Eurostat’s indicators can be seen in Table 7 in the appendix. They cover, to a large extent, the four domains used by UNECE and provide relatively up to date data. In addition, most of these indicators cover the five Nordic countries and allow for comparisons across the territories. Furthermore, several of these indicators are broken down by sex and age, and this gives the opportunity to examine them in greater detail.

European Social Survey

Another relevant source of indicators at the European level is the European Social Survey (ESS). Started in 2002 the ESS is presented every two years, and the ninth round was published in 2018 (European Social Survey, 2021). Due to the covid-19 pandemic, the fieldwork for the tenth round was postponed and, hopefully, some results will be released in May 2022. Finland, Norway, and Sweden have been the only Nordic countries to participate in each round since the beginning of the survey. Denmark participated in all but one round (2016), and Iceland has participated in only four rounds (2004, 2012, 2016, and 2018).

This survey is a cross-national survey that aims to measure the attitudes, beliefs, and behaviour patterns of European populations, and it includes a set of variables of interest for active and healthy ageing. Among its modules we can find indicators on subjective well-being, social exclusion, and subjective health. In addition, the survey aims to provide a representative picture of the participating countries and thus offers the possibility to filter the results according to several socio-demographic attributes such as age, sex, educational attainment, income, or ethnic background.

Some relevant indicators for the study of active and healthy ageing are the following:

Subjective happiness
Discrimination by age
Living with a partner
Feelings about household’s income
Subjective general health
Hampered in daily activities by illness, disability, infirmity, mental problems
Highest level of education
Main source of household income
Household’s total income
Social meetings with relatives, friends, or colleagues

Nordic databases

At the Nordic level, the two most relevant sources for indicators are Nordic Health and Welfare Statistics (NHWStat) and the Nordic Statistics Database (NSD). NHWStat is the shared website for the Nordic Medico-Statistical Committee (NOMESCO) and the Nordic Social Statistic Committee (NOSOSCO) under the Nordic Council of Ministers (NCM) (Nordic Health and Welfare Statistics, 2021). The purpose of NHWStat is to gather statistics within these fields, to ensure that health and social statistics in the Nordics are comparable, and to present these statistics and make them available (Nordic Health and Welfare Statistics, 2021). As such, Table 2 shows the relevant indicators in NHWStat for active and healthy ageing.

Table 2. Nordic Health and Welfare Statistics (NHWStats)

Indicator	Ages	Gender	Countries available
Social expenditure on old age (in millions of the national currency) by Function, Year, Country, and Expenditure and financing	No	No	Denmark (2007–2017) Finland (2010–2018) Iceland and Norway (2000–2019) Sweden (2010–2019)
New cases of cancer per 1,000,000 inhabitants by Cancer type, Country, Sex, Age group, and Year	55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85-89, 90+	Yes	Denmark, Finland, Norway, and Sweden (2000–2019)
People aged 65+ vaccinated against influenza, per cent by Year, Country, and Type of immunisation	+65	No	Denmark (2010–2019) Faroe Islands (2009–2019) Iceland (2003–2019) Norway (2000–2019) Sweden (2006–2009 and 2011–2019)
Discharges from hospitals after treatment for injuries, per 100,000 of the age group by Year, Country, Sex, and Age	65-79, 80+	Yes	Denmark (2005–2019) Finland, Åland, Iceland, and Sweden (2000–2019) Norway (2008–2019)
Treated patients in psychiatric wards by Year, Country, Sex, and Age	65-79, 80+	Yes	Denmark (2005–2019) Faroe Islands (2011–2018) Finland, Iceland, and Sweden (2000–2019) Åland (2001–2019) Norway (2008–2019)
Compensation rate when receiving old-age pension, retiring at age 65 by Family type, Year, Country, and Income in per cent of average wage in the private sector	65+	No	Denmark, Finland, and Sweden (2007–2019) Iceland (2017–2019) Norway (2011–2019)
Compensation rate when receiving old-age pension, retiring at age 67 by Family type, Year, Country, and Income in per cent of average wage in the private sector	65+	No	Denmark, Faroe Islands, Finland, Norway, and Sweden (2007–2019) Iceland (2017–2019)

The low number of relevant indicators provided by NHWStat is largely due to the fact that they are not from a primary source, meaning that the indicators are obtained from secondary sources such as national statistics institutes (NSIs), patient registries, and public health authorities. As such, each of these sources might use different methodologies to measure different indicators, and therefore the number of comparable indicators is limited. Another constraint found in these indicators is the time availability. Although covering long periods of time, the fact that they stop at 2019 make them obsolete at the time of writing this report. Nonetheless, an advantage of this database is that self-governed territories such as Åland, the Faroe Islands, and Greenland are to some degree included in them.

The other relevant database mentioned above, the NSD, “is a collection of comparative Nordic statistics which has existed and been funded by the Nordic Council of Ministers since the mid-1960s” (Nordic Co-operation, 2021). Similarly, as with NHWStat, the data for the NSD are gathered from national statistics institutes, Eurostat, OECD, and the UN, and the aim of the NSD “is to support the work of the Nordic governments and the Nordic region parliamentarians in creating joint solutions that benefit citizens in the Nordic countries” (Nordic Co-operation, 2021). Therefore, the number of indicators is also limited, but these are nonetheless relevant for active and healthy ageing (Table 3).

Table 3. Nordic Statistics Database

Indicator	Ages	Gender	Countries available
Relative median income ratio 65+ by sex, reporting country, and time	+65	Yes	Denmark, Finland, and Sweden (2004–2020) Greenland (2004–2019) Iceland (2004–2018) Norway (2004–2019)
Risk of poverty by sex, reporting country, age, and time	+65	Yes	Denmark, Finland, and Sweden (2004–2020) Iceland (2004–2018) Norway (2004–2019)
Total number of pensioners by reporting country, age, unit, and time	55-59, 60-62, 63-64, 65-66	No	Denmark, Finland, Iceland, Norway, and Sweden (2013–2017) Faroe Islands (2015–2017)
People aged 65+ living in institutions or service housing by time, unit, reporting country, and age	65-74, 75-79, 80+	No	Denmark (2000–2005, 2008–2014, and 2016) Faroe Islands (2003–2008, 2010, 2012–2013) Finland (2000–2016) Iceland (2000–2014) Norway (2000–2008, 2010–2014, 2016) Sweden (2000–2007, 2008, 2011–2016)
Life expectancy by time, reporting country, age, and sex	65	Yes	Denmark (1974–2020) Faroe Islands (1985–2019) Greenland (1977–2018) Finland (1980–2020) Åland (1990-2010, 2011–2019) Iceland (1961–2020) Norway (1960–2020) Sweden (1968–2020)

Similarly, the time coverage of NSD indicators is limited in most cases. Moreover, some of them present time gaps that would cause some loss of quality for longitudinal comparisons.

National statistics institutes

To establish what indicators and data are available at the national level from the Nordic countries, we have explored the national statistics institutes (NSIs) in each of the countries as well as some national agencies addressing some of the issues related to active and healthy ageing.

To show the availability of indicators at different levels of policymaking, Table 5 in the Appendix shows the number of indicators available at each territorial level. Some methodological considerations should be addressed here because the definitions of regional statistics vary depending on the body providing the indicators. While international, European, and national institutions provide data at the national level, they often also provide data at the regional level. This is the case, for example, with Eurostat and the NSIs. Eurostat has its own hierarchical system for dividing up the European territory (nomenclature) into territorial units for statistics (NUTS), and it is divided into three levels: NUTS1, NUTS2, and NUTS3. The first group of units (NUTS1) covers major socioeconomic regions, NUTS2 covers basic regions and, NUTS3 covers small regions (Eurostat, 2021). The coverage of basic regions in the Nordics shows why it can be problematic to use these data as they do not correspond to the usual political division of countries. For example, Denmark is the only country where basic regions and political regions are the same (Hovedstaden, Sjælland, Syddanmark, Midtjylland, and Nordjylland). In Finland, Iceland, Norway, and Sweden, Eurostat’s basic regions are an amalgamation of political regions in these countries, and thus we find here a challenge for statistical comparison. This could be solved by including NUTS3 data, which, at least in Finland, Norway, and Sweden, correspond to political regions. However, data at NUTS3 level are very scarce and we have not been able to find any relevant indicators at this level.

Another consideration is that different institutions within a country may provide data using different territorial categorisations. For example, in Norway, Statistics Norway (NSI) offers data on lifestyle habits in six regions that do not correspond to Norwegian political regions, but the Health Directorate (Helsedirektoratet, Norway) offers data on welfare technology in all Norwegian political regions. Therefore, although data are regionalised, they should be treated with care when comparing the availability of indicators because they may not refer to the same territorial division.

A final consideration refers to the degree of urbanisation data, which are provided by Eurostat. These data cover three different territorial typologies: cities (densely populated areas), towns and suburbs (intermediate density areas), and rural areas (thinly populated areas). This classification is based on the share of local population living in urban clusters and in urban centres and provides an analytical and descriptive lens on urban and rural areas.

Regional and municipal indicators

The availability of statistical indicators, and their comparability when these indicators are compiled, at subnational levels is significantly reduced when compared to national and supranational levels. One of the advantages of supranational institutions such as the WHO, OECD, and Eurostat is that their data are comparable across countries. Nonetheless, as we have discussed, the disadvantage is that these data do not comprise regions or municipalities. Data at the subnational level are often provided by ministries or public authorities such as the Finnish Institute for Health and Welfare (THL), the Norwegian Directorate of Health (Helsedirektoratet), or the Swedish National Board of Health and Welfare (Socialstyrelsen), but also by NSIs.

Denmark

For example, Statistics Denmark offers regional and municipal data on the following indicators:

Clients in nursing dwellings
Disposable income
Educational attainment
Free choice of dwelling and average waiting time for nursing homes
Gender equality indicator of activity and employment rates
Gender equality indicator of persons referred to home care
Home care, free choice (provided hours per week) by type of benefits
Home care, free choice (referral hours per week) by type of benefits
Income for people (14 years+) by type of income
Places in social measures (nursing homes, protected dwellings, private nursing homes, etc.) by number of places
Public health insurance expenses
Recipients of home care
Recipients of home nursing
Recipients of national old age pension
Recipients of preventative home visits
Recipients referred to home care, nursing homes/nursing dwellings

These indicators are disaggregated by sex and age group intervals and are up to date. They include both regions, provinces, and municipalities. The following two indicators are only available at the municipal level:

Quality of life
Recipients of rehabilitation and maintenance rehabilitation

Finland

In Finland, Sotkanet is the statistical information service that offers key population welfare and health data from 1990 onwards in all Finnish municipalities (Finnish Institute for Health and Welfare, 2021). As such, it provides the following list of indicators at the regional level that are relevant to active and healthy ageing:

Alcohol mortality among population aged 65 and over per 100 000 persons of same age
Average trust in decision-making in the municipality on a scale of 1–5, age 65 and over (years 2013-2016)
Daily smokers (per cent), age 65 and over
Daily smokers (per cent), age 75 and over
Great difficulties in walking 500 meters (per cent), age 65 and over
Great difficulties in walking 500 meters (per cent), age 75 and over
Great difficulties in running 100 m (per cent), age 65-74
Leisure-time physical inactivity (per cent), age 65 and over
Leisure-time physical inactivity (per cent), age 75 and over
Mortality from accidental falls among population aged 65 and over per 100 000 inhabitants
Obesity (Body Mass Index BMI ≥ 30 kg/m²) (per cent), age 65 and over
Participating in activities organised by associations, etc. (per cent), age 65 and over
Participating in activities organised by associations, etc. (per cent), age 75 and over
People who have great or greater difficulties in taking care of themselves, over 75 years old (per cent)
Persons who are satisfied with the safety of their neighbourhood (per cent), age 65 and over (years 2013-2016)
Persons who are satisfied with the safety of their neighbourhood (percent), age 75 and over (years 2013-2016)
Persons who do not receive adequate assistance (percent), aged 65 and over
Persons who do not receive adequate assistance (per cent), aged 75 and over
Persons who feel themselves lonely (percent), age 65 and over
Persons who feel themselves lonely (per cent), age 75 and over
Persons who rate their quality of life (EuroHIS-8) as good (per cent), age 65 and over
Persons who rate their quality of life (EuroHIS-8) as good (per cent), age 75 and over
Self-rated deterioration of work ability (per cent), age 65 and over
Self-rated health moderate or poor (per cent), age 65 and over
Self-rated health moderate or poor (per cent), age 75 and over
Severe mental strain (per cent), age 65 and over
Severe mental strain (per cent), age 75 and over
Suicide mortality among population aged 65 and over per 100 000 persons of same age
Persons experiencing poor memory, over 75 years old (per cent)

At both the regional and municipal level, the following indicators are available:

Assistive technology, number of devices handed out during the year (from 2006 to 2014)
Average retirement age
E-service appointments, per cent of outpatient appointments in primary health care
Hospital inpatient care for substance abuse, care periods for clients aged 65 and over per 1000 persons of same age
Mortality among population aged 65 and over per 100 000 persons of same age

Periods of care arising from accidental falls for those aged 65 and over per 10 000 inhabitants of the same age

At only the municipal level, we find the following indicator:

Living alone, population aged 75 and over, as per cent of total dwelling population of same age

Iceland

In Iceland, Statistics Iceland provides the following two indicators at the regional level:

Educational attainment of the population according to ISCED 2011 from 2003 to 2019, percentage distribution (Hagstofa)
Elderly households receiving municipal home-help service by type, sex, and age from 2004 to 2019 (Hagstofa)

Additionally, the Directorate of Health publishes statistics at both the regional and municipal levels through the Regional Public Health Indicators 2021 factsheets (Icelandic Directorate of Health, 2021a) and Public Health Dashboard (Icelandic Directorate of Health, 2021b) (Mælaborð lýðheilsu, in Icelandic).

The factsheets list up to 44 public health indicators by each of the 7 Icelandic health districts: the Metropolitan area (Höfuðborgarsvæðið), the Southern Peninsula (Suðurnes), the Western Region (Vesturland), the Western Fjords (Vestfirðir), the Northern Region (Norðurland), the Eastern Region (Austurland), and the Southern Region (Suðurland). Nonetheless, only two of these indicators are disaggregated by age and none of them offer gender differences:

Waiting list for a nursing spot for people aged 67+
Multidrug use for people aged 75+

On the other hand, the dashboard is a visualisation tool that allows to consult public health indicators related to lifestyle, health, and others, both at the regional and municipal levels. However, the indicators in the dashboard are disaggregated by gender but not by age.

Norway

In Norway, besides Statistics Norway (SSB), another institution producing regional and municipal statistical indicators is the Norwegian Directorate for Health (Norwegian Directorate of Health, 2021). The Directorate of Health manages both the Norwegian Health Statistics Bank (Norwegian Institute of Public Health, 2021) and the Municipal Health Statistics Bank (Folkehelseinstituttet, 2021).

Indicators focusing on the regional level include:

Educational attainment (NHC) – percent, age standardised (Norwegian Health Statistics Bank)
Level of functioning (per cent) by type of disability, age, region, contents, and year (SSB)
Lifestyle habits (per cent) by living habit, age, region, contents, and year (SSB)
Symptoms of health problems and use of medication (per cent) (SSB)
Need for care and unmet need for health services (per cent) (SSB)

Indicators covering both regions and municipalities include:

Primary health service per 1000, standardised (Municipal Health Statistics Bank)
Mortality, early death per 100,000, standardised (Municipal Health Statistics Bank)
Educational attainment (per cent), age standardised (Norwegian Health Statistics Bank)
Level of functioning (per cent), by type of disability, age, region, contents, and year (SSB)
Lifestyle habits (per cent) by living habit, age, region, contents, and year (SSB)
Symptoms of health problems and use of medication (per cent) by symptom, age, region, contents, and year (SSB)
Need for care and unmet need for health services (per cent) by type of care, age, region, contents, and year (SSB)
Location technology for people living at home with dementia (Norwegian Directorate of Health)
Location technology (GPS) (Norwegian Directorate of Health)
Electronic medication support (Norwegian Directorate of Health)
Digital surveillance (Norwegian Directorate of Health)
Security alarms (Norwegian Directorate of Health)

Sweden

In Sweden, up to five institutions provide statistical indicators at the regional and municipal levels. Besides the already mentioned Eurostat, Socialstyrelsen, and Statistics Sweden (SCB), these include Kolada (Kolada, 2021) and the Public Health Agency of Sweden (Public Health Agency of Sweden, 2021). Kolada is an open and free database for Swedish municipalities and regions. It allows comparisons and analysis in the municipal sector through the 5,000 statistical indicators they publish. Eurostat, Socialstyrelsen, and SCB offer some indicators that only cover regions. These are:

Life table by age, sex, and NUTS 2 region (Eurostat)
Life expectancy by age, sex, and NUTS2 region (Eurostat)
Causes of death - crude death rate by NUTS 2 region of residence (Eurostat)
Cause of Death Statistics, Age: 60-95+ (Socialstyrelsen)
Number of new cancer cases per 100 000 persons (crude rate), Age: 60-85+ (Socialstyrelsen)
Number of participants in folk high school courses by rate of study for the course, region, where the course is held, type of course, year, sex, and age group (SCB)

Indicators covering both regions and municipalities are provided by SCB, Kolada, and the Swedish Public Health Agency and include the following:

Sickness and activity compensation by age, sex, region, and year (Public Health Agency of Sweden)
Level of education by age, sex, region, and year (Public Health Agency of Sweden)
Fall accidents among those 65+ years, by sex, region, and year per 100 000 individuals (Public Health Agency of Sweden)
Satisfied Citizen Index - Elderly care (Kolada)
Fall injuries among people 80+, number/1000 (Kolada)
Cost of home care elderly care, SEK/individual 65+ (Kolada)
Residents 65+ who have been recipients of health and medical care for which the municipality is responsible (home health care), share (Kolada)
Life expectancy by region, period, and sex (SCB)
Population 16-95+ years of age by region, level of education, year, age, and sex (SCB)
Number of persons by household status, region, year, age, and sex (SCB)
Disposable income for households by region, type of household, age, observations, and year (SCB)
Number and percentage of persons by region, sex, age, observations, year, and type of housing (SCB)
Long-term income by region, region of birth, type of household, and age, equalised disposable income (SCB)
Low at-risk-of-poverty rate and high economic standard by region and age (SCB)
Total earned income, mean income for persons registered in the national population register during the whole year by region, age, year, and sex (SCB)
Self-employed 16+ (by type of work) by region, age, sex, and year (SCB)
Population 16-74 years of age by region, highest level of education, age, and sex. Year 1985–2020 (SCB)

In addition to these indicators, the Swedish Board of Health and Welfare has produced in 2021 the first survey for municipalities and regions specifically targeting welfare technology (National Board of Health and Welfare, 2021). The survey covers five areas:

Welfare technology in municipal health care
Welfare technology in ordinary functional housing
Welfare technology in ordinary housing for the elderly
Welfare technology in support and service housing
Welfare technology in special housing for the elderly

The survey asks both municipalities and regions if they have the following range of items for each of these areas:

A chat function for communication between individuals and social workers in elderly care
Digital medicine signature
Drug dispensary
Electronic planning tool for staff
Epilepsy alarm
Keyless locks for home care patients
Incontinence detectors
Other medical equipment
Digital support for physical exercise or activation
Digital supervision during the day
Coordinated individual plan with video when patient is discharged
Coordinated individual plan with video on other occasions
Other technology
Digital medicine cabinets
GPS alarms
Support for digital purchases in ordinary functional housing
Digital communication between individuals or relatives
Night supervision with digital technology
Internet access for the individual

Common Nordic indicators

In this chapter, we provide the existing indicators at different territorial levels, ranging from international to municipal indicators. However, we have found that there is currently no existing list of indicators that are common to all Nordic countries. While NHWStat and the NSD (see sub-section “Nordic databases”) are an attempt to provide Nordic indicators, they do not cover all aspects of active and healthy ageing, and most of the indicators are not up to date. Hence, we have here listed the indicators that based on our scanning of the data were up to date and covered all Nordic countries at the time of writing.

Table 4 classifies the indicators produced by Eurostat, the OECD, the ESS, and the UNECE based on the thematic domains of healthy ageing and wellbeing, socio-economic status, and social activity, engagement, and participation. These domains are inspired by UNECE’s and the WHO’s conceptualisations of active and healthy ageing (UNECE, 2019a; WHO, 2020).

Table 4. Nordic common indicators for Active and Healthy Ageing

Thematic areas/domains	Indicator	Source
Healthy ageing & well-being	Health status by degree of urbanisation	Eurostat
	Life expectancy	Eurostat
	Healthy life years at 65	Eurostat
	Life expectancy at 65	Eurostat
	Life table by age, sex, and NUTS 2 region	Eurostat
	Life expectancy by age, sex, and NUTS2 region	Eurostat
	Causes of death – crude death rate by NUTS 2 region of residence	Eurostat
	Average rating of satisfaction by domain, sex, age, and educational attainment level	Eurostat
	People having a long-standing illness or health problem by sex, age, and degree of urbanisation	Eurostat
	Self-perceived health by sex, age, and degree of urbanisation	Eurostat
	Self-perceived long-standing limitations in usual activities due to health problem by sex, age, and degree of urbanisation	Eurostat
	Self-reported unmet needs for medical examination by sex, age, main reason declared, and degree of urbanisation	Eurostat
	Self-reported unmet needs for dental examination by sex, age, main reason declared, and degree of urbanisation	Eurostat
	Self-perceived health by educational attainment	Eurostat
	Self-perceived health by income quintile	Eurostat
	Persons performing physical activity outside working time by duration in a typical week, educational attainment level, sex, and age	Eurostat
	Time spent on health-enhancing (non-work-related) aerobic physical activity by sex, age, and educational attainment level	Eurostat
	Self-reported long-standing illness or health problems, by age class	Eurostat
	Obese people aged >65 years, by sex	Eurostat
	Self-reported depressive symptoms, by sex and age class	Eurostat
	People aged ≥65 years who ate fresh fruit daily, by sex	Eurostat
	People aged ≥65 years who ate vegetables daily, by sex	Eurostat
	People aged ≥65 years who consumed alcohol at least once a week, by sex	Eurostat
	People aged ≥65 years who smoked tobacco products on a daily basis, by sex	Eurostat
	People aged 65-74 years spending at least three hours per week on physical activity outside of work, by sex	Eurostat
	Adults aged 65 and over rating their own health as fair, bad, or very bad, by income, European countries	OECD
	Limitations in daily activities in adults aged 65 and over, European countries, 2017 (or nearest year)	OECD
	Mental well-being	AAI 2018
	Remaining life expectancy at 55	AAI 2018
	Share of healthy life expectancy at 55	AAI 2018
	Subjective happiness	ESS
	Discrimination by age	ESS
	Lives with husband/wife/partner at household grid	ESS
	Feeling about household's income nowadays	ESS
	Subjective general health	ESS
	Hampered in daily activities by illness/disability/infirmity/mental problem	ESS
Socio-economic status	Population by educational attainment	Eurostat
	Population by educational attainment level, sex, age, and degree of urbanisation (%)	Eurostat
	Educational attainment	AAI 2018
	Material and social deprivation	Eurostat
	Severe material deprivation	Eurostat
	Inability to make ends meet	Eurostat
	At-risk-of-poverty rate	Eurostat
	Self-reported unmet needs for specific health care-related services due to financial reasons by sex, age, and degree of urbanisation	Eurostat
	Persons at two-fold risk of poverty by age and sex - experimental statistics	Eurostat
	Performing (non-work-related) physical activities by sex, age, and income quintile	Eurostat
	Disposable incomes of older people (incomes of people aged over 65, % of total population incomes)	OECD
	Income inequality by age: older vs. total population	OECD
	Income poverty rates by age and gender	OECD
	Highest level of education	ESS
	Main source of household income	ESS
	Household’s total net income, all sources	ESS
	Distribution by type of household of people aged ≥65 years, by sex, 2018	Eurostat
	People living in under-occupied dwellings, by age class, 2018	Eurostat
	People aged ≥65 years living alone, by tenure status, 2018	Eurostat
	Housing cost overburden rate ≥65 years and by sex	Eurostat
Social activity, engagement, and participation	People never having used a computer, by age class, 2008 and 2017, and by sex	Eurostat
	Digital skills of people, by age class	Eurostat
	Internet communication activities of people, by age class	Eurostat
	Did not use the internet in the previous three months, by age class	Eurostat
	Individuals – internet activities	Eurostat
	Use of ICT	AAI 2018
	Social connectedness	AAI 2018
	Frequency of getting together with family or relatives, by age class	Eurostat
	Frequency of getting together with friends, by age class	Eurostat
	People without anyone to discuss personal matters with, by sex and age class	Eurostat
	People without anyone to ask for help, by age class	Eurostat
	Participation rate in education and training (last 4 weeks), by sex and age	Eurostat
	Participation in formal or informal voluntary activities	Eurostat
	Individuals using the internet for voting	Eurostat
	Participation rate in education and training (last 4 weeks), by sex, age, and degree of urbanisation	Eurostat
	Volunteer activities	AAI 2018
	Caring for children and grandchildren	AAI 2018
	Political participation	AAI 2018
	People aged 65-74 years participating in cultural and/or sporting events, by sex (% participating at least once in the previous 12 months)	Eurostat
	People aged 65-74 years performing artistic activities, by sex	Eurostat
	Participation in tourism for personal purposes, by age class	Eurostat
	Employment rates by sex, age, and citizenship (%)	Eurostat
	Employment rate 55-59	AAI 2018
	Employment rate 60-64	AAI 2018
	Employment rate 65-69	AAI 2018
	Employment rate 70-74	AAI 2018
	Current normal retirement age by gender	OECD
	Social meetings with relatives, friends, or colleagues	ESS

This list features indicators from different sources, and it covers all aspects of active and healthy ageing. The boundaries between the thematic domains are not always clear as some of the indicators may fall in one or another domain depending on how they are interpreted. This is the case for employment, for instance, which we have included in social participation. We have done so because, despite being a central aspect of socioeconomic status, employment per se says more about how active a group of the population is than it says about their socioeconomic status. Even clearer examples, perhaps, are education attainment and social participation. While the first is a clear indicator of socioeconomic status, the second is a clear indicator of social participation. This is more evident for a group of the population (older adults) whose participation in education has not been expected and promoted until recently.

The table lists supranational institutions as each Nordic NSI defines their indicators independently, and thus these are not always comparable. This presents a challenge for the use of indicators in the Nordic context and, more importantly, for the pursuit of a common active and healthy ageing strategy in the region. In the following chapter we examine how indicators, or the lack thereof, are used in policymaking in the Nordic region.