Inequalities in health outcomes by income and education: The case of Norway

Reducing social inequalities in health is a priority in European policy and the UN’s Sustainable Development Goals. We aim to estimate the magnitude of health inequalities in Norway, a high-income country with a universal health care system but rising income inequality. Using survey and registry data, we estimated relative and absolute inequality in self-reported health, health behaviours and mortality by education and income, using the Relative and Slope Index of Inequality (RII/SII). Social disparities in health were evident across nearly all outcomes, for both income and education and for both sexes. Significant RIIs were found for self-reported health, long-standing health problems, global activity limitations, dental health and the behavioural risk factors of smoking, obesity, physical inactivity, low fruit (women only) and vegetable intake, and various causes of deaths. Inequality by income were particularly pronounced for mortality among men, with the RII for men’s all-cause mortality reaching 6.2 (CI 5.9–6.5) for income, compared to 3.6 (3.5–3.8) for education. SIIs were also significant for all outcomes, except for fruit intake for education among men. Thus, despite its extensive welfare system, income- and education-related health inequalities persist in Norway, highlighting the need for targeted policy interventions. Proportionate universalism may be a valuable strategy to address these disparities within European efforts to improve public health.