Ever since the beginning of the registration of county mortality approximately a hundred years ago, the mortality of the county of Finnmark has been much higher than for the rest of Norway. Men in our largest towns have a high mortality rate. However, compared to the other counties of the country, Finnmark has unfavourable mortality and the difference is still striking and considerable.
The high infant mortality in Finnmark has been the subject of several investigations,1,2,4,5,9 but no studies are available concerning the reasons for the high general mortality in the county, even though several investigations of particular diseases such as pneumonia, lung cancer and rickets have been carried out. Cardiovascular diseases are known to be a common cause of death, but not much is known regarding the reasons for this high mortality. Therefore we do not know whether there are geographical variations within the county, whether some groups of employees are at higher risk than others, or whether there are considerable differences between the different ethnic groups.
It is important to note that the high mortality is seen for both men and women (Figures 1 and 2). These data cover the population living in villages and rural areas in the time period 18901967. The population distribution in Finnmark makes such a comparison most useful, since as late as 1960, only 34% of the population inhabited urban areas. But even if one compares the rural areas of Finnmark county to the mortality of the towns of Norway, Finnmark still shows an unfavourable pattern.13 From 1960 and onwards, routine statistics make no distinction between towns and rural districts, but the tendency is the same when the comparison concerns the total mortality of the county (Figures 1 and 2
).
|
|
In the following, I will pay attention to a possible reason for the high mortality in Finnmark which has not been discussed earlier, namely that the considerably higher mortality today is a late consequence of the adverse circumstances to which a large part of the population was exposed during their childhood and adolescence.
It follows from the literature, word-of-mouth accounts and the medical records of doctors with responsibility for public health,6,12 that a large part of the population lived under very poor conditions, nutritionally, hygienically and socially. During the last century there have been periods of starvation in large segments of the population. Poverty and suffering existed until the last World War, and to a considerable part of the population, both those staying and those evacuated, the last stage of the war was a harsh time.
A major part of the population were living at a bare minimum living standard and depended upon livelihoods that were vulnerable to adverse climatic conditions and general economic circumstances. A failing fish season or a bad summer and autumn would be enough to make life difficult. A comparison to several developing countries today is apposite. Even if poor living conditions also existed in other parts of the country, these were probably not as large and long lasting as in Finnmark.
Another indicator of the bad conditions in Finnmark is that infant mortality has, until recently, been considerably above the average for the rest of the country (Figure 3). There seems to be consensus regarding infant mortality as a sensitive indicator of social conditions in the broadest sense.
|
Poor living conditions continue to be related to overall mortality, but economic and other social conditions have gradually been improving in Finnmark, and the difference between Finnmark and other parts of the country has declined which is indicated by the declining difference in infant mortality. It is, therefore, not reasonable to assume that the higher mortality in Finnmark today is due to current poor economic or other social circumstances.
Own Studies
To elucidate the problems further, mortality in Sør-Varanger municipality is compared to mortality in Finnmark county, Norway and Finland. This municipality is different in several ways from the rest of the county, with regard to settlements, ethnic background and economic activity.
The mining industry is dominant with more than 1000 employees. Roughly the same number of people are employed in farming and forestry, a few hundred are fishermen or both fishermen and smallholders, and a few are herding reindeer.
By comparing the age-group 3080 years for the time-periods 19491951, 19591961 and 19651967, we find that the mortality in Sør-Varanger municipality is considerably above the country average. For men, mortality is similar to that of Finnmark county, however for women the findings are less consistent, although there is a tendency to higher mortality than country average (Tables 1 and 2).
|
|
|
Almost everyone of Finnish origin in Sør-Varanger today was born and raised in the municipality. Due to the large migration to the municipality, their percentage share of the population has markedly diminished. Furthermore, there has also been a process of assimilation with the rest of the population. By research mainly based upon personal knowledge, I have found that of the male population in the age range 3079 years around 16% are of Finnish origin, meaning that at least one parent was Finnish. This percentage has remained stable in the population during the time period of 19491968 (Table 3). The pattern among women has been more difficult to discern, partly because of change of name by marriage, and the results are less certain.
|
A comparison of the mortality among men of Finnish origin in the age range 3079 for the periods 19491953, 19581962 and 19641968 with the mortality of the rest of the population of the county, and with country averages, shows a considerably higher mortality among those of Finnish origin (Table 4). Since the Finnish part of the population is relatively small, it has been necessary to calculate the mortality for five-year periods. The migration out of the municipality from this population group seems to be small and there is no indication of selective emigration, but within the borders of the county mobility was considerable. Most deaths among people of Finnish origin during the study period were second and third generation immigrants, only 6 persons having been born in Finland.
|
|
When considering the high mortality in Finland today,11 we might imagine that the subjects of Finnish origin in Sør-Varanger are still maintaining Finnish traditions in way of life which may influence present mortality. On-going research gives so far no indication of such traditions. For instance, smoking habits are not Finnish but quite similar to those found among the male population in Finnmark.8 The fat content of the diet is unfavourable, but not very different from what is usual in Norway today. A higher average blood cholesterol however, has been observed in men in some segments of the Finnish population. The only living tradition, which is actually adopted to a large part by the rest of the population, is sauna bathing. It seems, though, to be fully documented that saunas have no unfavourable effect on health.
When considering causes of death in Finnish and non-Finnish subjects in Sør-Varanger, the difference is mainly due to arteriosclerotic heart diseases (Table 5). Since the total number of deaths among Finnish people is quite small, caution should be taken in drawing inferences concerning the causes of the excess mortality of those of Finnish origin. It seems, though, (when putting aside the excess mortality from arteriosclerotic heart diseases) that there is an excess mortality from other causes of 30% among those of Finnish origin compared to the rest of the population.
|
Discussion
Since the last World War, several studies have been made regarding health deficiency as a late consequence of war and other disasters. This subject is treated by Lønnum.7 Even though much research remains to be done on this issue, it is probable that catastrophes may cause health deficiency as a late effect. Concerning the more extreme conditions in concentration camps and in some prisoner of war camps, this association must be called an established fact.
Similar studies concerning health deficiency as a late consequence in groups of individuals that have been living under harsh conditions during their childhood and adolescence do not seem to be available.
The question arises whether the living conditions in Finnmark during the last century were bad enough to be called catastrophic conditions. In my opinion, this was the case. Even if this has not been a permanent situation, the vulnerable economy would imply that such hard conditions would often appear and might be of long duration. Such poor living conditions would result not only in increased infant mortality, but children and adolescents that grew up under these harsh conditions might also have their health affected. It is not unreasonable to think that this may result in a health deficiency later in life. This might later be observed by an earlier ageing of the population, by increasing work disability and higher mortality. Besides higher mortality, Finnmark is also the county with the proportionally largest number of those registered with work disability,10 with 8.2% (6%) of the male and 7.4% (5.8%) of the female population in the age range 1869 receiving disability benefit.
The difference in the number of those registered with work incapacity increases from the age of 40 upwards, and in the age group 6569 45% (28.7%) of the men and 28% (16.9%) of the women are disabled. (The numbers in parentheses represent the country average.)
Among the non-Finnish part of the population in Sør-Varanger, infant mortality has been very high (Figure 5), and we would expect to find mortality among adults in this group of the population that was above what was actually seen in the time period 19491968 (Table 4
). But, because of the large immigration to the municipality, we find that among the non-Finnish men who died in this period, only 32% were born in Sør-Varanger. (Altogether, 50% were born in Finnmark, 33% in Troms and Nordland, 9% in the south of Norway and for 7% the place of birth was not possible to trace.) Half of the non-Finnish men were not born in Finnmark, and a considerable part of these probably did not grow up under such conditions that resulted in the high infant mortality of the county. From this we expect to find a lower mortality among adults in this group of the population compared to that shown for Finnmark, and this was also the case.
It is difficult to identify existing environmental factors that may explain the high mortality today among the adult population of Finnmark. As discussed above, the social conditions of Finnmark have radically improved, and infant mortality is at almost the same low level as the average for the country. Sør-Varanger municipality has, in spite of a different economic basis than the rest of Finnmark county, the same high mortality rate, and the difference shown between two population groups in the municipality cannot be explained by existing environmental risk factors.
To what extent climatic factors such as long winters, cold and polar nights, make a health difference, is disputable. In earlier times these factors have, without doubt, contributed to worsen an already bad social situation, among other things by forcing the population of Finnmark to a much larger extent than the rest of the country to stay inside in poor and crowded houses. Both in Norway and in Sweden mortality is highest in the northern counties, but this is not the case in Finland, where mortality is highest in North Karelia, which is in the south-eastern part of Finland.
It is apposite to compare existing data regarding those of Finnish origin in Sør-Varanger to the conditions in Finland (Table 6). The comparison shows no consistent difference in mortality, but by comparing corresponding age groups in the same periods, some excess mortality among the Finns in Sør-Varanger is found (in 10 out of 15 compared groups). If the high mortality is due to Finnish genes alone, one would expect to find a lower mortality among the Finnish people in Sør-Varanger because ofan admittedly smallmix with Norwegian genes.
|
The studies give no satisfactory answer as to what extent genetic factors may have any impact on the mortality in Finnmark. However, genetic factors alone are unlikely to explain the great difference in mortality existing between the population in Finnmark and the rest of the country.
These studies may suggest an association between very poor living conditions in childhood and adolescence and high mortality in adulthood so that the worse the living standards, the higher the later mortality. Thus, one should not expect that the difference in mortality between Finnmark and the rest of the country will disappear until the generation that grew up under these adverse conditions are gone.
Notes
* Reprinted with permission of Tidsskrift for Den Norske Iægeforening. Forsdahl A. Momenter til belysning ar den høye dødelighet; Finnmark Fylke. Tidsskr Nor Lgeforen 1973;93:66167. We thank Bjørgulf Claussen andAnne-Marie Nybo Andersen for translation.
References
1 Gjestland A. Spedbarnsdødeligheten i Finnmark og Nord-Trøndelag 19511960. T Norske Lægeforen 1968;88:26167.
2 Idem. Spedbarnsdødeligheten i Finnmark 19611965 I relasjon til 19511960. Ibid 1970;90:85052.
3 Härö AS. Disease Prevalence in Finland. Manuskript 1971.
4 Jonassen Ø. Sosiale og hygieniske forhold i flyttsamenes basis-område. T Norske Lægeforen 1959;79:11318.
5 Idem. Dødfødsel og dødsfall i 1. leveår og det lys det kaster over de sosiale forhold. Ibid 1964;84:1396404.
6 Kloster J. The distribution and frequency of rickets in one of the fishery districts of Finnmark and relation of the diet to the disorder. Acta Paediat 1931;(Uppsala)12:(suppl.3).
7 Lønnum A. Helsesvikt. En Senfølge av Krig og Katastrofe. Gyldendal Norsk Forlag A/S, Oslo 1969.
8 Pedersen, Magnus Mork et al. Lung cancer in Finland and Norway. Acta Path Microbiol Scand 1969;(suppl.199).
9 Rein K. Spedbarnsdødeligheten i Kautokeino 19461955. T Norske Lægeforen 1956;76:81516.
10 Rikstrygdeverket. Kvartalsoppgaver fra Regnskap og Statistikk, 4, Kvartal 1971, for Sosiale Trygder Administrert av Rikstrygdeverket. Mai 1972.
11 Statistikcentralen. Statistisk Årsbok för Finland. Utlandet. Dødligheten i Olika Åldersgrupper. Helsingfors 19511970.
12 Statistisk Sentralbyrå. Sundhetstilstanden og Medicinalforholdene i Norge. 18981903 IV1929 VIII.
13 Idem. Dødeligheten og dens årsaker i Norge 18561955. Oslo 1961 (tab. 130, 133, 144).
14 Idem. Dødelighetsforhold i Fylkene i Årene Omkring 1960. Oslo 1965 (tab. 2, 18).
15 Idem. Dødelighetsforhold i Fylkene 19641967. Oslo 1969 (tab. 4).
16 Idem. Statistisk Årbok 1969. (tab. 31).
17 Wessel AB. Befolkningen i Sør-Varanger efter 1870. Festskrift til Rector J Qvigstad. Tromsø Museum 1928, 304313.