Institute of Community Medicine, University of Tromsø, N-9037 Tromsø, Norway.
This investigation was undertaken in the municipality of Sør-Varanger, which is the most remote municipality in Norway, situated between the northern parts of Russia and Finland. The author was particularly qualified to do the investigations in this region because of his in-depth knowledge of the living conditions of the different ethnic groups. The author had grown up in the municipality, where his father was the district doctor, and where later, from 1963 to 1974, the author became the district doctor. According to an old Norwegian tradition the district doctor had a combined position; he was partly a private practitioner and partly the public health officer and chairman of the municipal Board of Health. This gave the author special knowledge of the population and their mode of living.
During the past 25 years several investigations have been carried out in order to find an explanation for the high mortality rates of arteriosclerotic heart disease in the municipality of Sør-Varanger and in the county of Finnmark. None of the investigations so far have weakened the main conclusion in this paper that there is an association between very poor living conditions in childhood and adolescence and high mortality in adulthood for the same cohort.
There may be several reasons for the observed association. Various types of injury to health during infancy may add up, so as to cause an increased risk of early ageing and death. This is not in contradiction to the Darwinian doctrine of survival of the fittest. Rather, whereas the weaker of the cohort die in infancy, the more fit survive and carry with them a life-long vulnerability because of their poor living conditions in early years.
It may at first sight seem paradoxical, not that early poverty is associated with later excess mortality, but that arteriosclerotic heart disease should be a major component of this excess. However, the prerequisite is a later exposure to affluence and its consequences in the form of our present way of life. Where this latter condition is not fulfilledas in the developing countriesthe mortality rates from arteriosclerotic heart disease remain low.
The standard of living in Norway has much improved and the regional differences have practically been eliminated, as shown by the current infant mortality rates. The relatively large mortality differences in middle age that still exist can therefore hardly be attributed to the living conditions of today.
The biological mechanisms that may be involved cannot be identified from the present analyses. However, some form of permanent damage in the cardiovascular metabolism caused by a nutritional deficit may be involved.