Nordic cooperation: comparative statistics and expertise on welfare and health

Over a period of more than 70 years, the Nordic countries have worked together to produce comparative statistics on social and health issues with the goal of informing researchers, public officials, politicians and the public. The collection of statistical data using internationally recognised standards combined with expert knowledge on national regulations makes the continued production of comparative statistics in the two committees, one on social welfare (NOSOSCO) and one on health (NOMESCO), a valuable resource. While some argue that the committees are less important now that European and international statistics are readily available, others consider that there is continued relevance in the production of detailed, comparative Nordic statistics by experts who have extensive knowledge of the legislative background and Nordic context.

2019.06.13 | Michael H. Feldballe Hansen

The Nordic Social Statistical Committee (NOSOSCO) collates statistics and legislative expertise on areas such as expenditure on pensions to help inform policy making. Photo: Cristian Newman, Unsplash.

Detailed and high-quality comparative statistics on welfare issues regarding Nordic social and health policies are publicly available due to the work of two intra-Nordic committees. They have the ability to produce unique and up-to-date information easily due to a long-standing well-developed network and are called:

  • the Nordic Social Statistical Committee (NOSOSCO), established in 1946, and
  • the Nordic Medico Statistical Committee (NOMESCO), established in 1966.

Both committees were established with the ambition of creating comparative data sources to allow for greater knowledge and a better understanding of the development of legislative measures, especially with regard to public expenditure on social and health issues and policy making. They laid the foundation for general comparable Nordic statistics, and have allowed the development of a unique comparison of Nordic social and health organisation and legislation.

Thematic reports and analysis: open access to information

The methods used have developed throughout the years. However, since mid-1990s the committees’ yearly publications of social and health statistics have been in the form of regular and comprehensive reports, not only providing statistics but also analyses built on the expertise within the committees and their national delegations. Statistical data and information on expenditure are publicly available in a database, along with other types of data used to calculate rates or develop indicators, available online.

In addition to the regular publication of statistical information, descriptions of legal changes and regulations on social welfare and health, both committees have published thematic reports on very different policy issues. Some reports have been specific in the focus on either social or health issues, such as:

  • old age pension schemes,
  • unemployment among young people,
  • challenges to the Nordic Welfare States – comparable indicators,
  • inequality in mortality,
  • medicine consumption, and
  • cancer.

Scholars affiliated with research institutions conduct the thematic reports. They often establish contacts to national specialists, thereby broadening the use of comparative measures and methods. The main goal of the thematic reports is to develop comparisons between the Nordic countries on the policy issues in a particular area. Committee delegates typically supervise thematic reports. Some thematic reports have been published repeatedly, analysing developments on social and health indicators over time, for example, from 2009 to 2016.

Due to the high degree of use of registers in hospitals and health services in the Nordic countries, much of the work of NOMESCO presents data concerning population trends, illnesses and hospital treatment, use of pharmaceutical products and morbidity. Another aspect of the work of NOMESCO has been taking part in the further development of the International Classification of Diseases (ICD) indicators. 

Key characteristics of the Nordic welfare model according to a 2017 report from the Nordic Social Statistical Committee
1Comprehensive public-sector responsibility for basic welfare tasks.
2A strong government role in all policy areas.
3A welfare system based on a high degree of universalism.
4Income security based on basic security for all.
5The model embraces the social and health sectors.
6Relatively even income distribution.
7Equal opportunitues and gender equality are a basic principle.
8Well-organised labour market and a high level of work participation in which tripartite cooperation is key.
9Funding from taxation and redistribution.

In its 2017 report entitled 'Social Protection in the Nordic Countries 2015/2016: Scope, Expenditure and Financing', the Nordic Social Statistical Committee sets out these key characteristics of the Nordic welfare model.

Looking beyond the Nordics: International comparisons

Intra-Nordic comparisons have not been the only focus for the committees and, even from the outset, comparisons have been made with international statistics. Historical accounts of the establishment and early development of these suggest how laborious the necessary tasks actually were, and the great effort that went into testing and controlling for details to allow for meaningful comparison. This is still the case for current experts and members of the delegations who are continuously adapting to the standards and definitions used for developing current statistics beyond the Nordics, in order to make statistics internally and externally comparable.

A revision of the structure of the NOSOSCO reporting system came in 1996 largely due to the five Nordic countries becoming members of either EEC or EFTA. From then on, the main structure of reporting statistics and expenditure followed the European system of integrated social protection statistics (ESSPROS), making the comparisons usable in a broader international context, but still with significant extra information. This included details on the Nordic countries with respect to legislation, regulations and indicators on, for example, changes in income in cases of substantial changes or key events including unemployment, childbirth and pensions. The changes also meant the possibility of widening the comparisons of the statistics to a European level and, from this point in time, NOSOSCO reports have included references to statistics from Eurostat.

In 1990s, the ambition changed from primarily collecting basic statistics to developing analysis on policy issues. One of the earliest results of this development is a workgroup computing disposable income for hypothetical households. 

The workgroup on disposable income computes yearly data on types of families (single, couple, age groups, with or without children, and across income-levels), in case of a key social event e.g. unemployment, childbirth or pension. Statistics, such as the variability of income, provide highly useful comparative statistics, as do the effects of welfare policies and living conditions across the Nordic countries. The comparable analysis covers several years of data.

A reference group on medicine statistics in NOMESCO is responsible for specific statistics and calculations concerning the use and consumption of medicine and pharmaceutical products.

Why keep collecting Nordic comparative statistics on health and welfare?

Creating statistical indicators takes a lot of effort, and it has been suggested that global or multinational indicators may be sufficient, such as those of the OECD or the EU, making Nordic indicators superfluous. On the other hand, it is argued that Nordic statistics have a higher degree of detail and quality. Additionally, the more frequent reporting on new data and the committees’ key understanding of similarities and differences relating to welfare models that are similar suggests that the committees are still relevant. Moreover, the committees supplement and supply available data on Nordic statistics with comparative contexts and analyses on health, expenditure and household incomes.  

The committees are currently working to increase the availability and online usability of data and indicators as the information that is accessible needs to be updated and publicised more effectively. A new database and platform for delivering comparative statistics and descriptions on-line is currently being implemented, with the establishment of a new digital platform by the end of 2019.

In a report from the Nordic Council of Ministers on social knowledge that works in practice, it is set out that there remains a demand for analysis and tools to research and improve welfare issues with respect to health and living conditions throughout the Nordic region. However, there is scope to review and develop the work of NOSOSCO from inputs to welfare systems, to impact of policy interventions. Additionally, with the statistical data and indicators provided, the report shows how analysis on welfare issues could be implemented in the future.

Social expenditure in percentage of GDP in the Nordic Countries

Example of some of the statistics produced by the Nordic Social Statistical Committee: Social expenditure in percentage of GDP in Nordic Countries, 2004-2014. Source: Nowbase.org, SOCEXP02. 

Internal organisation of the Nordic statistical committees on health and welfare

NOSOSCO and NOMESCO are independent, but cooperating committees financed by the Nordic Council of Ministers. The committees are made up of national delegations represented by relevant ministries, institutions and statistical bureaus in each of the Nordic countries and the self-governing countries of Åland Islands, Greenland and Faroe Islands. Through three-year contracts, the Nordic Council of Ministers govern the work in framework agreements.  

The committees have since 2014 been working more closely together with a common board of directors made up of the national heads of delegations from each of the committees. Ministers on social and health issues appoint national delegates to each of the committees. The number of national delegates in each committee is a maximum of three, with one appointed head of delegation. The national experts take part in editorial and other workgroups with respect to both committees, representing the grassroots of the national networks of expertise in statistical and relevant legislative areas.

The board of directors is chaired by the head of the delegation from the Nordic country which presides over the Nordic Council of Ministers at any given time. This way there is a relevant connection between the policy areas of the presiding country in the Nordic Council and focus areas of thematic reports in the committees on social and health issues.

Following the closer cooperation between the two committees, it has been possible to work on cross-sectional reports on social inequality in health. In addition, NOSOSCO was appointed a significant role in the development of Nordic welfare indicators (NOVI), in a project by the Icelandic chair of the Nordic Council in 2014.

Until 1979, the coordination of the work in the committees changed between the three countries of Denmark, Norway and Sweden, with the language of publication changing with the presiding country. From 1979, both committees have shared the same secretariat in Denmark. Until 2015, reports were published in both Danish and English, but regular and thematic reports have only been published in English since 2015.  

Sales of antidepressant in Defined Daily Dose pr. 1.000 inhabitants pr. day

The work of the Nordic Medico Statistical Committee (NOMESCO) benefits from the well-developed registers that are used for healthcare in the Nordic countries. This graph shows sales of antidepressant in Defined Daily Dose pr. 1.000 inhabitants pr. day. The Anatomical Therapeutic Chemical (ATC) classification system and the Defined Daily Dose (DDD) as measuring unit are the standard for international drug utilisation monitoring and research. Source: Nowbase.org, MED26 ATC-code NO6A.

The historical development of the welfare and health statistic committees

The usefulness of reporting on social expenditure in a way that was both comparable and related to legislation actually preceded the establishment of NOSOSCO. It reflected a tradition that already existed between the Nordic countries, namely, that they were aware of each other's national politics. It was also discussed at a meeting of Nordic social ministers in 1939, but it was only after the war that the first committee was established. This development was later described by the researcher Klaus Pedersen:

“This can be seen as an institutionalization of the prior tradition of mutual orientation on national political developments, and was important for the creation of ‘an imagination of’ a Nordic model of welfare.” (in his 2011 article entitled 'National, Nordic and trans-Nordic: transnational perspectives on the history of the Nordic welfare states'.)

The first report on social expenditure and statistics was printed in 1951. This was well-received and was followed by regular reports which were gradually extended with, for example, descriptions of social legislation and regulations allowing for a high level of continuity and, from the 1960s, the reports included the much-used title reference of 'social protection' in the Nordic countries. It was only from 1980 onwards that a regular publication of Nordic health statistics began. 

In the beginning, the committee of NOSOSCO consisted only of Denmark, Norway, Finland and Sweden with Iceland joining in 1953. All of the countries took part in the establishment of NOMESCO. It did, however, take some 50 years before the self-governing regions of Greenland and the Faroe Islands took part in the committees. In the case of Greenland and the Åland Islands, they are still only involved in NOMESCO, and with respect to the latter, only as part of the Finnish representation.

Whereas the ambitions of comparing social expenditure and legislation, which resulted in the establishment of NOSOSCO, originated specifically from the meetings of Nordic social ministers, the interests behind the establishment of NOMESCO came from the Nordic Council itself. However, it was only after individual countries began using classifications designed by WHO that the ability of developing comparative medical statistics came to the fore. NOMESCO was established in 1966 with the intention of establishing comparative Nordic statistics following the international classifications but developing them even further. 

Further reading:

  • Árni Páll Árnason, Knowledge that works in practice: strengthening Nordic co-operation in the social field (Nordic Council of Ministers; Denmark, 2018).
  • P. Kettunen and K. Petersen, eds., Beyond Welfare State Models (Cheltenham, 2011).    
  • T. Tanninen, T. Nielstierna, T., Ø. Haram, eds., 'Att jämföra för kunskap och välfärd. Et jubileumsskrift för NOMESKO och NOSOSKO'  [To compare for knowledge and welfare: A jubileum's text for NOMESCO and  NOSOSCO] (Nomesko - Nososko, 2019).

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