Alma D. Möller, the Medical Director of Health, addressed the meeting and spoke of challenges in healthcare that are, among other things, increased demand, lack of staff and a more complex environment. To meet these challenges public health and prevention, aimed at maintaining and improving health and preventing diseases as far as possible, must be promoted. In this context, Alma discussed influencing factors on health and health promotion approaches that the Directorate of Health manages; Health-Promoting Community, Health-Promoting Preschool, Primary and Upper Secondary Schools, and Health-Promoting Workplaces. Alma also announced that PHI are now for the first time being published for the most populous municipalities in addition to health districts. All indicators ever published by the Directorate of Health have now been made available in an interactive dashboard.

Value of public health indicators for municipalities

Mayor Dagur B. Eggertsson discussed the value of PHI for the work of municipalities. The mayor mentioned that data collection such as PHI helped with goal setting and policy-making and thus contributed to a better society. He also touched on the importance of city planning on the well-being of residents and various determinants of health.

Dagur hopes that in the future it will be possible to combine data from various sources, including PHI, to analyze how various factors have a direct impact on life expectancy, quality of life and wellbeing. On behalf of the city, Dagur welcomed the fact that PHI were now being published for the largest municipalities in addition to health districts. He also mentioned the importance for the city of examining PHI in more detail by city district.

Public Health Indicators related to society, health and disease

Sigríður Haraldsd. Elínardóttir, head of Health Information, introduced indicators related to society as well as health and diseases. Education is the first of many social factors related to health and several studies have shown a positive relationship between education and health. Access to quality education equals opportunities in many ways and has a positive impact on health and quality of life. When one looks at the proportion of people who have completed a university education, there is a difference between men and women, health districts and municipalities. In 2022, nearly 28% of men in the country had completed a university degree, while a total of 43% of women had completed it. The proportion of university-educated men and women is highest in the capital area and well above the national average. The proportion is significantly below the national average in all the rural districts.

According to Sigríður, a significantly higher number of adults assessed their physical and mental health as being fair or poor in 2022 compared to the previous three years. Overall, significantly fewer people evaluate their physical health as fair or poor in the capital area compared to the whole country, but significantly more people in rural areas. There is less difference in health districts when it comes to mental health evaluation.

Antidepressant use declined slightly in the country between 2021 and 2022, the first time that a decline has been detected since the first PHI publication in 2016.

Sigríður explained that diabetes is one of the four major chronic diseases that cause the greatest burden of disease. It has been shown that a large portion of cases of type II diabetes can be prevented with diet and physical activity, but 85-90% of diabetics have type II diabetes. No data are available on the prevalence of diabetes in Icelandic populations but the use of medications with blood glucose lowering properties, other than insulin, used to treat type II diabetes, give clues to the incidence of the disease. Thus, the use of blood glucose-lowering drugs has increased in the country and almost all health districts, particularly in the last three years, indicating an increase in the incidence of the disease and related determinants.

Finally, Sigríður mentioned that in 2022, 7.4% of individuals reported that they had not consulted a doctor in the last 12 months because they could not afford it. The proportion is lowest in Vesturland, 2.8% and highest in Suðurnes, 10.3%.

Public Health Indicators related to well-being and lifestyle

Dóra Guðrún Guðmundsdóttir, head of Public Health, presented indicators related to wellbeing and lifestyles. She revealed that the happiness of adults is still declining, with the rate of very happy now being 55% and 61% in 2016. Happiness is important for society, a reduction of one point on a happiness scale (1-10) costs society over 2 million krónur per year for each individual. It is therefore important to consider how to increase happiness and well-being in society. One explanation for the decline in happiness may be found in increased loneliness, which has been growing steadily since measurements began in 2016. At that time, 11% of young people aged 18-34 experienced loneliness often or very often, compared to 18% in the last measurement in 2022.

Dora stated that the percentage of 10th-grade students who feel anxious daily is 23%. This is not a measurement of anxiety disorder, but the proportion of 10th graders who experience the feeling of anxiety almost daily. Even so, it is important to find out what causes it and how it can be reduced.

Positively, 86% of young people in 8-10th grade find it easy to get emotional support and help from their family. However, it is important to take into consideration the 14% who do not receive support from their family.

Only about half of six-year-old children take fish oil or vitamin D, which is similar to the proportion in recent years. It is important to remind parents/guardians to provide their children with a vitamin D supplement.

Over one-third of adults reported eating whole grain products daily or more often in 2022, but it is recommended to eat whole grain products twice a day (70 grams per day). There is a difference in whole grain consumption between health districts, with the highest ratio in Vestfirðir, 46.4%, and the lowest in Vesturland, 31.7%.

Roughly half of children in the 4th grade consumed soft drinks 1-2 times a week in 2022. Studies show that soft drink consumption is correlated with chronic diseases, weight gain and tooth decay. In Iceland, soft drinks and energy drinks are exempt from the standard value-added tax, which is contrary to all public health recommendations.

Over 20% of children in 10th grade practice daily physical activity. There are some differences between the health districts where Vestfjörður stands out with a percentage of 40%. About 66% of the students in the 7th grade walk or cycle to school. There is some difference between health regions where the proportion is higher in urban areas. The proportion of adults who practise little vigorous physical activity is 25% nationwide. More than half of adults say they are trying to lose weight, and this proportion has not changed much over the years.

In 2022, almost a quarter of Icelanders (24%) fell under the definition of the so-called harmful pattern of alcohol consumption, 27% of men and 21% of women. There has been a significant increase in harmful drinking between years, whether considered as a whole or when analyzed by age groups and gender. If this ratio is applied to the whole population, it can be assumed that around 33 thousand men and 25 thousand women had a harmful pattern of alcohol consumption in 2022. It is worth noting that according to the latest research, there are no known limits on the harmlessness of alcohol, and therefore it can be argued that all alcohol consumption is harmful.

About 15% of 10th-grade students have used nicotine pouches nationwide, but the proportion is much higher in some health districts. In Vesturland and Suðurland the ratio is 21% and in Austurland 25%. It is important to consider what causes this use and how it can be reduced. When the age group 18-34 is examined, the proportion increases to 23% nationwide. The proportion is highest in Norðurland og Austurland or 30%.

This year, a PHI on discrimination is published for the first time. It indicates that 13% of adults have experienced some form of discrimination. Women are also much more likely to suffer discrimination, 16% compared to 9% of men. The same gender difference can be seen when it comes to sexual violence, where 24% of women have experienced sexual violence compared to 9% of men. Striking results can also be found in a new indicator of sexual violence by peers, which reports that 11% of girls in grades 8-10 have experienced serious sexual abuse (oral sex or intercourse against the will) by another teenager.

Public Health Indicators and the Work of the Health-Promoting Community

Gígja Gunnarsdóttir discussed PHI in the work of the Health Promoting Community. She gave a short presentation on the work, which has the main goal of supporting municipalities, schools and workplaces in working systematically to create an environment and conditions that promote a healthy way of life, health and well-being for everyone. A web-based system of checklists has been developed to assist contacts and steering groups to analyze the situation, work on improvements and evaluate progress in terms of environment and conditions. PHI are used, together with various other indicators and data, to analyze the situation regarding lifestyle, health and wellbeing, etc. Gígja said it was a welcome step that PHI were now being published for the nine most populous municipalities for the first time. She explained why it was not possible to do the same for all the municipalities, although there was a desire to do so. Gígja reiterated that although comparisons with other regions could be useful, the most important thing was for each municipality to review the public health indicators and interpret the situation based on their local community's knowledge. The conditions can be so different between, and within, the municipalities. It is also necessary to ask oneself if the situation is acceptable even though it seems to be good/best in comparison to others.

The next move includes a further introduction for Health-Promoting Community contacts and sharing the indicators with the smaller municipalities as the data allows. We will continue to look for ways to strengthen the data and coordinate and integrate it so that the work is of the best use for the municipalities.

Harpa Þorsteinsdóttir, Public Health Project Manager at the City of Reykjavík, chaired the meeting.