Denmark and the UK both wear the badge of universal healthcare with pride. Nobody is turned away, nobody is handed a bill on the way out. And the principle – that where you are born or how much you earn should not determine whether you live or die – is sacred in both countries. But principles are not the same as outcomes.
Denmark spends more per person on healthcare than the UK and operates one of the most expansive welfare states on the planet. It consistently outperforms the UK on some of the indicators that matter most: how long people live, how many babies survive their first year, and how many cancer patients are still alive five years after diagnosis. So is Denmark simply spending its way to better health? Or are other factors helping explain the gap?
The numbers in the most recent OECD report help us unpack this question. The UK devotes a larger share of its economy to healthcare than Denmark does – 11.1% of GDP compared with 9.4%. But once you adjust for currency and the cost of living and look at what each country actually spends, the UK spends US$325 (£243) less per person per year than Denmark. So although healthcare takes up a larger share of the UK economy, spending per person is still lower than in Denmark.
If the story were only about money, it might look as though Denmark is simply buying better health. And the numbers in the OECD report are striking: the average Dane lives 1.8 years longer than people in the UK; around 400 more babies per million survive their first year in Denmark; and five-year survival is higher for both cervical cancer (six more women in every hundred) and colon cancer (five more people in every hundred). Just as importantly, about one in four more people in Denmark feel their health system is there for them when they need it.
Its not just more money
But when you look more closely, a different picture appears. The gap isn’t just about how much money each country puts into its health system; it’s about how that money is used. Denmark gets more out of its spending by investing in the capacity to diagnose and treat illness early and by supporting the social and economic factors that shape people’s health. The UK has invested differently, and those choices are reflected in the results.
Denmark has 29 more CT, MRI and PET scanners per million people than the UK. Investing hugely in cancer equipment led Denmark to expand its diagnostic capacity and make it possible for cancer patients to receive treatment within two weeks of diagnosis, compared with around nine weeks in UK. Many more Danes than Britons participate in cancer screening – which leads to earlier treatment. For example, in Denmark, 17 more women in every 100 undergo breast cancer screening. Finding out early whether you have cancer and treating it early makes a real difference.
Then there is lifestyle. Ten more out of every hundred Britons than Danes report being obese. Obesity makes people more likely to become seriously unwell, need more medical care, and face tougher treatment when conditions such as cancer or heart disease develop.
Although their smoking and drinking habits are similar, many more Danes are physically active and exposed to less air pollution. Denmark also has the lowest diabetes prevalence among OECD countries: about 23 in every 1,000 adults versus 88 in the UK. Fewer people getting seriously ill means the health budget stretches further and can do more for everyone.
Beyond the hospital
People get sick not only for medical reasons. Social factors such as how educated, well-off and socially connected you are or where and how you live also cause sickness. Both Denmark and UK have chosen to look after their people by funding welfare through tax revenue. But Denmark’s welfare system is more inclusive.
Income after tax is more fairly distributed across people – Denmark has one of the lowest levels of income inequality among OECD countries. Almost every child between three and five years (97%) is in professional childcare, university education is free, and Danes get up to a full year of maternity and paternity leave. Danes generally benefit from high-quality housing and safe living environments .
In Denmark, spending on welfare is like putting money in social investments that pays healthy dividends by reducing the burden on healthcare. Denmark has built a system where the welfare state mostly prevents the conditions that produce postcode lotteries (where you live determines what services you get) in the first place.
The UK experience is different: the governments, particularly since 2010, have found themselves in financial stress and have backed welfare cuts as part of a policy of austerity, instead of viewing welfare spending as social investment, as Denmark did. Unlike Denmark, the UK has focused on fixing gaps in what the NHS could provide, without fully recognising that widening social and economic inequalities outside the NHS were driving poorer health outcomes in the first place.
Denmark gets a lot right, but it still has real challenges. Health gaps between groups are widening: wealthier men now live noticeably longer than men on the lowest incomes, and people with less education have shorter lives when they develop conditions such as heart disease or stroke.
Even so, Denmark spends more on each person’s health, and people tend to reach hospital in better shape than those in the UK. That difference comes from decades of social policies that support welfare, reduce inequality, improve housing and build a strong culture of prevention. By contrast, the UK has tried to use the NHS to treat its way out of deeper social and economic problems, even though no amount of NHS spending on its own can fix issues that start long before someone walks into a clinic.
Denmark and the UK share similar ambitions for improving the nation’s health, but Denmark has been far more successful in putting those ambitions into practice. Denmark treats the health of its people as the result of choices made across the whole of society, not just what happens in hospitals or surgeries.
Over many years, Denmark has kept building policies and structures that support healthier living. The UK had a comparable vision when the NHS was founded in 1948, but it didn’t continue developing the wider system around healthcare in the same way. Denmark did it differently and consistently, and that is what sets the two countries apart today.
This series was commissioned as part of a partnership between Videnskab.dk and The Conversation, where articles are published in English and Danish.
This article is republished from The Conversation under a Creative Commons license. Read the original article.
More from East Anglia Bylines
Friends of Bylines Network
There has never been a greater need for grassroots journalism that investigates the stories that really matter, holds power to account and champions the voices of everyday citizens. We are proudly powered by volunteers but what we do isn’t free.
STAND WITH US for independent, citizen-led journalism that makes democracy stronger, and you will even get some exclusive benefits.
