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May 14, 2018

Difference in Health: Denmark Versus the United States

Difference in Health

What’s the difference in health between Danish and Americans?  Sixteen and one-half percent is the answer.

The difference in health between Danish and Americans can be summed up with this single statistic: in Denmark the obesity rate is 19.7% and in the United States it is 36.2% based on 2016 data. That’s a difference of 16.5%. Obesity is defined as a BMI over 30.

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difference in healthDemographics of Denmark

My wife and I were recently in Denmark visiting our son who is living in Denmark for a year as part of a youth exchange program (gap year before starting college). We spent four days in Copenhagen, Denmark’s largest city by far, and we also spent four days in Stege, the largest city on the island of Møn where our son lives. Denmark is composed of about a 1,000 islands with four or five main ones. Between Copenhagen and Møn we got a taste of urban Denmark and rural Denmark.

Stege has a population of about 4,500 with about 11,000 people living on Møn which is only 84 square miles – about 17 miles at it longest dimension and 8 miles at its widest dimension. It is not a big place. But, Stege is the cultural hub of the island and has a bigger downtown than Dublin, Ohio (where we live) which has a population of 40,000. It’s main street is lined with restaurants, pubs (Danes do like their beer), art galleries, and the typical boutique retail shops.

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Copenhagen has a population of around 775,000 in the city and 1,310,000 in its metropolitan area. Population-wise it is slightly smaller than Columbus, Ohio. And, the population of Denmark is 5,700,000 which less than half the state of Ohio. Now that we have things in perspective, let’s get to the 16.5%.

Obesity Rates: Why the Difference

Obesity is an important measure or litmus test of overall health. Obese individuals are more likely to have high blood pressure, heart disease, cancer, diabetes, and musculoskeletal problems. Lowering the obesity rate will reduce mortality and morbidity from several diseases. For instance, death from coronary artery disease is 16.46% in Denmark versus 18.06% in the US.

Life expectancy in Denmark is 78.6 years for men and 82.5 for women. In the US life expectancy is 76.9 for men and 81.6 for men.

Why the difference in obesity rates between the Danish and pleasingly plump Americans? Based on my observations here are some of the reasons for the difference in obesity rates.

First, let me say that the obesity rate in Denmark, both in Copenhagen and on Møn, appeared to be less than the quoted 19.7%. Maybe the obese in Denmark stay indoors and you don’t see them. I don’t know. The rate seemed more like 10% on observation. Here are some of the reasons, I believe, for the difference in health between the US and Denmark.

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  • more active lifestyle
  • smaller and healthier meals
  • less stress and better work-life balance

difference in healthActive Lifestyle

An active lifestyle is just a part of the routine day in Denmark.

The streets of Copenhagen are flooded with cyclists riding to work or doing their shopping. It was not unusual to see men and women dressed in business casual clothing along with stylish scarfs cycling to work with briefcases/attachés securely fastened to the bike. Many women wore shoes with heels while pedaling their bikes.

difference in healthAnd, if they are not riding bikes, the Danish are walking. Because of taxes, it costs about twice as much to own a car in Denmark as it does in the United States. So walking and cycling have become prime forms of transportation.

Plus, there isn’t a lot of public parking. But, Copenhagen is equipped with an efficient subway, train, and bus system which gets masses of people close to their destination to which they walk once they get off public transportation. Vehicles are not permitted down many of the city’s center streets outside trucks and vans of suppliers and vendors.

Many of the residents of Stege live reasonably close to the center of town that walking is a viable option when going into town is desirable. Our son’s host family owns two cars as both his host father and mother work a considerable distance from home. But, around Stege they pretty much walk every where.

The time it takes to walk is just factored into the time it takes to get something done. Danish seem less time-conscious than we Americans. We seem to be in hurry to get to and do anything. To walk a mile to go to a grocery store then walk back is not a big deal to them.  Danish seem to move at a comfortable pace without being lackadaisical and without being in a hurry.

I saw no more than a half dozen people using walkers. And, only one person using a motorized scooter (unlike you see in Sam’s Club or Costco).

Meals

A couple of quick observations I noticed about eating and meals were the plate size is frequently smaller in Denmark and the utensils are smaller. Spoons are smaller – even smaller than a teaspoon, and forks are thinner typically having three tines rather than four. You cannot overeat in one bite and smaller utensils leads to eating meals at a slower pace which tends to be healthier. It takes 20-30 minutes for your stomach to tell your brain that you had enough to eat. And, if you eat too fast it becomes much easier to overeat before your brain gets that all important signal. So smaller portions and smaller bite sizes facilitates not overeating.

difference in healthPortion sizes in the US are not healthy. The meal portions served at many US restaurants these days is enough to feed two people.

Also, in Denmark there are no refills on your beverages – for free that is. You can get a refill – you just have to pay for it. Depending on what you drink there can be a lot of empty calories in beverages (especially sodas) and that can be unhealthy if the refills are free.  If you have to pay for that second Coke you may opt for water instead.

Pork and potatoes is a mainstay of the Danish diet but any food you can get in the US is available in Denmark. My son’s host father is a chef and from our discussions their food is not as processed as much in Denmark as it is in the US. He discussed many of the laws and regulations related to meal preparation in restaurants which are quite strict.

Danes are very environmentally conscious leading to healthier farming methods, too. So much of our food in the US is tainted with pesticides, hormones, and antibiotics – all of which place a toxic load on our US bodies. There is a push in the US for physicians to not write as many prescriptions for antibiotics, but 80% of the antibiotics used in the US are given to animals and poultry. Good luck trying to avoid them.

Speaking of toxic loads – and though I don’t know this for sure – I suspect Danes take fewer medications. Why is that important? Most medications are processed and broken down the liver. The liver’s main function, though, is to process carbohydrates and fats. The more attention and liver-space given to neutralizing medications means our livers in the US are less equipped to process fats and carbs contributing to obesity.

Less stress and Work-life balance

Stress is a killer. Reducing stress will make a huge difference in health. Lower stress will add more to your life span than exercising, not smoking, and not being obese. Danes are annually considered the happiest or one of the happiest people in the world and rank number one in Europe for having the best work-life balance.

Work-life balance reduces stress. Danes have more control of their work hours and can design flexible hours and their average work week is 33 hours. One may work 8 AM to 2 PM one day and the next day from 10 AM to 4:30 AM. This enables couples with children to make sure one parent is home in the AM to get the kids off to school with a parent being home in the afternoon when the kids come home.

difference in healthThey receive at least 5 weeks of vacation, too. Our son receives most of the same benefits as Danish citizens. In addition, to his five weeks off he gets all the school breaks and school vacations off, too. He is working as a teacher’s aid helping teach Danish middle schoolers with their English (everyone speaks English there). As I write this he is Norway for the weekend and will be in Finland next weekend. Danes have plenty of time for travel and our son is taking advantage of that opportunity.

Income taxes in Denmark are high. Though a certain amount (I believe around $500 US dollars is exempt from taxes each month) Danes have a 50% tax rate on their income and it can go up to 65%. Like us there are some deductions for mortgage loans. They don’t seem to mind the high taxes because in return higher education is free and health care is free though there are some out pocket expenses for medications.

But, at least according to our son’s host parents people don’t fret about how they are going to pay for college tuition or health care which can be big expenditures and sources of worry in the US. That reduces the stress level in Denmark. Though to me it seems that some of their higher taxes simply represent prepayment for tomorrow’s education and health care expenses that go into a government account rather than an individual account like an HSA or college savings account like it would be here.

It’s been said that no one (or few) will get rich living in Denmark, but no one (or few) will be poor. I only saw one panhandler on the streets of Cophenhagen. There is less discrepancy between the haves and the have nots compared to the US. They do not seem to be as consumed as many of us are with making money, yet are able to live a high standard of living.

Less stress regardless of the reason leads to a higher quality of life, increased life expectancy, and less tendency to being obese. Stress triggers production of cortisol which affects metabolism in unhealthy ways. So stress and obesity are linked especially for the many that are emotional eaters.

Overall the Danish approach to life seems to diminish unnecessary stress and while placing an emphasis on an active and healthy lifestyle.

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Some final observations of Denmark unrelated to health include the following.

Every Dane we encountered was competent at their work. They seemed to take a sense of pride in their work. I suspect employers do a good job in making employees feel like their job is important and that they are valued as employees. The waiters were very good. And, when you think about they have to be smart enough to speak three or four languages when serving tourists.

We did not see anyone wear baggy pants low revealing their buttocks. The streets were clean of paper but we did see areas in Copenhagen where empty and some half filled bottles of beer and booze were left on the ground near trash cans that were filled. The public bathrooms were impeccably clean.

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Education System

We visited the school are son works. The students at the school were polite and attentive and seemed eager to learn. Teachers all spoke English very well and some were dressed very casually including the headmaster.

The school our son works is a “free school” which means the school has some liberty in how and what subjects are taught. It is not free to attend like the public schools. It is a type of private school where parents pay tuition and are responsible for the upkeep of the school like taking out the trash and cleaning and painting the classrooms. That probably motivates students not to trash the school.

There is definitely more time spent on recreational activities than US schools (perhaps that encourages the more active adult lifestyle.) The day we were there students were playing a type of softball – and that was after a morning recess period where they were outside playing kickball and running around.

Danes go to school to the ninth grade (age 16) and then students have three options somewhat based on critical test scores. Education beyond 9th grade is not compulsory. They can go a college prep track or what is called Gymnasium which is 2-4 years. Or, they can go a vocational route which is typically three years. This would include those interested in hospitality industry which would seem to explain the competency of waiters and hotel workers. They are getting three years of training, not one week shadowing an American waiter before being turned loose on their own.

The third route was somewhat fuzzy as presented to us. But for students who don’t know what they want to do they can do an After School  program which is a year of exploration where students live away from home and are exposed to different occupations and then make a career decision after that year.

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So there you have it.  A snapshot of Danish health and education.difference in health

Møns Klint

 

 

 

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Dr. Joe Jacko


Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio. Read more about Dr. Joe Jacko

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