The Nordic Model: Behind the Hype

 

Although happiness, in all its variants, is considered a purely subjective feeling, it’s widely accepted that a happy life involves maximizing feelings of joy and minimizing feelings of pain. In the words of Steve Maraboli, the much quoted, slightly clichéd author, “Happiness is a state of mind, a choice, a way of living; it is not something to be achieved, it is something to be experienced.” Happiness, in its truest form, is much more than a transient moment of joy. It’s an inner quality, a mental or emotional state of well-being that affects our thoughts, feelings, and actions.

The World Happiness Index is, in its own words, “a landmark survey of the state of global happiness.” Measuring a nation’s happiness based on a principle called “overall well-being,” the 2015 WHI examined 158 countries and studied a variety of important information, including financial stability, life expectancy and gender equality. Interestingly, of the top 5 happiest countries in the world, four were Nordic: Denmark, Finland, Iceland, and Norway. Just in case you were wondering, Sweden, the home of ABBA, strikingly tall blondes and flat pack furniture, was in 10th place, the U.S. three places behind in 13th, while the U.K. found itself in 23rd place.

The Nordic nations have one prominent supporter in Bernie Sanders, Vermont’s answer to Doc Brown. If elected president, Sanders was keen to introduce a number of controversial policies, and the utopian socialist’s idea of a Nordic-styled America is perhaps the most contentious of them all. Ever the divisive figure, though his supporters lavish him with praise, those in diametric opposition ridicule and question his political acumen. Donald Trump, the maniacal demagogue who continuously refers to himself in the third person, labelled Bernie “Crazy,” while Hillary repeatedly reminded Sanders that “the U.S. is not Denmark.” Sanders, at 74 years of age, finds himself being treated like a kind-hearted, slightly naïve granddad. “Sure, Bernie. That Nordic model sounds great, now go sit in the corner and watch TV.”

Is Sanders’ infatuation justified?

By offering both high living standards and low income disparity, the Nordic countries are as intriguing as they are innovative. When U.S. presidential nominees aren’t name-calling and defending the size of their manhood, they occasionally focus on the ever increasing gap between the rich and poor. Scandinavia, which boasts a unique combination of free market capitalism and social benefits, is regularly cited by many scholars as a role model for other developed nations to follow, the U.S included. The promotion of private ownership, free markets and free trade, not to mention open access to public services such as free education and universal healthcare, played a major role in the economic expansion of the Nordic countries.¹ With secure public pension plans and low levels of political corruption, the Scandinavian region possesses two of the rarest things imaginable, guaranteed retirement plans and politicial transparency. In fact, according to Transparency International’s 2014 Corruption Perceptions Index, out of 176 participating countries, Denmark, Finland, Sweden and Norway ranked as four of the five least corrupt.

Although the Scandinavian countries offer free health care, job stability and paid vacation, the happiness reports can be very misleading. Each September, as a veil of darkness descends over the Nordic region, not lifting again until April, people ready themselves for copious amounts of snow, freezing cold temperatures, and limited daylight. In Oslo, Helsinki and Stockholm, night can fall as early as 2:00 p.m. and last until 9:00 a.m. the following morning. At winter’s peak, daytime seems to bring an incrementally lighter shade of gray. The further north you go, unsurprisingly, daylight becomes even more elusive. In Kiruna, for example, the northernmost town in Sweden, situated in the province of Lapland, the sun never rises around the winter solstice, which runs from December 18th to December 23rd inclusive. (Maybe this is one of the reasons Sweden finds itself in 10th place and not in the top 5.)

Living in perpetual darkness for so many months certainly sounds like a daunting, fear-inducing prospect, prompting one to ask: “People of Scandinavia, how and why are you so damn happy?” For all the region’s benefits, a paradox seems to exist, where happiness and high rates of unhappiness reportedly co-exist. While we hear countless reports praising the Nordic nations, we rarely hear about the drawbacks associated with living in the region. We hear very little about mental illness and prescription drug dependencies, because, after all, how can you market the Nordic dream if nightmarish elements exist?

 Why so SAD?

Seasonal affective disorder (SAD), also known as seasonal depression, is a mood disorder in which people who have normal mental health throughout most of the year experience depressive symptoms during the winter months.² Characterized by symptoms such as lowered mood, fatigue and decreased energy, SAD is classified as a subtype of bipolar or major depressive disorder, with some individuals also experiencing weight gain and hypersomnia.³ Sun exposure to the skin is our most effective and most neglected source of vitamin D, and low serum levels of vitamin D can lead to depression in otherwise healthy individuals.⁴ When asked why SAD is so prevalent in Scandinavia, experts regularly cite a lack of sunlight, but some geneticists disagree, referring instead to something called the genetic vulnerability hypothesis. Homogeneous populations within the region seem to be more vulnerable to symptoms of SAD, and the study of genetic factors in the etiology of the ailment have suggested a familial contribution, with reports stating that between 13% and 17% of first degree relatives are affected by SAD.⁵ This is significantly higher than the average U.S. rate.

Currently leading the way in happiness surveys, Denmark is a country that seems to embody the very notion of equality, “seems” being the operative word. Plagued by high rates of alcoholism, Denmark finds itself ranked second in the world for the consumption of antidepressant medication.⁶ An international study from Kings College London – in collaboration with the University of Southern Denmark (SDU) – found that 60 percent more Danish children take antidepressants today than a decade ago. Dr. CJ Bachmann and nine other academics collated eight years worth of research. The objective of this study was to assess recent trends in antidepressant use in youth using data extracted from regional and national databases of Denmark, Germany, the Netherlands, the United Kingdom, and the United States. The findings, calculated and stratified by age, sex, and subclass of drug, found Denmark to have the highest relative growth of dependency, especially amongst 15-19 year olds. SSRIs, or serotonin-specific reuptake inhibitors, appear to be the drug of choice. A class of drugs that are typically used as antidepressants in the treatment of major depressive disorder and anxiety disorders, SSRIs are the most widely prescribed antidepressants in Denmark,⁷ and the efficacy of SSRIs in mild or moderate cases of depression has been widely disputed. Meta analyses of short duration randomized clinical trials have established that SSRI use is directly related to a higher risk of suicidal behavior in children and adolescents.⁸ The Danish Centre for Health Technology Assessment, or DACEHTA, states that the prevalence of depression in the southernmost of the Nordic countries has increased from 2.0 to 5.0% and is now considered a public health problem.⁹

Denmark finds itself plagued by a prescription drug crisis, however, the sub-polar nation of Iceland – with a population of just 323,000 – finds itself in an even more precarious position. According to a recent OECD report, Iceland has the highest rate of antidepressant use in the world. The world financial crisis of 2008 actually began on this isolated, homogenous island, leaving The Alþingi, the national parliament of Iceland, in a state of disarray. The financial implosion left citizens in an unprecedented state of uncertainty. David Oddsson, Iceland’s former bank governor and prime minister, oversaw the privatization of Iceland’s banks. His Reaganesque approach to banking helped create a new, wealthy elite, with this select few exercising great political and financial power. Through rampant cronyism and sheer ignorance, the banking sector was always destined for disaster, and in October of 2008 the doomsday clock struck midnight. Prime Minister Geir Haarde addressed the citizens of Iceland, telling them what they already knew, that the tiny nation was on the brink of bankruptcy.

People were angry, and protestors took to the streets. In stark contrast to the U.S., Icelandic prosecutors made two decisions that helped the country regain some semblance of balance. Firstly, they decided to let the banks go bust. Funding assistance was denied to banks like Glitnir, Kaupthing and Landsbanki, and this refusal saw all three go into receivership instead. With their boards replaced, the failed banks were restructured in order to avoid a credit crunch. Secondly, justice was served.

December 21st, 2015 saw the former CEO of Glitnir bank become the 29th senior Icelandic banker to receive a prison sentence for crimes relating to the crash. The District Court of Reykjavík sentenced Lárus Welding to five years for his role in market manipulation and the abuse of fiduciary duties. (Notably, in relation to the financial crisis, not a single senior banking official in the U.S. has been jailed for illegal activities.) In a financial sense, Iceland is the model of recovery, however, according to the OECD’s “Health at a Glance 2015” report, the country with the highest divorce rate in Europe is still suffering, albeit in a more intangible manner. Ranking first amongst the countries surveyed for antidepressant usage, Iceland now faces a new crisis. A country of sharp contrasts, the volcanic island is a place where fire and ice co-exist, where long, dark winters are offset by the summer’s midnight sun, and where dark feelings of melancholy are offset by prescription drugs.

For every 1,000 people in Iceland, the report states, 118 are taking antidepressants on a daily basis. The aforementioned Denmark, with a rate of 96 per thousand, is in second place, while Portugal, with 88 per thousand, sits in third. Between 2010 and 2015, according to the OECD report, an additional 47 people per thousand in Iceland began taking antidepressants. A separate study examined trends in depression and anxiety amongst Icelandic adolescents, and found that the number of adolescents visiting healthcare specialists is rising on an annual basis.¹⁰

Out of all the Nordic nations, Iceland has the highest level of antidepressant sales. The Nordic Committee on Social Policy, or NOMESCO is responsible for the co-ordination of the health statistics in the Nordic countries, and a 2014 report of theirs focused on prescription drug use in Denmark, Finland, Iceland, Sweden and Norway. The statistical committee examined the daily dosage rates per 1000 inhabitants of the five countries. Iceland was in first place with 117.7, Sweden with 84.3 and Norway with 56.1.¹¹

 Why does Iceland suffer from a prescription drug problem?

 A study carried out by Sigurdsson, Olafsdottir, and Gottfredsson¹² attempted to answer this question. They concluded that the reason for high usage stemmed from a “perceived effectiveness” mindset. Furthermore, according to the study, limited access to counselling and other professional services only serves to encourage people to seek out other avenues of treatment. A follow-up study also concluded that Iceland’s increase in antidepressants had – and will continue to have – no positive impact on public health, and in the absence of therapeutic alternatives, dependency on antidepressants is expected to grow exponentially.¹³

With insufficient access to professional services and a trigger-happy prescription culture, the Nordic countries, rightly commended for their solid welfare policies, are failing to confront an evolving epidemic. Problematic drug use stemming from a lack of social and psychiatric aid threatens the fabric of Scandinavian society, and that is no exaggeration. Although many are quick to praise the Nordic nations, it is disingenuous of people in the know to conveniently ignore such a glaring issue.

 Combatting The Problem

Shortly after assembling a task force made up of representatives from several ministries, the Icelandic government announced plans to introduce a prescription drug prevention scheme. The Minister of Health defined quantifiable targets, with the main focus on restricting access to prescription medication, protecting groups at risk from the damaging effects of drug abuse, preventing young people from developing dangerous habits, and ensuring that those who have a history of abuse or addiction have access to continuous, professional assistance.

Furthermore, the government began working on the “2020 initiative,” basically a blueprint for the future, which developed through dialogue and collaboration between hundreds of residents, academics and healthcare professionals throughout the country.

The 2020 initiative is a broad policy statement, and seeks to create an efficient economy and society. It includes plans for investments in healthcare and the development of world-class infrastructures, all in the hope of creating more employment opportunities. The policies are broad and all encompassing, with a major focus on strengthening the education system and providing children with greater opportunities to avoid mental health issues.

By acknowledging the fact that quality of life revolves around, among other things, the welfare of individuals and high levels of mental and physical wellbeing, Icelandic officials are striving to create a more informed, harmonious country. It is important to remember, as the policy stresses, that these government policies are being introduced slowly and methodically. In the words of Frank Zappa, “without deviation from the norm, progress is not possible,” and with this special emphasis on prescription drug abuse, nutrition, exercise, and mental health, Iceland is most definitely moving in the right direction.

 

References

1. Torben M. Andersen, Bengt Holmström, Seppo Honkapohja, Sixten Korkman, Hans Tson Söderström, Juhana Vartiainen. The Nordic Model – Embracing globalization and sharing risks (2012), www.economics.mit.edu/files/5726
2. Oginska, Halszka, and Katarzyna Oginska-Bruchal. “Chronotype And Personality Factors Of Predisposition To Seasonal Affective Disorder.” Chronobiology International: The Journal Of Biological & Medical Rhythm Research 31.4 (2014).
3. Michalak EE, Wilkinson C, Dowrick C, Wilkinson G. Seasonal affective disorder: prevalence, detection and current treatment in North Wales. British Journal of Psychiatry (2001).
4. Roecklein, K. A.; Rohan, K. J. (2005). “Seasonal affective disorder: An overview and update.” Psychiatry (Edgmont (Pa. : Township))
5. Sher L. (2001). Genetic studies of seasonal affective disorder and seasonality.
6. Hagle, W. (2015). “The World’s Happiest Countries Take the Most Antidepressants.” Opposing Views, http://www.opposingviews.com/i/society/worlds-happiest-countries-take-most-antidepressants
7. Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, Fawcett J (January 2010). “Antidepressant Drug Effects and Depression Severity.”
8. Levenson M, Holland C (2011). “Statistical Evaluation of Suicidality in Adults Treated with Antidepressants.”
9. Directorate of Health Health and Well-Being [in Icelandic] (2012). Available from: www.landlaeknir.is/heilsa-og-lidan/verkfni/item16380/Thjod_gegn_thunglyndi
10. Vilhelmsson, A. (2013). Depression and antidepressants: a Nordic perspective. Frontiers in Public Health.
11. NOMESCO (2014). Health Statistics in the Nordic Countries 2014. Copenhagen: Nordic Medico Statistical Committee.
12. Sigurdsson, E., Olafsdottir, T., & Gottfredsson, M. (2012). Public views on antidepressant treatment: Lessons from a national survey. Nordic Journal of Psychiatry.
13. Helgason T, Tómasson H, Zoëga T. Antidepressants and public health in Iceland. Time series analysis of national data. Br J Psychiatry (2014).

 

 

 

 

 

A totally unknown internet phenomenon, John Glynn is a man full of contradictions. With a Ph.D. in Psychology, he works as a lecturer. When he’s not working or stunt doubling for Zach Efron, he enjoys playing sports, doing a little research, and listening to music. As an Irishman, he struggles with an addiction to Guinness and potatoes, perpetuating the stereotype in the process.