3. Good health and well-being

Structural differences in living conditions and lifestyles lead to inequalities in health at the societal level. The differences in health can eventually become so great that they result in differences in life expectancy between different groups. In Sweden, we generally have a high life expectancy, good self-rated health and good access to health care. However, one challenge is the structural health inequalities that exist between different groups in society.

The goal in a local context

Municipalities, together with regions, are responsible for a large part of the welfare services that have a major impact on the health of the population over a lifecycle. These include, for example, how schools and social care operate, how housing and community planning is carried out, and the extent to which cultural and leisure activities are available to all. These activities all have the potential to be both health-promoting and preventive (Glokala Sverige n.d.).

What it looks like in Malmö

Life expectancy and self-rated health

From an international perspective, Malmö residents generally enjoy good health and high life expectancy. However, there are clear differences between different groups, meaning that health is not evenly distributed across the population. For example, women live longer on average than men, with an average life expectancy of 84 years, compared to 80 years for men, in 2023. Although life expectancy is relatively high, it is still slightly below the national average, mainly because men in Malmö live one year less than the national average for men.

Although men die on average four years earlier than women, men generally rate their general health better than women of the same age. In terms of self-rated health, there are also differences depending on, for example, level of education, with people with post-secondary education rating their health better than those with less education.

Over the past decade, there has been a negative trend among children and young people in terms of self-rated health. The proportion of pupils with good self-rated health has fallen from 86 per cent in 2012 to 74 per cent in 2024. The negative trend is most evident among girls, where the decrease was about 18 percentage points between the years, compared to 5 percentage points among boys. It is worth highlighting that the negative trend may be about to reverse as the 2024 survey showed a slight improvement in self-rated health regardless of gender compared to 2021.

The same pattern is also found for psychosomatic disorders. The share of children in grade 9 reporting psychosomatic disorders in 2012 was 38 per cent compared to 45 per cent in 2024. The increase is mainly due to more girls reporting these disorders.

Physical activity

National studies show that as many as one third of both boys and girls spend almost all their leisure time sedentary with very limited physical activity, which has implications for their physical and mental health and school performance (Public Health Agency of Sweden, 2021). In general, the proportion of young people who are physically active for one hour a day, in line with the Public Health Agency of Sweden's recommendations, is low and has been so for the past ten years (Public Health Agency of Sweden, 2023). Of children in school year six in Malmö, about half are physically active for at least 60 minutes a day, and the proportion decreases with increasing age. It also differs depending on gender and background. Boys are more physically active than girls and children with a Swedish background are more physically active than children with a foreign background (Stadskontoret, Malmö stad kommande Hållbarhetsrapport).

For adults (18-64 years), the Public Health Agency of Sweden recommends being physically active at moderate intensity for at least 150-300 minutes per week or at high intensity 75-150 minutes per week. In 2022, 64 per cent of adults in Malmö were physically active at this level, which was marginally lower than the figure for adults nationwide (67 per cent). Even among adults, men are more physically active than women. There is also a correlation between level of education and physical activity, with the group with post-secondary education being physically active to a greater extent than the group with only pre-secondary or upper secondary education.

Alcohol, drugs and tobacco use

The proportion of people with risky consumption* of alcohol has generally decreased among Malmö residents since 2004 and stood at 14 per cent in 2022, slightly lower than the national average (16 per cent). The proportion is higher among men than women, but the decrease has been faster among men, which has led to a narrowing of the gender gap. The decrease has been greatest among younger age groups. However, the proportion of those at risk of alcohol consumption has increased slightly among the oldest age group (65-84 years), from 7 per cent in 2004 to 12 per cent in 2022.

The proportion of adults who reported having used drugs in the past year was slightly higher in 2022 in Malmö (6 per cent) than in the country (3 per cent) and was higher among men (8 per cent) than women (4 per cent). The proportion of children in school year 9 who used drugs in the past year decreased slightly between 2016 and 2024, driven by a decrease in use among boys, from 8.7 to 7.4 per cent. Among girls, on the other hand, there was a slight increase over the same period. Drug use differs between the different areas of the city, with a difference of 5 percentage points between the area with the highest and lowest consumption.

The trend in tobacco use has long been positive. The proportion of adults reporting daily cigarette smoking has more than halved over the past 20 years and stood at 8 per cent in 2022, slightly higher than the national average of 6 per cent. Over time, the proportion of children in year 9 who say they smoke or use snus has also fallen, from 19 per cent in 2012 to 10 per cent in 2021. However, the latest survey (2024) shows a break in the trend. At that time, just over 13 per cent stated that they smoked or used snus.

Road deaths and injuries

Road safety work is largely about reducing the number of accidents and making the city safe, secure and attractive for everyone who lives and spends time here. In recent years, pedestrians and cyclists have been the road users most frequently injured in Malmö. The average number of fatalities per year was 5.2 in 2016-2020 and 5.7 in 2021-2023 (Strada n.d.). Reducing the number of fatalities is a challenge as accidents have no common denominators in terms of accident type or location, for example.

Illness and death from chemicals and pollution

In the City of Malmö's environmental programme, there are objectives that highlight the exposure of Malmö residents to air pollution. A particular problem in southern Sweden is that we are more affected by air pollution from the continent. The largest local source of air pollution is road traffic. The development in Malmö is positive as air quality has improved over time.

Malmö's strategic chemicals plan includes several measures to reduce residents' exposure to harmful chemicals. In 2024, a common chemical management system was introduced in the City of Malmö, giving organisations better control over the use of chemicals and the possibility to replace hazardous with less hazardous substances. In general, people are most exposed to chemicals through products and food, an exposure that can be difficult to measure, rather than through direct contact with chemical products.

* Risky use of alcohol is measured in the national public health survey ‘Health on Equal Terms’ by three questions about drinking habits in the past year: how often you drank alcohol, how many standard glasses you usually drank, and how often you drank six or more standard glasses on one occasion. The scores from the answers are totalled to give a value between 0 and 12. Women with 5 points or more and men with 6 points or more are considered at risk.

Indicators

3.1 Heavy alcohol consumption, 9th grade, percentage (%)

3.2 Risky alcohol consumption, adults, percentage (%)

3.3 Antibiotic sales, prescriptions per 1,000 residents

3.4 Participation in sports clubs, children and youth, number per resident aged 7–20

3.5 Ease of accessing student health services, 8th grade, percentage (%)

3.6 Fall-related injuries among people aged 65 and older, number per 100,000 residents

3.7 Optimism among adults, percentage (%)

3.8 Physically active for at least 150 minutes per week, adults, percentage (%)

3.9 Premature mortality – ages 25–64, number per 100,000 residents

3.10 Good self-rated health, adults, percentage (%)

3.11 Good self-rated health, 9th grade, percentage (%)

3.12 Good mental well-being, adults, percentage (%)

3.13 Life expectancy, years

3.14 Drug use in the past year, adults, percentage (%)

3.15 Drug use in the past year, 9th grade, percentage (%)

3.16 Poor mental well-being, adults, percentage (%)

3.17 Psychosomatic complaints, 9th grade, percentage (%)

3.18 Sick leave, employees of the City of Malmö, percentage (%)

3.19 Sickness benefit days, days per insured person

3.20 Sedentary behavior for more than 7 hours per day, adults, percentage (%)

3.21 Tobacco: Daily cigarette smoking, adults, percentage (%)

3.22 Tobacco: Smoking or using snus, 9th grade, percentage (%)

References

Folkhälsomyndigheten (2021). Riktlinjer för fysisk aktivitet och stillasittande – Kunskapsstöd för främjande av fysisk aktivitet och minskat stillasittande. Tillgänglig: https://www.folkhalsomyndigheten.se/contentassets/106a679e1f6047eca88262bfdcbeb145/riktlinjer-fysisk-aktivitet-stillasittande.pdf

Folkhälsomyndigheten (2023). Skolbarns hälsovanor i Sverige 2021/22 Nationella resultat. Tillgänglig: https://www.folkhalsomyndigheten.se/contentassets/48b881b57779498595394ca05525d5d8/skolbarns-halsovanor-sverige-2021-2022-nationella-resultat.pdf

Glokala Sverige (u.å.). Arbetsbok – Agenda 2030. Tillgänglig: https://fn.se/wp-content/uploads/2021/04/Arbetsbok_Glokala_Sverige_2021.pdf

Stadskontoret, Malmö stad (kommande). Hållbarhetsrapport. En fördjupad analys av unga Malmöbors fritid. STK-2023-972.

Strada (u.å.). Swedish Traffic Accident Data Acquisition.