Iceland is one of the least densely populated countries in the world, with a total population of 290,500 people in 2003, averaging 2.9 inhabitants per square kilometer (Statistical Yearbook of Iceland, 2004). About two-thirds of the population live in and around the capital of Reykjavik, which is located on the southwest corner of the island. Mainly due to effects of the Gulf Stream, Icelanders enjoy a warmer climate than its subarctic location would indicate. The average July temperatures have passed 12° C in recent years from being 10.5° C in previous decades (Statistical Yearbook of Iceland, 2004). Unconfirmed, this has been viewed by many as one of the strongest indicators of global warming. The average temperature in January remains around the freezing point.
Both by ethnic and socioeconomic measures, the population is homogeneous. Still, its society and people offer a prototype of a western society with an advanced but small infrastructure. The past decade with rapid economic growth and low unemployment figures has stimulated immigration of workers from a variety of countries. During 2000 to 2004, the Icelandic Directorate of immigration has issued 5000 to 6500 residence permits of all categories annually (The Icelandic Directorate of Immigration, 2005). Hence, the historic advantage of a homogeneous population is about to disappear due to globalization. Instead, we will gain valuable prospective information on how a western society adapts to an influx of immigrants of all ages, and its effect on care and caregiving for the elderly.
In the year 2000, the costs of healthcare, including long-term care, were 7.7% of the gross domestic product. The healthcare system is nationalized, with 85% of total cost paid for through taxes (Highlights on health in Iceland. WHO Regional Office for Europe, 2000). By conventional measures and indicators through health statistics, Icelanders enjoy good health status. Strong economy, favorable social situations, and good access to healthcare have brought Iceland into a leading position as having one of the world's highest life expectancies at birth. Life expectancy at birth has increased from 61.0 years for women in 1921 to 1930, to 82.5 years in 2001 to 2003. During the same period, the life expectancy for men has increased from 56.2 to 78.7 years, the highest in the world (Statistical Yearbook of Iceland, 2004). This gender difference in life expectancy of less than four years in Iceland is smaller than in most industrialized countries, where it is usually five to seven years. Although the group of older citizens in Iceland has increased remarkably by absolute numbers in recent years, the proportion of older than 65 years remains less than 12% mostly due to relatively high fertility rate with 1.98 births/woman (Statistical Yearbook of Iceland, 2004).
Eighty-seven percent of Icelanders over the age of 65 live independently in the community. The remainder live in facilities for assisted living or nursing homes. A major disadvantage of the health care system in Iceland is its waiting lists. This is particularly true in Reykjavik, where long lists remain for both assisted living and nursing homes and where there is congestion of elderly awaiting discharges form acute hospitals (Ingimarsson et al., 2004).
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