The 2018-edition of NAFKAMs national survey was carried out by Ipsos MMI at the end of November/ start of December 2018, and brought data from telephone interviews with a total of 1,000 residents aged 16 and over. Original analysis and reporting was done by Vinjar Fønnebø and Ola Lillenes.
The report was first published on June 25, 2019. In November 2022, the figures were re-analysed by Agnete E. Kristoffersen for an increased basis for comparison with NAFKAM's other such surveys. The report was therefore upgraded in January 2023 because of this, as well as requirements for universal design.
From then on, this report provides knowledge based on 980 telephone interviews with Norwegian residents aged 18 and over. At the end of 2018, the total population for this age group, according to Statistics Norway, was 4 166 612 people, divided into 2 088 912 men (50.1%) and 2 077 700 women (49.9%). In our survey, the proportion of men was slightly higher (54.4%) and the proportion of women correspondingly lower (45.6%) than the actual proportions in the population.
Total use of complementary and alternative medicine in 2018
This year, a total of 36.5% reported having used complementary and alternative medicine (CAM), in one or more of the following forms:
- Received one or more CAM therapies (E.g acupuncture, massage therapy, homeopathy etc) from a practitioner (22.4%), and/or
- Used herbs/natural remedies such as ginseng, garlic, ginger or the like (9.6%), and/or
- Used self-help techniques such as yoga, mindfulness, meditation or the like (16.9%).
In general, use of CAM was more common among women than men: 46.8% of the women in the survey reported having used such treatment, compared to 28.0% of the men. The user group was thus divided into 41% men and 59% women.
The average cost for everyone who stated having used CAM was NOK 2,970.50. The average cost for male users was NOK 2,158.8, and for female users it was NOK 3,560.80.
Transferred to the population level, these figures correspond to 1.5 million Norwegians aged 18 or older using CAM in 2018, for a total of NOK 4.5 billion.
A closer look at the data shows the following:
CAM therapies from providers
22.4% of all respondents stated that they had received one or more CAM therapies (such as acupuncture, homeopathy, healing, reflexology etc.) from a provider, within or outside the official healthcare system. This was more common among the women (29.1%) than the men in the survey (16.9%). The user group was thus divided into 41% men and 59% women.
The average cost for everyone who stated that they had received a CAM therapy from a provider was NOK 3,113.60 per user. For male users, the average cost was NOK 2,568.90 and for female users it was NOK 3,490.70.
Transferred to the population level, these figures correspond to 933,300 people receiving CAM therapy from providers in 2018, for a total of NOK 2.9 billion.
Most used CAM therapies in Norway in 2018 (Table):
The differences in the use of the predefined therapies were small, except for massage therapy, which also in 2018 constituted a significantly higher proportion than the others. You can read more about this in our general summary on NAFKAM's population survey, or in the report from the 2014 survey.
Use of herbs/natural remedies
9.6% reported using herbs/natural remedies (for example ginseng, garlic, ginger or the like) for health purposes. This was more common among the women in the survey (11.9%) than the men (7.7%). The user group was thus divided into 44% men and 56% women.
The average cost for everyone who used this was NOK 994.70 per user. For male users, the average cost was NOK 1,165.80 and for female users it was NOK 862.40.
Transferred to the population level, these figures correspond to 399,900 people using herbs/natural remedies for health purposes in 2018, for a total of NOK 397.8 million.
Use of self-help techniques
16.9% reported using self-help techniques (for example yoga, mindfulness, meditation or the like) for health purposes.This was more common among the women in the survey (24.4%) than the men (10.7%). The user group was thus divided into 34% men and 66% women.
The average cost for everyone who used this was NOK 1,732.80 per user. For male users, the average cost was NOK 814.00 and for female users it was NOK 2,258.8.
Transferred to the population level, these figures correspond to 704,100 people using self-help techniques for health purposes in 2018, for a total of NOK 1.2 billion.
CAM users' experiences
The 36.5% who stated having used CAM were also asked three follow-up questions about their experiences with the treatment they used. These were related to perceived side effects, worsening or improvement of their
Almost 2/3 (63%) of CAM users meant that their state of health improved from such treatment. Only a minority (5%) experienced side effects, and/or that their state of health worsened as a result of the treatment they used (2%). Transferred to the population level, this represents up to 106,000 people. In our view, this indicates that patient safety must still be taken seriously within CAM.
Only a few reported both, i.e. having noticed both improvement and deterioration of their health. This could mean that experiences differed among several therapies; treatment consultations, or different providers.
Gender differences in CAM use
The survey's 1,000 respondents consisted of 545 men and 455 women. The 2018 figures showed that women used CAM more than men:
With the exception of herbs/natural remedies, women also spent more money than men on CAM than in 2018:
Norwegians' state of health
The respondents were asked to evaluate their own health situation, by rating it from "very good" to "very bad":
Almost 8 out of 10 rated their health as good or very good, regardless of whether they used CAM or not. However, CAM users generally rated their health slightly worse than non-users.
Norwegians' use of dietary supplements
NAFKAM does not consider ordinary use (in line with the package insert) of dietary supplements (vitamins, minerals, fish oil, trace elements etc) to strengthen health as an CAM, but measures the population's use of supplements on behalf of the health authorities:
A total of 68.8% reported having used dietary supplements in 2018. This was more common among the women (76.3%) than the men (62.5%) in the survey. The user group was made up of 51% women and 49% men.
The average cost to dietary supplements was NOK 1,013.30 per user. For male users, the average cost was NOK 1,038.00 and for female users it was NOK 989.10. Transferred to population level, this corresponded to 2.8 million people using dietary supplements in 2018, at a total cost of NOK 2.9 billion.
What does this mean, and why?
While the total use of CAM in 2018 was slightly higher (+0.7 pp) than in the previous survey (2016), users' costs were +16.6% higher in 2018. Male users' costs were +34% higher than in 2016, while female users' costs were +12.2% higher. In addition to general price increase, there are several aspects of this that can be commented on:
The proportion who received CAM therapy from a provider remained almost unchanged (-1.1 pp lower) from 2016-18. Use of such CAM has been decreasing since 2012. However, users' costs for such treatment rose by +13.7% in the same period. At the same time, the number of providers in the official CAM Provider Registry rose by +10.3% to 3,575. These were exempt from VAT on the provision of treatment services in both 2016 and -18, and could thus keep lower prices for customers than non-registered ones. We do not know to what extent the user group sought out registered or non-registered athletes.
The proportion who used herbs/natural remedies has been fairly stable throughout most of NAFKAM's surveys, and we only saw a small increase of +1.2 pp from 2016-18. However, the user group's costs were as much as -31.2% lower in 2018 than in 2016. Such differences and variations among these figures can partly be explained by variations in purchase volumes and market trends from one survey to the next (users do not state either the type of herbs, the cost per unit or the quantity they buy). An almost unchanged share of users in the population together with a decrease in costs, could indicate that users have bought roughly the same volume but cheaper products
The proportion who used self-help techniques for health purposes rose by +2.6 pp slightly from 2016 to 2018, while the user group's costs rose by a surprising 122%. Such a gap in the development of use and costs can be explained by the fact that the costs of self-help techniques are mainly linked to instruction/training; not to the practise of what was learned in the course. A greater increase in costs than in use may indicate that the use of such CAM was to a greater extent linked to course participation in 2018 than previously.
By 2018, the declining use of CAM providers appeared to have slowed down; the use of herbs was virtually unchanged, and the use of self-help techniques experienced a slight increase from 2016.
Self-help and -treatment appeared to increase its proportion in the population's total use of CAM, at the expense of treatment from providers. This brings along a reduction of professional responsibility in the area, which may lead to new aspects to consider in patient safety work. Furthermore, it will be interesting to see how the growing number of registered athletes attracts the users of such treatment.
Bottom line, the use of CAM in 2018 was considered high and in line with what is found in comparable countries. CAM still makes up a large part of Norwegian patients' total healthcare. The same can be said for the population's use of dietary supplements.