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The question we raise in this paper is whether the educational gradient in avoidable mortality differs from overall and non-avoidable mortality among men and women in Norway. By avoidable deaths we refer to deaths caused by diseases that are either treatable if given appropriate medical care, or preventable if available preventive measures were implemented. The data set is derived from official administrative registers and includes all Norwegian men (1 107 427) and women (1 087 842) aged 25-67 years with information about status alive/dead during the period 1994-1999. Adjusted for sociodemographic and socioeconomic factors, education forms a marked and independent gradient in overall and non-avoidable mortality and an even steeper gradient in avoidable mortality - in particular in ischemic heart disease and preventable deaths. The educational gradient is shallower for deaths considered treatable by health care, but is still present. These patterns apply to men and women alike. The findings of our study suggest that health care and health policies may play a role in reducing inequalities in deaths that are 'avoidable, unnecessary and unjust'. [ABSTRACT FROM AUTHOR]

Earlier studies, mainly based in the UK, the US, Canada and the Netherlands, indicate that GPs are reluctant to follow guidelines. This study explores the rationale behind GPs' reluctance to follow guidelines through focus group interviews with Norwegian GPs. A central concern appearing in the interviews is the GPs' notion of professional identity. The GP was identified as an autonomous generalist with a close alliance to the patient and a sceptical distance to academic medicine and health authorities. Guidelines are seen to conflict with the GPs' sense of clinical autonomy. Another aspect discussed by the GPs was an authority-based clinical insecurity which made them sceptical about the evidence. The findings highlight the need to ground the debate about standardisation of practice in the practitioners' professional identity. The study also underlines the importance of transparency in the standardisation process. [ABSTRACT FROM AUTHOR]