Norway was awarded first place according to the UN's Human Development Index (HDI) for 2013. In the 1800s, by contrast, poverty and communicable diseases dominated in Norway together with famines and epidemics. From the 1900s, improvements in public health occurred as a result of development in several areas such as social and living conditions, changes in disease and medical outbreaks, establishment of the health care system, and emphasis on public health matters. Vaccination and increased treatment opportunities with antibiotics resulted in great improvements within the Norwegian population. Improved hygiene and better nutrition were factors that contributed to improved health.