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Social Change and Health in Sweden 250 Years of Politics and Practice

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Social Change and Health in Sweden 250 Years of Politics and Practice Social change and health in Sweden 250 years of politics and practice Jan Sundin and Sam Willner Swedish National Institute of Public Health R 2007:21 ISBN: 978-91-7257-534-9 ISSN: 1651-8624 Graphic design: AB Typoform Photos on front cover, from the left: IBL bildbyrå, Photos.com, Popperfoto/IBL bildbyrå, Photos.com and Sydsvenskan/IBL bildbyrå Printing: Alfa Print AB, Solna 2007 Table of contents List of tables and figures ............................................ 6 Glossary ......................................................... 7 Preface ......................................................... 10 Foreword ........................................................ 13 1. Introduction ................................................. 17 Introduction ..................................................... 18 Outline.......................................................... 18 250 years of public health .......................................... 20 Health transition after 1750 ......................................... 21 Aims, concepts and perspectives .................................... 26 Reference list .................................................... 38 2. Pre-Enlightenment: Life and death in God’s hand ............. 43 Introduction ..................................................... 44 State, church and people .......................................... 44 War ............................................................ 47 The Black Death .................................................. 48 Summary: Public health before the Enlightenment ...................... 52 Reference list .................................................... 53 3. Mercantilism, the Enlightenment and the birth of epidemiology .. 55 Introduction ..................................................... 56 Mortality according to the statistics .................................. 59 Famines ......................................................... 61 Men and women.................................................. 61 Town and country ................................................ 63 Science, learned societies and enlightened priests ...................... 65 Popular advice from Sweden’s first paediatrician ....................... 68 The enemies according to an enlightened provincial doctor .............. 71 Local administration, literacy and church discipline ..................... 74 Summary: The public health legacy of the Age of Enlightenment .......... 77 Reference list .................................................... 78 4. Society in transition: Population growth, proletarianisation and increased life expectancy (c. 1800–1870) .................... 81 A society in transition.............................................. 82 Epidemiological trends ............................................ 83 Children and adults ............................................... 84 Men and women ................................................. 85 Regional and social differences ..................................... 88 Material deprivation and mortality .................................. 90 Health administration, provincial doctors and midwives ................. 92 Public health and local administration ............................... 94 Smallpox vaccination ............................................. 96 Breastfeeding, infant care and cleanliness ............................ 100 Pre-industrial urban areas and hygiene .............................. 102 Cholera – the last large-scale epidemic .............................. 103 Strong liquor – a point of order and a health risk ...................... 104 Social control and stigmatisation: Supervision of prostitutes ............ 106 Summary: The first phase of the epidemiological revolution ............ 108 Reference list .................................................... 111 5. Industrialisation and hygienism (c. 1870–1920) ............... 115 Introduction .................................................... 116 Epidemiological trends ........................................... 118 Men and women ................................................ 122 Regional and social differences in mortality ........................... 125 The growth of medical knowledge and medical institutions .............. 126 A national statistics agency, Statistics Sweden ........................ 128 Industrialisation, ideologies and the welfare state ..................... 129 Occupational health .............................................. 131 Healthcare administration as a local issue ............................ 133 Urban hygienism ................................................ 134 Urban water – two local examples .................................. 137 Alcohol legislation and the orderly worker ............................ 139 Philanthropy – humanitarian aid and social control .................... 141 Philanthropy and public institutions – corporative cooperation .......... 142 Popular movements – social and political grassroots in a new society ..... 144 Summary: Hygienism, economic growth and social stabilisation ......... 146 Reference list ................................................... 147 6. Between two wars: Towards the Swedish welfare state (1920–1945) ................................................... 151 Introduction .................................................... 152 The epidemiological regime ........................................ 153 Social and regional differences ..................................... 154 The institutionalisation of maternal and child healthcare ................ 155 District nurses in the line of public health duty ......................... 156 The fight against tuberculosis ...................................... 157 The Bratt system – solidarity among decent folk ....................... 159 Solving societal problems with the help of “social medicine” ............ 160 Social utopia: Scientific faith and paternalism ......................... 162 From urban to rural health risks: “Dirty Sweden” goes rural ............. 163 The birth of the welfare state ...................................... 168 Summary: Increased life expectancy, welfare and social hygiene .......... 172 Reference list ................................................... 173 7. Harvest time for welfare policy and medical progress (1945–2006) ............................. 177 Introduction .................................................... 178 Epidemiological trends ........................................... 178 Men and women ................................................ 182 Social differences in health ........................................ 186 Regional differences in mortality ................................... 188 Harvest time for the welfare state .................................. 190 Urbanisation, housing crisis and the “million-homes” programme ....... 192 Biomedical progress ............................................. 193 The health service in economic crisis ................................ 195 Occupational and environmental health risks ......................... 196 Swedish Public Health Institute .................................... 197 Epidemiology, risk factors and health ................................ 198 Restructuring the economy, social stress and health ................... 199 Care of the body, the perfect body ideal and health as market commodities ... 200 Swedish public health in a global individualistic world .................. 203 A comprehensive Swedish public health policy ........................ 205 Health – a field of compromise .................................... 207 Summary: Harvest time for welfare policy ............................ 208 Reference list ................................................... 209 8. Conclusions – lessons from the past ........................ 213 Introduction .................................................... 214 Social determinants and health – a Swedish example .................. 214 Health and the response of society ................................. 222 Health and social change ......................................... 227 Sweden and its European neighbours – converging systems ............ 230 Swedish history and the world today ................................ 233 Health and lessons from history ................................... 238 Reference list ................................................... 246 Appendix ..................................................... 250 List of tables and figures tables Table 1.1 Remaining average life expectancy at different ages, 1751–2002. Table 3.1 Causes of death among men and women 20–44 years old. Sweden, 1779–1782. Age-standardised deaths per 100,000. Table 5.1 Mortality from certain infectious diseases (and infection-related diagnoses) in Swedish towns, 1875–1879 and 1921–1930. Deaths per 100,000. Standardised for sex and age after 1875–1879. Table 6.1 Causes of death per 100,000, 1921–1930. Table 7.1 Cause-of-death patterns for men and women aged 15–19 and 50–59 years. Deaths per 100,000. figures Figure 1.1 The demographic transition. Sweden, 1750–2000. Figure 1.2 Health, economic capital (EC), cultural capital (CC) and social capital (SC). Figure 3.1 Sex-specific mortality in the 25–49 age group for major causes of death in the town of Linköping and surrounding countryside parishes, 1750–1814. Figure 4.1 Life expectancy for males. Sweden, France and England & Wales, 1800–2001. Figure 4.2 Excessive male mortality in the 25–49 age group (%). Sweden, 1751–1900. Five-year periods. Figure 4.3 Sex-specific
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