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Child Health in Sweden: Historical Sociopolitical Perspective

This presentation on May 14, 2017, at the SASUF satellite workshop in Durban discusses the historical development of child health in Sweden, including sociopolitical reforms and the milestones in the Swedish healthcare system. It also addresses current issues in child health in Sweden, such as life expectancy and under-5 mortality rates.

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Child Health in Sweden: Historical Sociopolitical Perspective

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  1. Child Health in Sweden in a historical sociopolitical perspective Presentation on May14 2017, SASUF satellite workshop in Durban P-O Östergren, Division of Social Medicine and Global Health, Dept of Clinical Sciences in Malmö, Lund University

  2. Outline of presentation Child health in Sweden in a historical perspective Sociopolitical reform (the welfare state) relevant for child health Development of the Swedish Health Care system Current issues of child health in Sweden

  3. Life expectancy at birth historically in Sweden Men 32, Women 37 1770Men 41, Women 43 1870Men 55, Women 57 1920 Men 72, Women 79 1970Men 81, Women 84 2015

  4. Under 5 mortality historically in Sweden 42% 1750-60 31% 1850-60 6% 1930-40 2% 1950-600.3% 2015

  5. Milestones in the socio-political development in Sweden (1):1749: National Statistics Bureau 1700s: Education and breastfeeding campaign by the clergy, expansion of midwifery services1805: Church assistents were obliged to learn how to vaccinate against smallpox1816: Law that stipulated that all children under 2 years should be vaccinated (quickly 90 % coverage)

  6. Milestones in the socio-political development in Sweden (2):1842: Compulsary elementary school 1874: Swedish Sanitation Act (Public Health Board, and Public Health Inspectors) 1881: Child Labour Protection Law (Prohibited employment of children under 12 years of age, limited working hours to 6h/day for 12- 14 years old children)1902: General Child Protection Law

  7. Milestones in the socio-political development in Sweden (3):1934: Book: ”Crisis in the population issue”1937/38: MoC Health care services 1938: Help to mothers (in kind)1938-55: Maternity grants (to those uninsured)1955: Compulsoratory National Health Insurance which cover the whole population1970-80: Public pre-school care expanded with the ambition to cover all children1974: Parental grants (1995 first ”Daddy month”, 2002 second ”Daddy month; 2015 third ”Daddy month”) • 1

  8. The welfare state in Sweden (1):Understanding the context; four grass-root movements emerging during the 19th century Free churches Co-operative movement Labour movement Temperance movement

  9. The welfare state in Sweden (2):Typical features Universalistic social programs Provision of services mainly by the public sector at the local level Financing through taxes Relatively small inequalities both between social classes and betwen men and women

  10. The welfare state in Sweden (3):Outcomes Low poverty rates among among socially vulnerable groups: Families with many children Single parents Elderly individuals

  11. The welfare state in Sweden (4):Mechanisms behind good population health (Specific across the life course) Universalistic maternal and child health systems and social benefits Family policy legislation, (e.g. dual earner family support) System of alcohol control (e.g. ”Systembolaget”) Generous pension benefits

  12. Milestones in the development of the Health Care System in Sweden 1600s (1) A few doctors (Provincial doctors) were employed by the Government in some counties 1660 The first Medical Faculty (first professor in Medicine) was established at Uppsala University (at Lund University in 1666)

  13. Milestones in the development of the Health Care System in Sweden 1600s (2) 1663 Collegium Medicum was established to overlook over the medical profession Midwives were established and looked after by Collegicum Medicum and the State Church

  14. Milestones in the development of the Health Care System in Sweden 1700s (1) 1744 The provincial doctors got a Government Instruction, they were now 32 in the whole country 1750 All midwives should according to Collegium Medicum be educated in Stockholm (later this century, also education of midwives in Lund and Göteborg)

  15. Milestones in the development of the Health Care System in Sweden 1700s (2) 1752 First hospital-based delivery ward (Serafimer Hospital in Stockholm) 1765 The Swedish parliament decided that dioceses, counties or local municipalities could build hospitals at their own expense

  16. Milestones in the development of the Health Care System in Sweden 1800s (1) 1812 The Government stipulated that each parish (or several, if small) should employ a midwife 1813 College of Health (Sundhetskollegium) was established

  17. Milestones in the development of the Health Care System in Sweden 1800s (2) 1819 Only licenced midwives were allowed to attend births 1850 The Government established education for nurses

  18. Milestones in the development of the Health Care System in Sweden 1800s (3) 1862 A fundamental constitutional reform was made and the present day three-tier system of governance was introduced: the National level, the County Concils (Landstingskommunerna) and Municipal Councils (Primärkommunerna), which all have an elected body and right of taxation.

  19. Milestones in the development of the Health Care System in Sweden 1800s (4) 1864 The County Councils were established, with the primary task to organize hospital-based health care. Many of the existing hospitals (or their forerunners) were built. 1878 The Royal Medical Board (Medicinalstyrelsen) was established, replacing the College of Health and Collegicum Medicum

  20. Milestones in the development of the Health Care System in Sweden 1900s (1) 1915 The number of Provincial doctors had increased to 317 some of which were employed by local municipalities 1950s Midwifery became a specialization of the nursing profession and educated at nursing schools, which were integrated into the Medical/Nursing Faculties of universities during the 1980s

  21. Milestones in the development of the Health Care System in Sweden 1900s (4) 1982 The Health Care Act. A major reform giving responsibility to the County Councils for all Health Care under public management (hospitals as well as primary health care service) in the county. Did also stipulate responsibility for equal access to health care and to monitor health in the county’s population (i.e. a public health task). End to the system with Provincial doctors.

  22. Milestones in the development of the Health Care System in Sweden 2000s (1) 2009 Primary Health Care based on geographical boundaries abandoned, new law (LOV) makes it compulsory for individuals to choose PHC-unit. System open to private operators to ”bid” for tax-financed services within the ”public” system. In some counties (especially in Stockholm) also specialists could be given this opportunity, in practice creating specialized private hospitals (e.g. in area of othopedics, ophtalmology, gyneacology, pediatrics, etc) who sign contracts with the County Council and are thus tax-financed and a part of the ”public” system.

  23. Milestones in the development of the Health Care System in Sweden 2000s (2) 2013 Health and Social Care Inspectorate (IVO) established, six regional offices (The Board of Health and Welfare became a support organization) 2016 The private operators of Swedish Health Care System represent 13% of the total budget. About 13% of the Swedish citizens have private health insurance (in addition to the compulsory National Health Insurance) which allow them to seek care in ”pure” private health care sector or by private institutions abroad.

  24. Current issues in child health in Sweden Mental health Overweight/obesity

  25. Mental health issues among contemporary Swedish children Psychobehavioral conditions ADHD etc Autistic spectrum disorders Cooperation between parents, school and health care, suppoted by special social benefits (Law for support of certain individuals with functional disabilities (LSS) 1994)

  26. Thank you for your attention!

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