Social Change and Health in Sweden: 250 Years of Politics and Practice (review)

This work is an abridged version of the much larger and thematically organised Swedish language publication edited by Jan Sundin and others to which Sundin and Willner contributed.¹ As such it certainly represents a very welcome addition to the paucity of material available in English about the development of medical care in this frequently neglected part of the world.

The authors have two primary objectives: to demonstrate that Sweden’s remote location did not prevent it from becoming actively involved in the European medical world particularly from the early modern period onward; and to suggest how current efforts to combat medical challenges in the underdeveloped world might benefit from understanding how Sweden confronted and largely overcame similar problems in the past. Pierre Bourdieu’s concepts of social, cultural and economic capital and the purpose that serves provides the theoretical framework for this book. Sundin and Willner also employ Robert Putnum’s distinction between ‘bonding’ and ‘bridging’ social capital and Simon Szreter’s ‘linking’ social capital to suggest the mechanism by which diverse segments of Swedish society gradually embraced ideas and practices aimed at promoting the health of the individual and by extension the well-being of the state. (30–32) Such measures included the acceptance of breast feeding, vaccination, and temperance.

The authors launch their chronological survey by briefly exploring efforts to combat the arrival of the Black Death in the 14th century. However, their coverage really begins with an examination of how mercantilism and the Enlightenment influenced the state’s involvement in medical care. Remaining chapters are largely devoted to examining the impact of the industrialisation and population growth of the 19th century, and the rise and extension of the welfare state from the 1930s onward.

Swedish bureaucrats and physicians charged with improving the state’s health were well aware of major developments on the continent. The work of Johan Peter Süssmilch and his efforts to gather mortality and population data in Prussia prompted Swedish officials to gather similar information for all the Swedish parishes. This led to the creation of Tabelleverket, Sweden’s first statistical office, in 1749 and the production of the first quantitative evidence demonstrating regional and longitudinal mortality patterns. Medical officials armed with this information could then concentrate their efforts on those parts of the country and segments of the population whose level of health was below the norm. Similarly, Swedish doctors were quick to recognise the significance of Jenner’s work and launched extensive vaccination campaigns even before the state introduced compulsory vaccination in 1816. During the nineteenth century leading Swedish physicians became members of the numerous medical societies that emerged throughout Europe. The development of the Swedish Public Health Act in 1874 and legislation that provided insurance in the event of occupational injury mirrored similar legislation passed on the continent and in Britain. The international eugenics movement also found support in Sweden and the result was approximately 25 years of forced sterilisation of the mentally ill. (153, 160–2) State involvement in matters of public health continued to expand until the 1990s when the country’s economic slowdown not only reduced the amount of money available for such programmes, but also contributed to rising unemployment and a host of ‘psychosocial factors’ that contributed to ill-health. (199) By now government officials were firmly convinced that they ought to direct their efforts towards modifying behaviours that led to ‘lifestyle’ diseases rather than focussing on larger social and environmental causes of disease. The Swedish Public Health Policy introduced in 2003 clearly reflects this new agenda.

The authors do an admirable job in each chapter of contextualising medical developments within their political, cultural and economic contexts. The 16th century witnessed the Swedish state’s preoccupation with military expansion that diverted funds and attention away from initiatives of health. The Enlightenment challenged beliefs that supernatural forces were responsible for sickness and death and instead opened the door for...