Denmark

DENMARK, occupies an area of 44,325 km², with a population of 3,457,390 (1925). Denmark is one of the countries with the best health indicators. In 1927, the birth rate was 19.6 per 1,000 population, mortality was 11.6, and population growth was 8.0. For the years 1910-14 to 1927, mortality decreased by 1.3 (i.e., by 10.1%), but the birth rate fell by 6.8 (i.e., by 25.8%), and the growth rate decreased by 5.5. Infant mortality under 1 year is 8.0 per 100, and average life expectancy is 58 years. In 1926, a Ministry of Hygiene was established. Its responsibilities include: public hygiene, central sanitary legislation, epidemic control, medical personnel, housing and industrial hygiene, sickness insurance societies, accident insurance, tuberculosis control, protection of childhood and motherhood, quarantines, psychiatric assistance, institutions for the defective, mentally retarded, etc. Alongside this, the War and Navy Ministries manage military hygiene issues; the Ministry of Justice handles forensic medicine, venereal disease control, food inspection, matters of the Red Cross Society, and cremation; the Ministry of the Interior manages water supply and sewage; the Ministry of Agriculture handles veterinary affairs, dairy and meat inspections; the Ministry of Public Works manages the sanitary condition of transportation; and the Ministry of National Education handles medical education and school hygiene. Attached to the Ministry of Hygiene is the National Health Council (Sundhedsstyrelsen). The council has eight members: a hygienist, pharmacologist, bacteriologist, specialist in tuberculosis, psychiatrist, dentist, pharmacist, and practicing physician. The tasks of the Health Council include coordinating all work in the field of healthcare, monitoring compliance with sanitary laws, control of medical personnel, consultation on these matters, supervision of statistics, control of pharmaceutical affairs, and approval of plans for hospitals and public health institutions. From a medical standpoint, the entire country is divided into 26 sanitary areas (amts) and 80 districts (distrikts) with hygienic physicians at their head. These physicians serve as government sanitary agents and also as forensic medical experts. In the areas and districts, there are hygienic and epidemiological commissions consisting of persons elected by the municipality. Hygienic physicians participate in them as consultants. The hygienic commissions are responsible for all housing and communal sanitation and municipal medical care, while the epidemiological commissions directly supervise anti-epidemic measures. Medical assistance in rural areas is organized by communities, which usually hire a physician and midwife under specific conditions, or by mutual aid insurance societies, in which about 60% of the population is insured. Water supply is managed by municipalities, regulated by general sanitary legislation, and supervised by general sanitary control. Of 79 provincial cities, only 7 do not have water supply systems. Questions of sanitation are resolved in special commissions (local ones elected by the district council, and a central one appointed by the Ministry of Agriculture) based on the 1907 law, which defines the concept of sewage and establishes the procedure for this matter. Sewage is widely discharged into the fjords that cut into the peninsula from all sides; often this discharge occurs without any treatment. The housing question from a sanitary-technical standpoint is resolved by housing commissions in municipalities, which have housing inspectors (not physicians) at their disposal. Housing construction cooperation is widely developed in cities. For sanitary supervision of meat, there is a sanitary inspection. Supervision of dairy products is carried out by a special inspection. There is an extensive network of model dairy farms hygienically equipped (largely cooperatively) and a similar network of enterprises for manufacturing standardized dairy products. The fight against epidemics is organized as follows. Notifications of patients are mandatory for 'dangerous' diseases: cholera, plague, yellow fever, typhus, smallpox, dysentery, leprosy, and venereal diseases. The obligation to isolate and hospitalize may be declared by the epidemic commission; the same applies to disinfection. Laboratory analyses and treatment for contagious diseases are free. Vaccination is mandatory, but verification is conducted only upon entering school and the army. Infectious morbidity is low. There is no cholera, typhus, or relapsing fever, smallpox; malaria consists of individual imported cases (33 cases in 1925, and 18 in 1926), and typhoid and paratyphoid give low figures (241 in 1926). The fight against tuberculosis is conducted by municipalities and the National League Against Tuberculosis, with state subsidies. There is extensive legislation (prohibition of work for tuberculosis patients in the food, railway, postal, obstetric, psychiatric, educational, and other sectors), measures regarding wet nurses, sanatoriums, children's institutions; legislative measures and sanitary supervision of dairy affairs in general and especially of milk for children. There is a network of dispensaries (11) and sanatoriums (24 with 1,873 beds), homes for invalids and convalescents (6), and schools for tuberculosis patients, as well as departments and entire hospitals for severe cases (36 with 1,396 beds). In total, there are 3,439 tuberculosis beds, i.e., 1 bed per 1,000 population. In the field of fighting venereal diseases and prostitution, regulation of prostitution was abolished and brothels were closed (1906); compulsory treatment and legal responsibility for infection were introduced; the 1923 law requires presentation of a medical certificate upon marriage regarding the absence of venereal diseases or the absence of risk of infection in a cured disease. There is a network of dispensaries. Protection of childhood is based on child protection councils (in each municipality), consisting of persons elected by the municipality, with the mandatory participation of a lawyer. The tasks of the council are: a) to help poor parents raise children and b) to assume parental duties if parents do not care for their children. Councils have the right to isolate children from parents by court order. The 1924 law forbids tuberculosis patients from taking children for upbringing and nursing. The 1908 law obligates the father of illegitimate or abandoned children to pay ³/₅ of the cost of maintaining the child; the 1913 law does not allow children to be taken to factories until they complete school. Night work is prohibited for them (1922 law) and work in a number of harmful enterprises in general (1918 law). There is no mandatory school-sanitary organization (it exists only in large cities). Physical culture is widely developed in the form of a network of gymnastic associations (831). There is a large network of various children's institutions for normal and abnormal children. Medical assistance is organized by insurance societies and municipalities (330 general hospitals, about 15,580 beds; of which 11,228 are therapeutic and surgical, 3,108 infectious, 892 dermatovenereal, 326 psychiatric, and 29 tuberculosis). In specialized psychiatric hospitals, there are 6,185 beds (in total: 1.9 psychiatric beds per 1,000 inhabitants, 1 bed per 1,000 population for the mentally retarded, and 0.2 beds per 1,000 for epileptics). Worker insurance is optional: the state subsidizes those societies that adopt the state model charter. All these societies, while autonomous, are generally organized in the same way and united on a provincial scale and in a national union. The insurance fund must provide outpatient, inpatient, psychiatric assistance, and assistance to tuberculosis patients and parturient women. If the fund additionally provides special types of assistance, dental care, home care, massage, and at least ³/₄ of the cost of medicines, then the state reimburses it ¹/₄ of the cost of these types of assistance. Insurance covers 63% of residents over 15 years old. Insurance against illness is optional, but the state gives subsidies to those insurance societies that adopt the model state charter of insurance societies (societies are homogeneous in structure and united in a national union); insurance covers ³/₅ of the population. Expenses are shared equally by the enterprise, workers, and the state. Disease insurance is linked to disability insurance. There is old age insurance: the state pays the costs, and the rest is paid by communes. Accident insurance is mandatory at the expense of the employer. Unemployment insurance is optional (usually provided by collective agreement); expenses are borne: ⁴/₅ by workers, ¹/₅ by the state, and ¹/₅ by communes. The budget for 1926/27 amounted to 367,233,537 Danish kroner. In the country, there are 2,485 physicians, 675 dentists, 1,092 midwives, about 5,000 nurses, and 750 masseurs.