Sweden

SWEDEN. Area 448,460 km². Population in 1932 was 6,190,364. Population density was 13.5 per 1 km² in 1910, and 14.3 in 1920. Population movement figures were as follows (Table 1): Table 1. Births Deaths Natural Increase Child Mortality (per 1,000) (per 1,000) (per 1,000) 17.6 11.7 5.9 5.6 16.8 11.8 5.0 5.6 16.1 12.7 3.6 6.0 16.0 12.0 4.0 - 15.2 12.2 3.0 5.9 15.4 11.7 3.7 6.5 14.8 12.5 2.3 5.7 14.5 11.6 2.9 5.1 Sweden is currently the country with the lowest birth rate in Europe. The percentage of urban population rose from 9.8 in 1800 to 21.5 in 1900 and 33.3 in 1932. The percentage of illegitimate children is very high and is increasing each year. In 1923 it was 145.5 per 1,000, and in 1927 it was 164.2. Sanitary Organization. Sweden has no separate Ministry of Health. All health questions are handled by the medical-sanitary department (3rd bureau) in the Department (Ministry) of Social Welfare. The head of this department is a director, to whom are subordinate the heads of six following sub-departments: medical (medical practice, official doctors, forensic-medical expertise), hygiene (infectious diseases, vaccinations, quarantine stations, etc.), general sub-department (hospitals, sanatoriums, pharmacies, control of drug sales, etc.), psychiatric hospitals, veterinary, personnel and accounting sub-department. In each department (province) of the country there is a chief sanitary inspector, from whom depend district official doctors (about 260 doctors in all of Sweden). These doctors treat the population at a tariff approved by the state. In most cities there are also city doctors of the same type as the district doctors. The provincial sanitary inspector is a sanitary advisor to the provincial governor. In addition, a departmental council is attached to the governor, the functions of which include organizing medical aid for patients in general and for indigent patients in particular, managing hospitals, fighting tuberculosis, etc. In each city there is a separate Hygiene Council, which manages health care in the city. Under the state are hospitals for psychiatric patients and for lepers (26 beds), as well as 4 state laboratories - bacteriological, forensic-medical, pharmacological and veterinary - and 2 quarantine stations. Medical Practice (medical personnel and hospitals). Numerical data on medical personnel and hospitals in 1931 are given in Table 2: Table 2. Medical Personnel Quantity Medical Institutions Quantity Dentists ... 2,351 Midwives ... 1,283 Pharmacies ... 2,606 General Hospitals ... 2,361 Beds in hospitals ... 26,257 Beds for psychiatric ... 15,882 There are 3 medical faculties (Uppsala, Lund and the Karolinska Institute), in which in 1932 there were 1,968 medical students. In 1931, per 10,000 inhabitants, there were (Table 3): Table 3. Medical Personnel Doctors ... 3.8 Dentists ... 2.1 Midwives ... 4.2 Pharmacies ... 0.68 General Hospital Beds ... 42.8 Psychiatric Hospital Beds ... 25.3 In addition to 25 psychiatric hospitals with 15,882 beds belonging to the state, in 1931 there were 62 private hospitals with 2,176 beds. Infectious hospitals numbered 140 with 6,777 beds that same year. Almost all infectious patients are treated in hospitals, not at home. Thus, in 1928, 97.6% of all registered diphtheria cases were treated in hospitals, all registered scarlet fever cases, and 98.9% of typhoid abdominal cases. In 1929, Parliament adopted a law on the internment of psychiatric patients. Each psychiatric patient may be admitted to a hospital at their own request. In addition, the police may intern a patient if a doctor recognizes in writing that they are dangerous to others. Fight against Social Diseases. Tuberculosis. Mortality from tuberculosis, which had been continuously rising until 1917, began to decrease rapidly thereafter, as shown by the following figures (Table 4): Table 4. Years Died from TB (absolute figures) Per 1,000 inhabitants 1911-1915 ... 2,049 1.94 1916-1920 ... 1,992 1.81 1921-1925 ... 1,743 1.48 1926-1930 ... 1,512 1.32 In the northern provinces (Norrbotten), populated by heavily exploited and poor Lapps and Finns, mortality from tuberculosis is twice the average for Sweden. The fight against tuberculosis is conducted by the Swedish Association for the Fight against Tuberculosis, subsidized by the government. Almost all dispensaries are also subsidized by the government. The number of dispensaries grew from 188 in 1923 to 225 in 1929. In total, in 1931 there were 90 hospitals, sanatoriums, and departments in tuberculosis hospitals with 8,048 beds. The Swedish Association for the Fight against Tuberculosis allocates about 500,000 kronor per year to dispensaries and to the treatment of children. Since 1927, the Calmette vaccination has been applied, mainly in Norrbotten. Thus, from 1927 to 1929, 3,387 children were vaccinated there, and in 1929 the vaccination covered 38.8% of all births. Venereal Diseases. There is a strong growth in venereal diseases, only partly explained by better registration and greater patient attendance at medical institutions. Thus, in 1919 only 1,009 syphilis patients were registered, whereas in 1929 there were 5,823; in 1919 there were 13,893 gonorrhea patients, whereas in 1929 there were 20,471; in 1919, 207 patients with soft chancre were registered, whereas in 1929 there were 482. The fight is insufficient. In 1929 there were 20 central consultations for venereologists, which treated 14,301 patients, 3 centers for the treatment of congenital syphilis, and 4 other institutions. Cancer. Morbidity and mortality are high. In 1927, 12 people per 10,000 inhabitants died of cancer. In addition to treatment in general hospitals in Stockholm, there is a special hospital for cancer patients, which in 1929 hospitalized 1,014 patients and treated 6,352 on an outpatient basis. Protection of Motherhood and Childhood. The number of curative-preventive institutions for women and children is not high. In 1929 there were 6 consultations for pregnant women and 29 special hospitals with 865 beds for parturients. In 1931 the number of beds was determined to be 1,142. In addition, there were 3 hospitals for infants with 155 beds. In 1931 there were 20 children's hospitals with 2,162 beds. Protection of Labor and Social Insurance. Laws on labor protection and hygiene in industrial and commercial enterprises are very numerous. In 1919 a law on the 8-hour workday was temporarily adopted, which became permanent for industrial workers, commercial-industrial employees, workers in forestry and transport from 1930. According to Nordin's data, this law covers 73% of all workers. Accident insurance in industry and trade is compulsory by law. In 1929 it covered 1,556,078 people. Sickness insurance is carried out by mutual aid funds receiving a subsidy from the government. In the development of these funds a process of their consolidation is observed, as shown by the following figures (Table 5): Table 5. Number of Funds Number of Members Years in them Funds' Capitals 2,121 434 808 8,537,529 kronor 2,400 591 315 13,303,577 kronor 1,255 572 133 12,182,628 kronor 1,291 738 154 19,889,500 kronor 1,212 1,016 846 39,965,859 kronor 1,931 1,223 1,058 129 39,489,009 kronor Budget. The state health budget constitutes a little more than 3% of the general state budget. It grew strongly from 1913 to 1920 and continued to grow until 1931, when due to the crisis a reduction in loans began, as shown by the following figures: 1931/32 - 36,022,044 kronor; 1932/33 (estimate) - 34,982,474 kronor; 1933/34 (estimate) - 30,638,159 kronor. Expenses for maintaining medical faculties are not included in these expenses. To these expenses one must add the following, from other departments (for example, expenses for 1930-1931 are taken): Military Sanitary Administration - 654,000 kronor; Naval Sanitary Administration - 188,000 kronor; Fight against Alcoholism - 557,000 kronor; Aid to Indigent Children - 2,571,980 kronor. In the budgets of the provinces, expenses for health care take first place, constituting on average 53% of the provincial budget. Thus, in 1930 the provincial budget was 72,562,949 kronor, of which 38,394,942 kronor were spent on health care (including medical-sanitary aid to the population).