The ‘urban penalty’, i.e. higher urban mortality compared with the countryside, existed at a national level in Sweden until the twentieth century. However, at a regional and local level, the urban-rural dichotomy was less true. In three countryside parishes in 1750-1859, three different patterns emerge. Socioeconomic and geographical factors defined life chances from cradle to grave. In a suburban parish, in a cohort born in the 1790s, about half of the females died before they were 30 years old and half of the males died before they were 20! This example is at the worse end of the scale with survival rates below the Swedish average – but it is not unique. In contrast, among those born during the same decade in a forest parish, about half of the females lived until they were 60 years old and half of the males were still alive at the age of 50! This second example is at the positive end with survival rates much better than the Swedish average. A third example, an iron foundry, had low infant mortality but high adult mortality, resulting in survival rates close to the Swedish average.

‘Public health’ investigates the determinants of health, born during the Enlightenment in the seventeenth/eighteenth century. But ‘public health’ is also policies, aiming at the improvement of a population’s health. There is a mutual interchange between public health as science and as politics. A brief historical background is followed by an analysis of the impacts of political changes during the first two decades of the twenty first century in Sweden. In 2005, a policy document accepted by all political parties except for the Moderate Party highlighted socio-economic factors and structural reforms to decrease the health gaps in the population. The general election in September 2006 resulted in a new majority in the parliament and a center-right coalition government, including the Moderates and three parties that had approved of the 2005 document. In 2007 a “new public health policy” was introduced. Its priority lists stressed individual behavior and the new policy should be incentives to work instead of “allowances”. The Public Health Institute got instructions in accordance with the new policy. The ten years following this policy change has seen public health policies and attitudes to research shifting almost year by year. The new policy met a counter-stream from the very beginning. Influenced by Michael Marmot’s WHO Commission on health inequalities, regional commissions started in Sweden, Recommendations how to decrease social health gaps was adopted with almost no opposition by regional health boards in 2012–2013. But new problems were now occupying politicians and media—how to finance the growth of the old, multi-sick part of the population and increasing costs for new medical technologies and drugs. Public health as an academic discipline was in the middle of this fluctuating political landscape with direct effects on what has been considered worth listening to or support by public money.

The impressive improvements in health for the Swedish population during the last two and a half centuries can be ascribed to many reasons. There has been a multifold of important public health measures including the regular collection of vital statistics from 1749 on a national level through the state church, which also played an important role in the early and widespread vaccination coverage against smallpox. Preventive mother and child care, access to health care free of charge, restrictive alcohol policy, accident prevention in several sectors and anti-tobacco campaigns have also been important. However, the increased living standard due to universal welfare policy strategies including social security, high educational standard, high degree of employment for women and men, regional and housing subsidies, appears to be equally or even more important.

The Swedish National Institute of Public Health, SNIPH, has been responsible for supporting the implementation of the Swedish public health policy adopted by the Swedish Parliament, the Riksdag, in 2003, and for reporting on the implementation process as well as the results. The policy has been made available in English in a supplement to the Scandinavian Journal of Public Health (volume 32, supplement 64; eds. Hogstedt C, Lundgren B, Moberg H, Pettersson B and Ågren G) as well as in a summary of the first Public Health Policy Report published in 2005. SNIPH has also contributed to the evaluation of Swedish public health research in another supplement (no. 65) to the Scandinavian Journal of Public Health 2005.

Today’s public health policies and results can to a large extent be explained by history and experiences from earlier decades and even centuries. Therefore, we were very pleased to publish a book in 2005 on the health of the Swedish people in a historical perspective (eds. Sundin J, Hogstedt C, Lindberg J and Moberg H) in Swedish in cooperation with Professor Jan Sundin and Associate Professor Sam Willner from Linköping University and others. We are now equally pleased to be able to publish a summarised and modified version in English by Professor Jan Sundin and Associate Professor Sam Willner focusing on the health development in relation to social changes over the last 250 years. Bernt Lundgren, Christer Hogstedt and Henrik Moberg from SNIPH were responsible for the discussions with the authors and the processing of the book.

The new Swedish public health policy from 2003 has attracted much attention internationally due to its focus on structural determinants as well as lifestyle factors. The policy has been mentioned in the WHO Bangkok Charter on Health Promotion in a Globalized World and the WHO strategy for prevention and control of non-communicable diseases in the European Region, as well as by the Independent WHO Commission on Social Determinants. It is our hope that this publication shall contribute to the understanding of the background and context for this policy.

Historical lessons from one country can not be transferred uncritically to another country or be used as a basis for future decisions. However, the likelihood of the effects of different policies could be indicated by comparing differences and similarities in the contexts. We hope that this book will prove useful for policy comparisons and in the training of public health policy-makers, researchers, administrators and field workers.

Östersund, December 2007

Gunnar Ågren

Director General

Forskningsinriktningen vid den historiska avdelningen vid Linköpings universitet har sedan länge en stark socialhistorisk profil. kollektivens vardag studeras på en rad områden, på olika nivåer och över sinsemellan skilda tidsperioder. Det gäller inom såväl agrara som industriella miljöer, på samhällelig liksom på grupp-, familje- och individnivå samt över tid som omspänner senantiken till det sena 1900-talets historia. Hur identiteter skapas, tillägnas och förändras är en alltmer växande inriktning, liksom anknytningen till socialpolitiska ideer, normsystem, attityder, värderingar och mentaliteter. Även den  rättshistoriska och ekonomiskhistoriska forskningen ryms inom detta fält. Den historiska demografin utgör också traditionellt en stark del av det socialhistoriska fältet. Studier av arbeta och ohälsa, sjuklighet, dödlighet och hälsopolitik ligger långt framme. Bredden i den socialhistoriska profilen morsvaras av en mångfald melodologiska inslag.

Skriftserien Socialhistoria i Linköping uppmärksammar denna profil och vilka uttryck den tar sig i grundutbildningen. I serien publiceras i första hand uppsatser skrivna på C- och D- nivå, men även bidrag från lärare och doktorander vid avdelningen förekommer.

Detta nummer av Socialhistoria i Linköping är en specialutgåva till Svenska historikermötet i Linköping 23-25 april 1999