Social rights and social security: the Swedish welfare state, 1900-2000

A large decrease in the magnitude of seasonal fluctuations in mortality among elderly explains part of the increase in longevity in Sweden during 20th century

BACKGROUND

Mortality rates are known to depend on the seasons and, in temperate climates, rates are highest during winter. The magnitude of these seasonal fluctuations in mortality has decreased substantially in many countries during the 20th century, but the extent to which this decrease has contributed to the concurrent increase in life expectancy is not known. Here, I describe how the seasonality of all-cause mortality among people ages 60 years or more has changed in Sweden between 1860 and 1995, and investigate how this change has contributed to the increase in life expectancy observed during the same time period.

METHODS

Yearly sex-specific birth cohorts consisting of all people born in Sweden between 1800 and 1901 who reached at least 59 years of age were obtained from a genealogical database. The mortality rates for each cohort were modeled by an exponential function of age modulated by a sinusoidal function of time of year. The potential impact of seasonal fluctuations on life expectancy was investigated by a novel decomposition of the total mortality rate into a seasonal part and a part independent of the seasons. Cohort life expectancy at age 60 was used to quantify changes in lifespan during the time period.

RESULTS

The magnitude of seasonal fluctuations in mortality rates decreased substantially between 1860 and 1995. For cohorts born in 1800, the risk of dying during the winter season was almost twice that of dying during summer. For cohorts born in 1900, the relative increase in winter mortality was 10%. Cohort life expectancy at age 60 increased by 4.3 years for men and 6.8 years for women, and the decrease in seasonal mortality fluctuations accounted for approximately 40% of this increase in average lifespan.

CONCLUSION

By following a large number of extinct cohorts, it was possible to show how the decrease in seasonal fluctuations in mortality has contributed to an increase in life expectancy. The decomposition of total mortality introduced here might be useful to better understand the processes and mechanisms underlying the marked improvements in life expectancy seen over the last 150 years.

Social Democratic Solidarity and the Welfare State: Health Care and Single-Tier Universality in Sweden and Canada

Although it is not generally done, it is useful to compare the history of the evolution of universal health coverage (UHC) in Canada and Sweden. The majority of citizens in both countries have shared, and continue to share, a commitment to a strong form of single-tier universality in the design of their respective UHC systems. In the postwar era, they also share a remarkably similar timeline in the emergence and entrenchment of single-tier UHC, despite the political and social differences between the two countries. At the same time, UHC was initially designed, implemented, and managed by social democratic governments that held power for long periods of time, creating a path dependency for single-tier Medicare that was difficult for future governments of different ideological persuasions to alter.

A critical comparison of welfare states and their relevance to people with an intellectual disability

This article compares the welfare services for adults with an intellectual disability in three European countries: England, Norway and Sweden. The purpose of the comparison is to develop an understanding of the welfare state and institutional contexts of the country-specific policies and to develop a critical analysis through a comparative method based on selected secondary literature. Typological frameworks of European welfare states are applied as analytic frameworks to enable comparison between the countries. It is argued that there are international policy developments but these are shaped at a national level by different types of welfare states and histories. Through a comparison of similarities and differences, the article suggests that international policy ideas that impact on the lives of people with intellectual disabilities are mediated by different types of welfare states and institutions.