Special issue on inequality in health connected to political decisions

In Sweden, once one of the most equal countries in the world, we are now seeing large and growing disparities in living conditions and health, where lower levels of education or income are associated with a higher risk of ill health and premature death. 

The differences in life expectancy are striking: there is a gap of approximately ten years between groups with the highest and lowest incomes. This trend is occurring despite the Swedish Parliament’s 2015 adoption of a national public health goal: "to create societal conditions for good and equitable health across the entire population and to close avoidable health gaps within a generation".

The causes of these health disparities can be traced to people’s social and economic living conditions, including household finances, working life, education, healthcare, and social insurance systems (the welfare system), as well as migration and development aid. All of these areas are shaped by political decisions.

"Inequality kills – what is politics doing?"

The recently published special issue of SMT, titled Inequality kills – what is politics doing?, aims to highlight the growing disparities in living conditions and health, and to demonstrate the effects of political decisions. A central question throughout the issue is the extent to which policy decisions are evidence-based.

The thematic section includes 16 articles written by 26 authors, presenting different perspectives and proposing ways to reduce health inequalities. The articles are in Swedish.

Several contributions in the issue are written by researchers at the Department of Global Public Health:

Bo Burström, together with Finn Diderichsen and Göran Dahlgren, authored the article Inequality is increasing – what is Sweden doing?. They question whether policymakers believe it is more important to allocate increased resources to disadvantaged groups with a high burden of disease, rather than providing benefits to the very wealthy, who have a significantly lower disease burden. The authors also present a number of proposals to prevent premature death, promote better and more equitable health, and express hope that these will be highlighted in this year’s election campaign.

Bo Haglund, editor-in-chief of SMT, and Bo Burström discuss in the article The erosion of the welfare system how the Swedish welfare state has weakened, both in terms of social insurance compensation levels and resource allocation to healthcare and elderly care. Reduced state support to regions and municipalities, along with a declining share of GDP allocated to social insurance, has led to fewer resources for welfare services. This has contributed to increasing poverty among people with long-term illness and unemployment, those born abroad, and single-parent households with children. However, the proportion of people receiving financial assistance has not increased. The article provides concrete examples of how the welfare system has changed over time.

In the article Antimicrobial resistance needs to be addressed from a societal development perspective for greater impact, Nina Viberg, Jaran Eriksen, and Cecilia Stålsby Lundborg show, using antibiotic resistance as an example, how insufficient development aid efforts in other countries can have negative consequences even for donor countries, since resistance does not respect national borders.

In SMT’s series on female pioneers, Ann Liljas writes about Karolina Widerström, Sweden’s first female physician and a pioneer in social medicine. Karolina Widerström (1856–1949) was one of the most influential women of her time, both as a gynecologist and through her advocacy for women’s rights.