Health and Social Change Health and Social Change How does How does South Africa, Russia and 19th Century Sweden South Africa, Russia and 19th Century Sweden compare compare ? ? Points Points of of departure departure … … • Transitions that are fundamental and rapid have immediate, profound effects on health. • Changes in the labour market, social structure and social security systems put a heavy burden on people’s occupational flexibility, social adaptability, and ability to find economic safety for themselves and their families. • In times of rapid change, old rules, norms, and institutions no longer function as efficiently as they did before. • If social and geographical mobility increases, some people benefit while others lose out.
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Health and Social Change - World Health Organization · Health and Social Change How does South Africa, Russia and 19th Century Sweden compare? Points of departure … •The impact
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Health and Social ChangeHealth and Social ChangeHow doesHow does South Africa, Russia and 19th Century SwedenSouth Africa, Russia and 19th Century Sweden comparecompare??
PointsPoints of of departure departure ……
• Transitions that are fundamental and rapid have immediate, profound effects on health.
• Changes in the labour market, social structure and social security systems put a heavy burden on people’s occupational flexibility, social adaptability, and ability to find economic safety for themselves and their families.
• In times of rapid change, old rules, norms, and institutions no longer function as efficiently as they did before.
• If social and geographical mobility increases, some people benefit while others lose out.
Health and Social ChangeHealth and Social ChangeHow doesHow does South Africa, Russia and 19th Century SwedenSouth Africa, Russia and 19th Century Sweden comparecompare??
Points Points of of departuredeparture ……
• Welfare and health also depend on gender, age, and social class.
• Cultural and gender factors within a particular epidemiologicalsetting often have different effects on the health of men and women.
• The negative effects, even when change is positive in the long run, can be summarized as “social stress”.
Health and Social ChangeHealth and Social ChangeHow doesHow does South Africa, Russia and 19th Century SwedenSouth Africa, Russia and 19th Century Sweden comparecompare??
PointsPoints of of departure departure ……
• The impact of change is always filtered through formal and informal institutions.
• “Social capital” is one factor that determines who will become winners and losers.
• Public institutions can distribute and redistribute material resources, welfare, and social capital
• Informal institutions - such as voluntary associations, social networks in the workplace or among neighbours, the family, and other primary groups - and the way civil society functions can enhance social capital and are essential for social stability and security.
Facts and trends 1
Factor 19th C. Sweden Russia RSAPolitical change Moderate Yes Yes
Economic & Social ChangeChanges in production Yes Yes YesChanges in agriculture Yes Yes YesDe-industrialization No industrialisation Yes YesEmployment crisis Yes Yes YesPauperization Yes Yes YesIncreased inequality Yes Yes YesWelfare provision crisis Yes Yes Yes
Demographic ChangePopulation size Up Stable->down? Stable->down?Migration to cities Yes Yes YesInfant & child mortality Down Stable? UpAdult female mortality Down Slightly up UpAdult male mortality Up Up UpFamily/household structure Crisis Crisis Crisis
Epidemilogical changeSTD’s/HIV STD’s high HIV up HIV up
Tuberculosis High Up? High>upOther infectious diseases High>down Low>up? High>?
Facts and trends 2
Factor 19th C. Sweden Russia RSA
Health differentials
By gender Yes Yes Yes?
By marital status Yes Yes Yes?
By class/ethnicity/”race” Yes Yes Yes
By region Yes Yes Yes
Urban/rural Yes Yes Yes
Socio-cultural change
Uprooted societies Yes Yes Yes
Norm crisis Yes Yes Yes
Social losers` Yes Yes Yes
Abuse of alcohol and drugs Up Up Up
Violence Up Up Up
Juvenile delinquency Up Up Up
Other crimes Up Up Up
Health and Social ChangeHealth and Social ChangeHow doesHow does South Africa, Russia and 19th Century SwedenSouth Africa, Russia and 19th Century Sweden comparecompare??
Fig 1. Social structure of the agricultural population. Sweden 1751 and 1850. Number of male heads of household.
0
50000
100000
150000
200000
250000
1751 1850
peasants
landless
Sweden early 19th centuryCities* In-migration* Pauperisation* High average age of marriage among the poor• High illegitimacy rate* High male mortality* Uprootedness* Class divisions* Social conflict* Old rules do not work* Drunkenness among men* Crime increases violence and theft
SoDS: Population and health IIIHealth and Social ChangeHealth and Social ChangeHow doesHow does South Africa, Russia and 19th Century SwedenSouth Africa, Russia and 19th Century Sweden comparecompare??
Health and Social ChangeHealth and Social ChangeHow doesHow does South Africa, Russia and 19th Century SwedenSouth Africa, Russia and 19th Century Sweden comparecompare??
Why infant and child mortality down?* Functioning local communities* Breast feeding campaigns* Better child care* Smallpox vaccination* Small - important hygienic measures in cities* Synergy effects increases resistance* Trained midwives – lower maternal mortality* Healthy children means healthier adults
19th c. SwedenFemale adult mortality declines, male adult mortality reacts negatively
Health and Social ChangeHealth and Social ChangeHow doesHow does South Africa, Russia and 19th Century SwedenSouth Africa, Russia and 19th Century Sweden comparecompare??
SoDS: Population and health III• 19th c. Sweden
Female adult mortality declines, male adult mortality reacts negatively
F ig 3 b . S e x d if f e re n c e s f o r s e le c te d c a u s e s o f d e a th , 2 5 -4 9 y e a rs o f a g e . S w e d e n 1 7 7 6 -8 0 a n d 1 8 2 6 -3 0
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Health and Social ChangeHealth and Social ChangeHow doesHow does South Africa, Russia and 19th Century SwedenSouth Africa, Russia and 19th Century Sweden comparecompare??
SoDS: Population and health III• 19th c. Sweden
Alcohol – the painkiller• Men’s gender roles make
them vulnerableFig 4. Acute alcohol intoxication (deaths or autopsies) per 1,000000
1804-1870.
0
5
10
15
20
25
1800 1810 1820 1830 1840 1850 1860 1870
deaths autopsies
Health and Social ChangeHealth and Social ChangeHow doesHow does South Africa, Russia and 19th Century SwedenSouth Africa, Russia and 19th Century Sweden comparecompare??
HEALTH
CC EC
SCK
AGRICULTURALCHANGE
AGRICULTURALCHANGE
UNEMPLOYMENTPOVERTY
ALCOHOLVIOLENCETHEFTSMIGRATIONMIGRATION
UNSTABLEHOUSEHOLDS
UPROOTEDCITIZENS
DEMOGRAPHIC GROWTH AMONG CHILDRENAND WOMEN
DEMOGRAPHIC GROWTH AMONG CHILDRENAND WOMEN
Health and social Change – Sweden c. 1800-1850.
PLAGUEEC = economic capitalCC = cultural capital
SC= social capital
Long term trends in life expectancy at birth since 1890:France, Japan, Russia and the USA.
Long term trends in life expectancy at birth since 1890:France, Japan, Russia and the USA.
bb Males aged 15Males aged 15--39 experienced the highest mortality caused by 39 experienced the highest mortality caused by unnatural causesunnatural causes
bb Females in the same age group died primarily as a result of HIV/Females in the same age group died primarily as a result of HIV/AIDSAIDSbb For young children, intestinal infections is still one of the leFor young children, intestinal infections is still one of the leading ading
causes of death but declining over timecauses of death but declining over timebb Influenza and pneumonia are other leading causes of death for Influenza and pneumonia are other leading causes of death for
childrenchildrenbb In SA, there is a unique racial topology of mortality. In SA, there is a unique racial topology of mortality.
•• Black African and Black African and ColouredColoured malesmales -- unspecified unnatural causes and unspecified unnatural causes and TBTB
•• Indian and White Indian and White malesmales –– ischaemicischaemic heart disease and unspecified heart disease and unspecified natural causesnatural causes
•• Black African Black African females females –– HIV/AIDSHIV/AIDS•• ColouredColoured femalesfemales –– CerebrovascularCerebrovascular diseasesdiseases•• Indian and WhiteIndian and White females females –– ischaemicischaemic heart diseaseheart disease
Health, capital and social change: Russia - RSAHIV
EC = economic capitalCC = cultural capitalSC= social capital
Political change
POLITICAL INSTITUTIONS
FRIENDS, NEIGHBOURS, KIN, ETC.
HOUSEHOLD AND FAMILY
INDIVIDUAL
Challenges of ChangeMending the weak society – weak community model
PLAGUE
WAR
HUNGER
What turn the tide in Sweden (Western Europe) What turn the tide in Sweden (Western Europe) from c. 1870 onwards?from c. 1870 onwards?
Should/could it be repeated?Should/could it be repeated?Hygienism – cleaning cities•The epidemiological revolution• Stable work• Stable family structures • Industrial work discipline• the role of local institutions• Workers discipline themselves by:• Voluntary associations• Free churches• Temperance movements• Trade unions • Political parties• Democracy for men 1906• and for women 1919 (!)• Institutions for social safety• I. e. tools for the people to interpret and handle the new societyTowards the welfare society