Defeating Disease : Lasting Effects of Public Health and Medical Breakthroughs between 1880 and 1945 on Health and Income in Sweden

Sammanfattning: This thesis has the general aim of exploring the role of public health and medical interventions between 1880 and 1945, targeting infectious diseases, in health and income improvements in Sweden throughout the twentieth century. It applies methods of causal inference to longitudinal individual-level data from both local and national datasets combined with multisource archival data on the implementation of reforms. The bacteriological discoveries of the latter part of the nineteenth century helped the public to target infectious diseases through isolation, disinfection and treatment. The studies of this thesis show that these societal measures have had a sizable role in the contemporaneous decline in infectious disease rates. In the pre-drug period, public health interventions related to isolation and disinfection substantially reduced infant, child and infectious disease mortality in southern Sweden. In the period after the nationwide introduction of sulpha antibiotics in Sweden, the vast majority of the pneumonia decline was attributable to the antibiotics.Moreover, these studies find that by reducing the likelihood of infection, societal health measures led to beneficial consequences for the income and long-term health of the affected cohorts, extending through old age. In the long term, the cohorts treated in the early neonatal period by qualified midwifery in southern Sweden obtained strong reductions in all-cause mortality in adulthood and in mortality due to cardiovascular diseases and diabetes in old age. Throughout rural Sweden, similar preventive measures extended the lives and positively affected the lifetime incomes in old ages. The reduction in pneumonia mortality due to the nationwide arrival of sulpha antibiotics boosted the labour income and health of the cohorts that received these antibiotics in infancy. The largest effects on health have been found for hospitalizations due to cardiovascular diseases, diabetes, arthritis and respiratory diseases.This thesis therefore supports the endogenous growth theory, which posits an interaction between health improvements in early childhood and health technology, based on application of the germ theory of disease, as a determinant of economic growth in the long run. Although the health benefits due to this dynamic process cannot be viewed as a main driver of economic growth, societal health investments nonetheless led to income growth sufficient to yield a high rate of return on the investment. The cause – that is, the reforms under study that are targeting infectious disease – and the consequence, reductions in the rates of specific chronic diseases in adulthood and old age, point to the inflammation mechanisms behind the lasting effects. The studies also suggest that the early neonatal period and infancy are the critical period for intervening such processes.