Kapronczay Károly szerk.: Orvostörténeti Közlemények 202-205. (Budapest, 2008)
TANULMÁNYOK — ARTICLES - VARGA, Gabriella: A comparative study of the social-political determinants of infant and child mortality in Sweden and Hungary 1850-1945. - Összehasonlító tanulmány a svéd és a magyar csecsemőhalandóság szociálpolitikai tényezőiről 1850 és 1945 között
eracy was only 22-29% in the region on the right bank of the Danube, the under-5 mortality was higher here with 437 compared to 347 in Transylvania, where 60-70% could neither write nor read (M.St. Evk, 1893). This might suggest that the higher literacy rate alone cannot in itself explain the better IMR in Sweden either. Inside a region however literacy of the fathers and mothers correlate with the U5MR. Although publications with health information about child care, disease prevention and other health promotion appeared in both countries already at the end of the 18 th century the bigger strata of illiterates in Hungary implies that less of them could benefit from the publications. Differences in economy were considerable and long-lasting. Hungarian GDP was only 58% ofthat in Sweden in 1910. It is important to note that the poorest region of the country Transylvania had also the lowest U5MR in 1890, so the economical prosperity cannot explain the differences on its own. The unreliable GDP also hampers our analysis. Both the high percentage of heavy alcohol consumption and the injuries occurred among drunk men suggest that alcohol affects the families' including the infants' health in several ways. Firstly it increases stress and violence at home taking attention away from the infants and probably directly physically harming them. Secondly the injuries at workplaces worsen and the high expenditure on alcohol leaves less to the families other expenses like quality of dwelling. Measures lowering the alcohol consumption were introduced almost half a century earlier in Sweden than in Hungary, 1855 compared with 1901. More classes of society were represented in the Swedish Parliament than in the Hungarian, which might have lead to the earlier detection and handling of this social problem. In Sweden smallpox vaccination became compulsory in 1816. The fact that it coincides with the start of IMR decline in Sweden suggests that it might be an important factor to a better infant health. Hungarians have also introduced the vaccine already at the end of the 18 th century, but it was not compulsory until 1887, this delay have probably cost. Hungary remained predominantly a catholic country in the 19 th century but had several minority groups of different nationalities and religions concentrating in certain areas. The resulting heterogeneity might itself hamper the performance of centrally managed health policies. Persistently lower IMR among Israelites reveal an example of a different and effective health behaviour which did not spread to the rest of population. However we did not analyse confounders and we did not adjust the results. The Swedish model of almost universal literacy depended on the organization of the Lutheran church which alone dominated the country. This demonstrates how effective a homogenous authoritarian system can be if it works for a common good. The high variety of seven spoken languages suggest bigger difficulties in reaching people with any information than in the Swedish case with a Swedish speaking majority. It is important to consider the effects of culture and religion on mortality statistics as Weszelovszky (1882) suggested. He found inexplicably low numbers of stillbirths in Catholics registries in parts of the country, suggesting that they were registered as live births in order to be able to baptise them. This fact can distort results by overestimating the IMR. Number of unmarried mothers in Hungary did not increase (Bakács, 1948) after 1910, when the IMR for infants born out of wedlock increased. Therefore it is more difficult to find the reason why the peak of the IMR among children born out of wedlock occurred earlier in Stockholm than in Budapest. One of the explanations could be the more drastic increase of the population in Budapest (200.000 immigrants in the first 15 years of the 20 th
