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

ics sustain that McKeown dismisses the role of the public health intervention. On the other hand it is important to discuss the issue of cost effectiveness, should we choose the interventions aimed to risk groups or to a broader base. Kidanemariam (2003) on the other hand underlines the importance of the egalitarian redistribution of the economic resources and shows that high GDP alone is not enough to lower IMR. Benefit distribution has more significant impact on a population's health status. This paper is a review of the studies from the period 1800-1945, focusing on the late 19

th century, regarding the IMR and child mortality in Sweden and Hungary, and their capital cities, Stockholm and Budapest. Listing the groups and the points of view how the IMR was registered and studied we can also attempt to suggest further subjects for studies that could uncover further reasons behind the differences between the two countries. As the debate about McKeown shows there is no scientific consensus regarding the IMRs most relevant determinants and their importance. It is also difficult to do comparison based on studies using different methodologies and determinants. Since we have found much more literature from Sweden than from Hungary in the selection of the most relevant determinant factors we rely mainly on Swedish studies. One of the main factors of infant mortality was studied by Lui ing (1900), who could show the protective nature of breastfeeding in Paris already more than 100 years ago. Family size and hygiene level influenced exposure to food-borne, waterborne, air-borne diseases and the other reservoirs like rats and louse. Resistance to diseases highly correlates with the nutritional status of children. Improvement of these conditions contributed to mortality decline according to Sundin (1995) who named it as an "epidemiologic transition" between 1750-1850. The state's engagement in family and childcare was emphasised already by Höjer (1934). According to him determinants such as lower fertility, health education through publications about childcare, new legislation for health care, foster children and children born out of wedlock all improved infant's health. Regarding Hungary, Buday (1917) suggested that one of the possible reasons for Hungary's top rank in the European IMR-list could be the climate, but the most important factor must be ignorance and neglect of children by the parents. After a research we decided to focus as it follows. In this review of studies we compare infant and child mortality in Sweden and Hungary using an analytical framework we created based on the model of Mosley and Chen (1984). They urge further multidisciplinary studies. Mosley and Chen subdivide determinants into different levels: • proximal determinants like nursing habit, maternal factor • intermediate determinants as household environment, immunisation status which are dependent on • distal determinants like socio-economical factors, cultural factors and ecological factors. As one of the proximal determinants, nursing habit was found to be in correlation with IMR in one of Lithell's studies reviewed by Bengtsson and Lundh (\999). She found that widespread breastfeeding is associated with lower IMR in Sweden. The role of midwives in the decline of IMR was studied by Andersson et al (2000). The midwives impact on mortality could be observed after that knowledge of asepsis was included in their education in 1881 when also a law was instituted to use them.