3. 1 Sweden
At the end of the nineteenth century, liberals and the labour movement questioned the traditional power structure of the Swedish state, i.e. nobility, clergy, burghers, and farmers. They agitated to reform the political system towards a more representative parliamentary democracy. In addition, other social movements played an important role in the struggle for civil rights.
In modern Swedish history, a special place is assigned to the popular movements in shaping and influencing values and policies. According to Gunnar Heckscher (1951: 77), the fundamental dividing line between popular movements and other types of (interest) organisations is their basis of recruitment: a popular movement must comprise a large number of individuals, have a democratic structure and a certain degree of equality between its members (Ibid. 79). Furthermore, popular movements are characterised by a "spiritual" dimension. Both interest and idealistic organisations are able to create conventions that determine the individual member's behaviour, but these conventions are different when made with a claim to moral authority compared with opinions that are exclusively based on a specific economic interest (Ibid. 84).
The most important popular movements at the beginning of the twentieth century were the free churches, the temperance movements, and the labour movement (Lundström and Wijkström 1997: 60). The free church movement (meaning independent from the Lutheran State Church 6 was primarily a rural phenomenon. The modern temperance movement became the largest single popular movement. These two movements were inspired in particular by models in the US. The third popular movement was the labour movement.
At the end of the nineteenth century, left-wing liberals became concerned with the social consequences of industrialisation. They were urban reformers, often with an affinity for temperance movements that stressed individual responsibility and help-to-self-help (Ibid. 88). They belonged to the liberal faction that advocated larger responsibility for the state and local government in social reforms. Many of its members became high-ranking officials in the state bureaucracy and played a crucial part in forming policies in areas such as poor relief and child welfare (Lundström and Wijkström 1997: 67).
Even if the idea of social reforms and social policy stems from the liberal movement (Olsson 1993), its character and extension are very much associated with the labour movement and especially the Social Democratic Party. Since the elections of 1915, the Social Democratic Party has been the largest party in the Lower House and the largest single political force in Swedish society. The social democrats have governed the country alone or in coalitions from 1932 until today.7
The People's Home
In 1928, the social democratic leader Per Albin Hansson launched the concept of the "People's Home". The ideal of the People's Home comprised not only the creation of a welfare state that aimed for a redistribution of income among the population by tax policies or by making education, health service and social security accessible to all. A spirit of Gemeinschaft, symbolising solidarity, helpfulness, cordiality, consideration, compassion, and kindness among people was also part of the concept (Inghe 1968). It was based on a patriarchal frame of mind in which the benevolent state should take care of everyone (Hirdman 1989: 90). The project of creating the People's Home was interrupted by the Second World War but was to continue with renewed energy after the war, resulting in the so-called Swedish welfare state model, a model characterised by a universalised social policy; i.e. in principle covering all citizens.
Even if the country stayed neutral in the war, a state of crisis was proclaimed. A national coalition government was installed and administration became more centralised. The latter development strengthened a trend towards centralisation had already been going on due to the economic crisis since the 1930s (Hadenius, Wieslander, Molin 1967: 174). Furthermore, the mobilisation of public resources (by taxation and newly established central administrative bodies) during the war afforded the possibility of redirecting public expenditure towards non-military peacetime purposes (Olsson 1993: 115). The Second World War also had other consequences. Although not directly experienced by the Swedish people, the horrors of the war and fascism meant a blow to confidence in the progress of society. The war had demonstrated that democracy was not gained once and for all, but was to be created, planned, and mediated to the people. Democracy was the only rational way to escape a destructive development, and people had to be educated to become democrats (Hirdman 1989). The experience of the planned economy during the war was a stimulus for
the social democrats to encompass a general "planning optimism" even in peacetime.
From the description above some basic characteristics of the Swedish state can be discerned concerning the structure of health and social services, namely the strong involvement of central and local governments. The strong involvement of the central and local governments in these fields can be traced back to 1847. Responsibility for poor relief was delegated to municipalities by the Poor Law, and every municipality was to establish a poor relief council (Qvarsell 1993: 221). Until the Second World War, municipal councils and NGOs worked together in many fields of poor relief. This relation would change drastically in the post-war period when the role of NGOs was played down. Roger Qvarsell (1993: 236) has identified two main reasons for this development. The increased interest of the Social Democratic Party in social policy since the 1920s (after the political change from revolution to reforms) and the emergence of strong organisations representing occupational groups within public health and social services.
The political dominance of the social democrats with their preference for a planned society would have a radical impact on the social welfare that had been provided by NGOs. The care of the elderly, poor relief and childcare eventually became largely a public service, tax-financed, and regulated by the central government in the period 19401960. The justification for the take-overs was that such important provisions should be guaranteed by the state. Other advantages were that the quality of these services could be better controlled, standardised, professionalised, and equality between services promoted (Lundström and Wijkström 1997: 70).
The 1960s and early 1970s are described by Olsson (1993: 116) as a period of expansion of public service and of decentralisation of central government to regional and municipal governments. This means that almost all health care is both tax-financed and operated by public organisations.8 With the state take-over of activities formerly run by NGOs, the totality of social service had become the responsibility of municipalities, regulated by law and supervised by state authorities. Developments in Sweden as depicted above, endorse the picture of the central state as a good father that takes care of society (samhället).
6 In 1952, freedom of religion was extended when permission from the King was no longer needed for the establishment of churches outside the State church.
7 With three interruptions, 19401945 when a national coalition government was installed, and 19761982 and 19911994 when a non-socialist government was in office.
8 An exception to this development of decentralisation was the centralising of the police, the courts, and executive authority to the central state level in 1965 (Gustafsson 1996: 37).