Societies in Transition: 3 Case Studies
Introduction
The Health and Social Change Module further explores the idea that health behaviour and health outcomes cannot be adequately understood, or explained, by referring to individual factors alone. In the course of the module you will be introduced to frameworks for analysing the dynamic relationship between social factors, health behaviour and health outcomes. To make the point, the module takes as its focus the health challenges of societies in rapid transition.
And thus we welcome you to Unit 1.
Unit 1 introduces case studies – stories of individual people and families, and sociological analyses – that depict experiences of life in societies undergoing dramatic transformation in the social order. The case studies vividly illustrate the concepts, arguments and theoretical frameworks discussed in the module as a whole.
We wish to draw your attention to the effects on different parts of society of the dramatic changes occurring in long-established social patterns – including economic and political relations, as well as ordinary relations between individuals and segments of the society, living conditions and opportunities both social and economic.
What we wish you to particularly note are health and mortality outcomes associated with these changes, and the interplay between individual and society-level factors in segments of the population.
The unit grounds the module, and should provide helpful hints when you start to assemble your assignment. In unit 4, you will once again consider some of the explanations for the trends identified in this unit.
There are three case studies in this unit.
Case Study 1:Health and Social Change: Sweden - From Traditional Farming to Industrial Society
Case Study 2: Health and Social Change: A Case Study from South Africa
Case Study 3: Health and Social Change: A Case Study from Russia
Timing
There are seven readings, and 5 tasks in this unit.
READINGS
Author/s / Reference detailsSundin, J & Willner, S. / (2004). Sweden – from Traditional Farming to Industrial Society. Sweden: University of Linkoping. (Unpublished paper.)
Ramphele, M. / (2002). Ch 4 - Family. Steering by the Stars: Being Young in South Africa. Cape Town: Tafelberg Publishers: 62-86.
Chopra, M. & Sanders, D. / (2002). Health and Social Transition: A Case Study from South Africa. Cape Town: University of the Western Cape (Unpublished paper.)
Shkolnikov, V.M., Cornia, G.A., Leon, D.A., & Meslé, F. / (1998). Causes of the Russian Mortality Crisis: Evidence and Interpretations. WorldDevelopment, 26 (11): 2006-2011.
Wines, M. / (December, 2000). An Ailing Russia Lives a Tough Life That’s Getting Shorter. The New York Times. USA: The New York Times Company
Wines, M. with Zuger, A. / (December, 2000). In Russia, the Ill and Infirm Include the Health Care Itself. The New York Times. USA: The New York Times Company.
McDonald, M / (March, 2004). Russia’s Presidential Election: Poverty, Despite Promises. Detroit Free Press. USA: Detroit Free Press Inc.
We shall now introduce the first of the three case studies to be dealt with in this unit.
As mentioned before, the case studies are used to illustrate the themes of the module.
From the case studies we would like you to note the following features: how people’s lives changed, how the social changes affected them, and the impact of these changes on health.
The first task will guide your reading of the case study.
Case Study 1
Health and Social Change:
Sweden – From Traditional Farming to Industrial Society
TASK 1 – Summarise case study
a)Describe the changes in family life featured in the case study.
b)What are the main features of the lives of the women described in the case study?
Case study by Jan Sundin and Sam Willner
Life in Early Nineteenth-Century Sweden
Usually, historians and social scientists study aggregated numbers of people, trying to find regularities or patterns that can tell something about society. Individual life histories are – if ever – usually used as illustrations and to give the readers a feeling that the story is really about human beings of flesh and blood. Individual life histories can also serve as a tool for empathy with the people under study. They can also give something more, an understanding beyond mere figures, that only the unique – and yet often in many respects typical – life can represent. Before entering the “macro-history” of early nineteenth-century Sweden, the rich Swedish populations registers will introduce us to the concrete lives of the poor in pre-industrial Linköping.
Dramatically high rates of infant mortality could be found in some families during the decades before 1800, for instance among the offspring of the postman Johan Peter Dahlström and his wife Sara Christina Påhlman. They were both born outside the little pre-industrial city of Linköping (with a few thousand inhabitants) like so many of their neighbours who had migrated from one place to another in order to find work. Johan Peter arrived at Linköping in 1789 from Denmark, 27 years old, and Sara Christina was 35 years old, when she came from the nearby city of Vadstena in 1790. They married in 1792 and had nine children (including three sets of twins) between 1792 and 1799, all dying before their first birthday. Twins had a high fatality rate, usually because of their weakness at birth. The common cause of death for these nine children was, according to the register of deaths and burials, “stroke”, which only means that death had come suddenly. This diagnosis is, however, during previous centuries often related to diarrhoea and other infections caused by the introduction of contaminated food at an early age. Bad hygiene can also have been one of the factors in the Dahlström family, indicated by the diagnosis of “thrush” for one of the deceased children. Thrush is a non-fatal infection in the mouth and throat, caused by bad hygiene.
In the midst of a very cold winter, when temperature was often far below freezing point, a daughter, Sophia Christina, was born in the year 1800. She was the first of their children to survive childhood, like her brother who was born in 1802. The birth register calls their mother “madam”, which tells us that her husband belonged to the lower middle class. This year was not only cold, but represents one of the frequent occasions when the harvests had been bad the summer before and prices for food were high. The social situation caused some people to engage in riots, directing their bad temper towards the authorities, who were not thought to be handling the economic situation well. One of these riots took place in Linköping, actually triggered by the rising price for aquavit, but it was quickly suppressed by the intervention of the military. As a modest servant of the state, Sophia Christina’s father did not, however, much participate in the event. Considering her social position, Sophia Christina’s chances looked relatively good compared with the situation of many children born in the pre-industrial urban proletariat.
Sweden was, after the Reformation in 1527, a protestant country. The Bible, interpreted by the orthodox protestant priests, and Luther’s Catechism, was required to be read and memorised by everybody, in order to learn the official guidelines for a good Christian life. These rules were internalised by a system of home education where the parents were obliged to teach their children to read and to memorise the central religious texts. Yearly catechetical examinations of all persons above the age of seven took place in order to ensure that these duties were fulfilled and that nothing was forgotten later in life. Special attention was also paid to church discipline, not only concerning purely religious shortcomings but also juvenile delinquency, family disputes, drunkenness and other disorderly behaviour which was not serious enough to be brought to the civil courts. Sophia Christina’s mental capacities were good, according to the marks in ‘reading’ and ‘comprehension’ given by the priest in the examination records and her brother was even a “scholaris”, which means that his parents had sent him to the elementary school, which did not become an option for the poorer people before the middle of the century.
Daughters of the middle classes usually married when they were about 24-26 years old, but Sophia Christina appeared in the register already when she was 19. The reason for this young matrimony is recorded in the birth register: the new couple had a son, Claes Johan, only one month after the wedding. Illegitimate births were a source of shame in Sophia Christina’s social milieu, and we have strong reasons to believe that she had no other option than to marry the father. This would explain why she had to choose Olof Claes Fredriksson, a man of dubious social and moral character. Olof was a drafted military musician, who had already been tried for theft, but the case “rested” due to lack of proof. For some years, however, life seemed to be relatively calm and free from dramatic incidents and a second son, Gustaf Herman, was born in 1822.
One event, which probably turned Sophia Christina’s life course towards its tragic ending, occurred in 1828, when her husband moved 400 kilometres south of Linköping to become a trumpeter at the Crown Prince’s regiment in Helsingborg. Her own father had already died of cold, so she was left alone with an ageing mother and two young sons. In 1832, she had an illegitimate son, either as the result of a casual relation or because she tried to make a living from prostitution. The child died a year later of “stroke” and other misfortunes came successively thereafter. Sophia Christina and her mother were convicted of illegal sale of alcohol several times, a common way of making a living for poor women. Her sons were convicted of attempted burglary in 1834, when they were 15 and 12 years old. The older son, Claes Johan, started a career as “professional thief” a year later, was sent to prison in Stockholm and did not return to Linköping until after his mother’s death, then an ex-prisoner and former inmate at an institution for compulsory work.
Claes Johan’s brother Gustaf Herman was luckier and became an apprentice at a bakery when he was 15 years old. Two years later, in 1838 his father returned to his wife . He had been dismissed from his regiment (either because of his age or misconduct). Getting a reasonably stable job was, under these circumstances, hard, when people had to be careful with their sparse belongings and beware of untrustworthy persons. It is therefore not surprising that it took only two more years before he suffered corporal punishment and public repentance at church for theft. The couple was then living among the poorest parts of the population and Sophia Christina was “drinking a bit”, according to the examination register. This note was changed to “drinks” a year later, indicating that her need for alcohol had increased. The family carried on living at several places in the city before Sophia died, 42 years old of a “wasting disease”, probably tuberculosis or, maybe, cancer.
Sophia Christina’s life was of course not “representative”, but it was, on the other hand, not unlike the fates of many other men and women in her surroundings. It illustrates the insecure social conditions during this transitional period. Being born, as it seems, in relatively good circumstances did not guarantee a safe and calm life. An unhappy marriage and an ageing father, who was dead when she and her mother were left alone with two young boys, was difficult to handle within the norms and possibilities of their time. Illicit sale of alcohol was not the worst sin in the eyes of her neighbours, but having an illegitimate child and a thief as her husband was definitely not in accordance with the middle class perceptions of an orderly life. Aquavit and beer became a comfort and an escape from the pains of everyday life, but probably also a cause of Sophia Christina’s early death. The court’s lists of fines tell us that this “lifestyle” was relatively common among men, but even more stigmatising when it occurred among a limited number of women.
Even those who succeeded to live within the limits of the law could, however, face many difficulties. Brita Stina Samuelsdotter, born during the same year as Sophia Christina, was the daughter of a crofter outside Linköping. Her biological father died and her mother re-married when she was 12 years old and she had to leave home and become a servant in the families of other crofters. She arrived in Linköping when she was 27 years old and married Petter Pettersson Mars, a former soldier (with a family name after the Roman god of war) later employed as a gravedigger. Their first residence was located in a house called Fåfängan, Vanity, but the couple did not stay long, and continued migrating more than once a year between the poorest houses in the city. They gave birth to three sons and one daughter, all surviving childhood. When Brita Stina was 44 years old, her husband died of a “wasting disease” at the age of 53. The widow continued to migrate within the city borders, while the children left her when they were old enough to be employed as “little servants”, i.e. between 12 and 15 years of age. At the age of 55, she was left alone and entered the poorhouse, Mörnerska stiftelsen, where she spent her last 15 years in life.
The family had managed to live without poor relief from the church while the husband was alive, but that was impossible for a lonely woman with four young children, a common fate of many wives in the proletariat due to the high male mortality. But there were also more young women than men in Linköping, which meant that a lot of women became spinsters. They carried on living with or without their children, depending on the good will of their masters and were replaced by younger and stronger competitors on the labour market when they passed the age of 40. From then on, these middle-aged, single women often had to depend on poor relief for the rest of their lives, but this did not happen to Stina Larsdotter. She came to Linköping as a 25-year-old servant in the households of the upper middle class and gave birth to five children with “unknown fathers”. Illegitimate births were very common during this period of female urban surplus, but Stina was certainly exceeding the average number of such births. Three of her daughters survived childhood, living alternately with mother and foster parents. At the age of 36, Stina became a servant in a merchant’s house for 18 years. After that, she was found as an “ex housemaid” in different families or living together with widows and single mothers in situations similar to her own. Her three daughters took it in turns to live with their mother, moving away when a younger sister was old enough to assist in daily work. In the registers, mother and daughter appear like a team, sometimes ‘embedded’ in a wider network of social equals. This life kept Stina away from poor relief, until she died of tuberculosis, 62 years old. Her youngest daughter Emilia Augusta stayed until the very end, moving from Linköping soon after the funeral.
Stina’s limited luck was to become a trusted servant in the town’s establishment and to have daughters who stood by her when she was old. Olof Finström’s wife Brita Catharina Olofsdotter was too old for childbirths, when they married. He came from the city of Vadstena in 1829, when he was 27 years old, and became an apprentice of a carpenter master and alderman of the guild. Olof made a career and became an independent carpenter, although not with a master’s certificate. He married Brita Catharina when he was 45 and she was 44 years old. She brought an illegitimate son to the new household, who went to another town after two years.
Olof was a respected member of his trade, often living in the same house as other colleagues – a clear sign of the occupational networks. His popularity among the clerical authorities was, however, damaged, when he asked for permission to leave the State Church and join the Evangelic Methodist Church. It took the authorities six years to grant the request, when Olof was 78 years old. At the same time, the examination registers tell us that the couple was “destitute” and remained in that situation, until they died of “old age”, when Olof was 84 and Brita Catharina was 87 years old. Olof had, as far as we have reason to believe, led a decent, orderly, diligent and sober life. Not having children in the neighbourhood who could help was enough to bring the family into poverty when he could no longer work for his living. The register’s notation about their poverty is primarily recognizing that they would not have to pay any taxes, but there is no evidence that they ever received poor relief from the municipality. We do not know how they managed without it, but it would not be unrealistic to guess that they were assisted by their Methodist ‘brothers’ and ‘sisters’, who were expected to live up to the standards of the early Christian congregations, while at the same time symbolising the birth of new types of networks formed by voluntary associations.