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From universalism to needs assessment. Public health in Denmark and Sweden from 1930s and onwards
| One of the characteristics of the Scandinavian welfare states is their universalism, many of the services and benefits were given to all citizens irrespective of needs and resources. Gradually from the 1970s a change took place in two aspects. 1) Interventions were increasingly targeted those considered to be in need either by medical or social standards. The needs assessment implied a categorisation of the recipients of the services. A number of risk groups were defined. 2) Interventions increased in numbers and scope. These two processes were probably interrelated since the urge to target increased when more resources were invested. This paper focus on health checks for pregnant women and children which were introduced in the 1930s and 1940s.
While most attention in the beginning was given the physical conditions of the children the focus expanded from the 1970s to include the social and mental well being of not only the children but the whole family, hereunder efforts to improve social networks of the parents and their ability to handle their relationship.
The categorisations and thus risk group creation both concerned medical and increasingly social conditions and necessitated definitions of normality in a number of areas and more information to be gathered. More surveillance and registration was needed, in order to assess which women and children did live up to the criteria of normality. An example is that in the 1970 Danish obstetricians defined 25 conditions which required extra interventions or attention. The definitions of risk groups or categorisations both shape the field of intervention and most likely the self perceptions of those categorised.
The needs assessment has not had the effect that those considered well functioning or healthy get less, only that part of the increase in interventions have been targeted those considered to be in need. Universalism is thus combined with an increased needs assessment and categorisations.
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