HEALTH, ENVIRONMENT, AND SOCIAL CHANGE, FINLAND 1750–2000

Project leader: Pertti Haapala, University of Tampere, Department of History, Tampere, Finland,
tel. +358-3-2156542, e-mail: Hipeha@uta.fi
 
 

PUBLICATIONS

TIIVISTELMÄ SUOMEKSI

Researchers:
Heikki S. Vuorinen, Department of Public Health, University of Helsinki, tel. +358-9-19127397, e-mail: Heikki.Vuorinen@helsinki.fi
Kari Pitkänen, Population Research Unit, University of Helsinki, tel.+358-9-19123895,e-mail: Kari.Pitkanen@helsinki.fi
Minna Harjula, Department of History, University of Tampere, tel. +358-3-2158021,e-mail: Himiha@uta.fi and
Petri Juuti, Department of History, University of Tampere, tel. +358-40-5575632, e-mail: PJ@nic.fi,

Financing SYTTY organisation: The Academy of Finland
Funding from SYTTY / Total funding of project (€): 306329 / 306329
Person-months of work funded by SYTTY / Total person-months of work: 103,5 / 115,5

KEY WORDS: historical epidemiology, epidemiological transition, mortality decline, public health, urbanization
 

EXTENDED ABSTRACT

1 Introduction

The project "Health, Environment and Social Change, Finland 1750-2000" studies the long-term development in the relationships between health, environment and social change in Finland. The objective of the project is to increase our understanding of the impact of environment on health and, in particular, to explain how this relationship is socially conditioned. The project studies, which factors have resulted in the historically remarkable changes in public health.  This requires a careful analysis of environment, demography, diseases, human behavior and mentalities in a long-term perspective.

The project has four specific research objectives:
1. Demographic data and changes in mortality and health
2. Conceptual history of environment, diseases, and health
3. Historical epidemiology : History of diseases
4. Changes of man-made infrastructure: Water supply and waste management in Tampere

2 Methods

Studying the long-term development requires a careful historical and inter-disciplinary analysis. The project combines different approaches: epidemiology, demography, engineering, sociology and social history. Each approach is able to cover something invisible to others. Through all the data we make up a case (Finland) in which all aspects of public health are recognized both theoretically and empirically. Finland is an ideal case to study the long-term developments in the relationships between health, environment, and social change because the country underwent a radical change in all these aspects at a relatively late stage and, consequently, there is an abundance of source materials (archival and published) illustrating these changes. Besides the general development in Finland, the project concentrates on local features in health conditions and public health policies of Tampere, the most industrialized town in Finland.

3 Results and Discussion

The results can be grouped into four different sections, and they will be briefly described in the following.

Intriguing trends in the Finnish mortality transition

In many European societies the early phases of industrialization and urbanization led to negative consequences in terms of health and mortality. Throughout the nineteenth century urban death rates were consistently higher than those in rural areas. Thus, as a rule urbanization exposed growing proportions of the population to the health hazards of urban environments, often referred to as "urban penalty". Health problems typically intensified as the population size and crowding increased in urban centers.

Finland does not fully comply with this generalization. Even though the levels of mortality in the towns had traditionally been higher (regardless their size) than in the rural areas, the situation started to change along with urban growth. Mortality declined in both the rural and urban areas during the last decades of the nineteenth century, but the change was more substantial in the towns. By the end of the century, urban mortality was clearly below the rural levels in a number of age categories. The most pronounced exceptions were men at the working ages. These findings indicate that there were significant changes in the health patterns of urban environment during the late nineteenth century (largely concealed if only crude mortality rates are used). These changes, however, did not extend to the working conditions of manual laborers, and thus, persisting high levels of male excess mortality.

Concepts of disease

Concepts of disease have had a profound change during this period: problems of interpretation are great. Some skepticism is justified when we try to interpret the names of diseases before the bacteriological revolution to modern names. Before the end of 19th century the Finnish nomenclature of diseases was shaky and variable. Even for a disease such as smallpox there were typically some ten Finnish names. Many of these names were also used for measles and even for venereal disease.

Caution is required when trying to construct a mortality panorama for Finland in the 18th or 19th century from the archival sources. Therefore other types of sources (skeletal and mummified human remains) are needed to get more valid picture of the health of population for the 18th and early 19th century.

Several infectious diseases were serious health risks in the pre-industrial Finland: plague, smallpox, malaria, leprosy, and tuberculosis. Plague disappeared already in early 18th century, and smallpox, leprosy and malaria had practically vanished before the end of 19th century. It seems that the culmination of tuberculosis epidemic occurred also in the 19th century or at the latest in early 20th century. The disappearance of plague is mystery but some reasons for this radically changed disease panorama are evident. The disappearance of smallpox is definitely linked to the better immunization of population during the 19th and early 20th century - compulsory vaccination for less than two years old was introduced in Finland in 1886. The disappearance of malaria might well be connected to the wider and more effective use of quinine in the middle of the 19th century. Finland has also been a marginal area for the continuous existence of malaria parasites: quite small environmental changes - e.g. colder periods, modernization of agriculture - might have been disastrous for malaria plasmodia. Clinical manifestations of leprosy and tuberculosis - caused by related mycobacteria - are highly dependent on the status of the immune system of the infected person. So the diminishing of both of these diseases may be connected to the gradually improving living conditions - nutrition and housing conditions - during the late 19th and early 20th century. Active search of   leprosy sufferers and their prompt isolation at the turn of 20th century may have been crucial for the disappearance of endemic leprosy from Finland. After the Second World War specific and effective chemotherapy and preventive measures rapidly diminished the number of new cases of tuberculosis.

Tuberculosis is typically a disease, which has traditionally been connected to the industrialization and urbanization of a country. “Vadstenadiariet” reveals, however, that even the Mediaeval Nordic people knew consumption. The Finnish experience clearly demonstrates that tuberculosis had a firm footing already in the pre-industrial society. The tuberculosis epidemic in Finland seems to have culminated in the 19th century. The evidence from Finland provides some support for the hypothesis that improved nutritional status was a precondition for the decline of tuberculosis epidemics. However, tuberculosis infection must still have been an almost universal feature of childhood in many areas of Finland, even in the early decades of the 20th century.

Malaria in Finland was most probably caused by Plasmodium vivax. Malaria was endemic in Finland in the 18th century and 19th century, and Finland was the northernmost country ever to have endemic malaria. The islands of Ahvenanmaa (Åland islands) in south-western Finland were the most severely affected area during late 18th and early19th century. Sever malaria epidemics occurred in Finland in 1749-58, 1774-1777, 1812-16, 1819-21, 1830-32, 1846-48 and 1853-62. The last epidemic was especially widespread. The epidemics started after warm summers and ended abruptly after a cold summer. Most of the cases of malaria were noticed in spring and in autumn. Contemporaries considered malaria one of the most common disabling diseases, especially during the epidemics, but quite a rare cause of death.

Malaria practically disappeared from Finland in the early 20th century. However, there was a severe malaria epidemic in Finland in 1945. During this epidemic it was established that malaria parasites had a long incubation period (wintered) in affected persons and caused the disease in the following spring.  Two explanations for the existence of malaria in Finland have been offered: 1) it was repeatedly imported or 2) it was genuinely an endemic disease.

Conceptual history of environment and health

Wide discussion on public health and environmental issues began in Finland as a part of an international debate in the late 19th century.  A new scholarship,  hygiene, was established in medicine, and the ideas of preventive medicine, sanitary reforms, and personal hygiene were spread to everyday life by popular education  and legislation.  In Finland the Public Health Act (1879) gave municipal administration responsibility for controlling health conditions  especially in urban areas.  With this act health gradually became a new criterion for perceiving, valuating and evaluating the environment.

Especially adapting to live in the new urbanized environment was noticed to require measures to improve public health. Eliminating the health risks connected to cholera and typhoid epidemics was the main focus in the late 19th century, and new sewerage and water supply systems were built to avoid the danger of damp soil, puddles and latrine dirt. In the early 20th century beating tuberculosis was thought to require a total reform of town planning to bring light and air into the city.  Besides that, the solutions of previous decades - untreated waste water and unfiltered drinking water - caused still severe typhoid epidemics, and many other infectious diseases (smallpox, typhus) spread especially during the World War I and civil war in 1918.  While acute epidemics less frequently caused a risk of death and while the campaign against tuberculosis focused on the homes of a tuberculous patients, the connection between environment and health started to fade in the 1920s and 1930s.  At the same time the knowledge and perception of health effects caused by chemicals were vague.  The study shows that the uniform hygienic discourse, which was widely accepted in the late 19th century, became more and more incoherent and specialised in the 1920s and 1930s and, consequently, became less influential in the society.

Water supply and sewerage systems in Tampere

The history of water supply and water pollution control in Tampere is much like that of Finland as a whole except on a smaller scale. Firstly, surface water was initially drawn from nearby sources, and as these became contaminated, from farther away. Utilization of groundwater started later. Secondly, wastewaters spoiled water systems until efficient treatment started at a relatively quick pace. Industry began to protect waters later on by increasing cooperation with the water and sewage works. Thirdly, when the increase in water consumption levelled off in the 1970s, the emphasis shifted to water quality.

Development stages of water supply and sewerage systems can be divided roughly into three systems. Used points of comparison must be from research subjects (water supply and sewerage) that are not only contemporary but also of similar technological level: 1) Bucket systems, 2) Protosystems, and 3) Modern systems. The purpose of this is to show that various solutions for city infrastructure, at different times, could have been feasible then. This way, we can also avoid a predestined, technologically deterministic view of water supply and sewerage advancing unavoidably towards the modern, "right" solution. The first municipal "water pumping installation" in Tampere, and probably in Finland too, was founded in 1835. The system was quite simple and constituted a so-called bucket system. The first water-protection regulation in Tampere concerned this system. The first actual waterworks in Tampere, a clear protosystem, was completed in 1882. In the construction no attention was paid to the earlier critique. The high-pressure facility was completed on 1898, but not on the scale of the original, modern system plan. Since slow sand filtration was rejected and the outlets of the sewers were too close to intake pipes, the efficiency of the new facility was also its weakness: later typhoid fever spread fast over a wide area aided by the water pipe network. In 1916 hundreds of peoples died which finally prompted the necessary decisions to be made. The threat of typhoid fever and other diseases spreading through water was removed in 1917 when chlorination of water was started. There have been no typhoid epidemics in Tampere since then.

Over the years, Tampere City Water and Sewage Works has sought knowledge from abroad, the Finnish capital and other cities - even the countryside. As a rule, the development has not, however, been quite as capital-centered as historians until now may have led us to believe. Certain strategic selections have been made with regard to the utility which have determined the direction of its activities and closed out other development paths for decades to come ( "path dependence"). Tampere City Water and Sewage Works is an example of a local government-owned public utility that has been capable of providing services at reasonable cost.  The utility has decisively improved the city's fire safety, hygiene and health conditions, and the quality of the city environment.

4 Conclusions

We expect the final results of the project to lead into new interpretations of the factors inducing health improvements and to show the importance of human consciousness and social organizations in affecting the health of the populations. As a conclusion, the research team will present an interpretation of the interrelations between health, environment and social change. Such an interpretation is valuable when the future health policies are being formulated or evaluated.

The projected has (really) enriched the understanding of bio-social processes, the role of knowledge etc. in the fields of history , medicine (public health) and engineering.  Collaboration  across the disciplines has developed promisingly. Deparments of history, engineering, medicine and public health have organized and will organize joint MA courses on health and environment.
 

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