Our history

The National Board of Health and Welfare was formed in 1968 by the fusion of the Royal Medical Board and the Royal Board of Social Affairs.

The Royal Medical Board had a history that could be traced back to the Collegium Medicorum, which was founded as far back as 1663. The intention was to regulate the activities of the small group of doctors who were then active in Stockholm. In time it developed into an administrative board with overall supervision of the nation’s health and medical care.

The Royal Board of Social Affairs came into being in 1912 as an authority dealing with labour issues: industrial safety, assistance to the poor, alcohol abuse and juvenile delinquency. Over the following decades, social policy developed and the work of the Board came to be focused on social services, care of the elderly, child and youth care and support for disabled persons.

From Collegium Medicorum to National Board of Health and Welfare

It was in 1663 that a handful of Stockholm physicians formed the Collegium Medicorum, the predecessor of the present National Board of Health and Welfare. Then as now, great care was exercised over the control and supervision of the various branches of the medical profession. At the time it was largely a matter of keeping the apothecaries in check and keeping out the quacks.

In 1912, 250 years later, the Swedish Parliament gave the green light for a new official agency: the Royal Board of Social Affairs. This authority was to gather together all the dispersed "worker issues": poor relief, temperance care, maladjusted children and worker protection. In 1968, after friction and doubt, the Royal Medical Board (modern successor to the Collegium Medicorum) and the Royal Board of Social Affairs were merged.

Table of Contents

Seventeenth century

In the middle of the seventeenth century there were only a few what we today would call doctors, professional practitioners of the healing arts. People who fell sick had to go to the apothecary, the village wise woman or a quack. There was no authority to exercise control over medical activity. The small group of doctors practising in Stockholm at that time ("the provinces" was hardly to be reckoned with in this respect) consisted chiefly of foreigners. Domestic medical training was practically speaking non-existent. Surgery was entirely separate from medicine and was not counted as a science. It was practised by barbers and it was very important that they should not attempt to treat internal disorders.

Such was the picture on 16 May 1663 when four Stockholm doctors with the Frenchman G.F.du Reiz in the lead formed the Collegium Medicorum. The reason was primarily the wish to regulate the practice of medicine and delimit it from quackery. In addition the founders wished to gain control of the trade in poisons.

From this small private association of a handful of doctors there has grown the entire system of Swedish health and medical care:

1663 Collegium Medicorum
1688 Collegium Medicum
1813 Royal Health Board (Kongl. Sundhetskollegium)
1878 Royal Medical Board (Kungl. Medicinalstyrelsen)
1912 Board of Social Affairs (Kungl. Socialstyrelsen)
1968 National Board of Health and Welfare (Socialstyrelsen)

First medical regulations 1663

The very first Collegium received Queen Hedvig Eleonora's blessing but met strong resistance elsewhere in society. It was chiefly the apothecaries and the medical faculties at universities who were strongly opposed to any superior authority that would issue prohibitions and limitations. One purpose of the college was to regulate medical training but the power to do so was not gained until 1789 after bitter struggles. Other important issues were the production of a pharmacopoeia, doctors' fees and the trade in poisons. It was decided that dealers in spices would no longer be permitted to sell those that could be considered as pharmaceuticals.

Medical regulations were also issued - the first in 1663 - but they were often couched in such vague terms that they were misunderstood. Thus the Collegium did not gain the power its members themselves had envisaged. In the revised edition (1699) of the very first medical regulations it is possible to read of the Collegium's purpose to drive out the shady characters who "smear the people with their counterfeit, deplorable and extremely injurious medicaments". Nobody was permitted to practise as a doctor in Stockholm without permission from the Collegium and thorough checking. Foreign doctors were forbidden to come here to practise - in this way it was hoped to encourage domestic studies. Training was to last at least six years.

The eighteenth century

On the accession of every new monarch the Collegium's privileges had to be reconfirmed. In a royal edict dated 15 June 1719 Ulrika Leonora graciously approved "this your humble supplication" and at the same time admonished the Collegium on several points. It was to be particularly diligent in the examination of future physicians "out in the provinces so that the sick may not be caused to suffer through the attempts of the ignorant". It was also important to check the activities of the apothecaries. The Collegium was also to monitor various major diseases, smallpox vaccination, the ravages of the venereal diseases and general health and medical care. Sometimes the king appointed special commissions, for example for plague or other great crises.

Towards the end of the eighteenth century the Collegium Medicum was given increasing duties now exercising supervision of the whole medical field including surgery. As early as 1758, Abraham Bäck, the then head of the Collegium, had written a memorandum on, among other things, how surgery should be handled, how surgery and medicine belonged together and how surgeons should be trained to gain the same status as physicians. Abraham Bäck also considered that the country was too "widely spread" for the few physicians then practising and that parish clerks ought therefore to be allowed to learn to "open veins". Another way of managing care of the sick was, according to Abraham Bäck, to further train regimental and field surgeons to become district medical officers "for the prevention of raging diseases". The midwives, the "earth mothers", had long been under the control of the Collegium. In a 1782 handbook it was required of the midwife that she should first and foremost have the correct religious beliefs, that she should preferably be a widow or at any rate married and that she should have small and soft hands. The Collegium was permitted to collect annual reports from all physicians and to impose fines for infringements of the medical statutes. But supervision of hospitals, sanatoriums and asylums was retained by the Guild of the Order of the Seraphim until the middle of the nineteenth century.

The nineteenth century

The Royal Health Board was founded in 1813, 150 years after the advent of the Collegium Medicorum. The first director-general was David Schultz von Schultzenheim, a true firebrand who remained at his post until he was over 90. Towards the end, when his health required, he was sometimes permitted to miss the meetings. The new civil service department was to have "supervision and control of the state of health, medical care and nursing", both among the population in general and in the armed forces on land and at sea. "Farm animal medicine" also came under the Health Board, which was now divided into two departments: one for civilian matters and one for military.

Organisational committees and inquiries have accompanied the medical system ever since the seventeenth century. In 1858 one such committee criticised the dual role of the Health Board: as being an administrative authority at the same time as it supervised teaching. This time it took 20 years for a new organisation to leave the stocks: in 1878 the Royal Medical Board started its work. The Board was to have the overall supervision of the country's general health and medical care - everything from health spas and bathing establishments to the welfare of its soldiers.

The twentieth century

From the beginning of the twentieth century, the Royal Medical Board was expanded with various committees and bodies for different purposes. In 1915, for example, the scientific committee was established, initially on a modest scale with ten members. In the same year the Board received new terms of reference and was divided into sixth offices: medicine, asylums, health care, general, veterinary and financial. Military medicine had been moved in 1907 to the newly formed Armed Forces Medical Board.

A constant theme throughout the history of the medical system has been the demands of those in power for savings and higher efficiency in the authority. The savings experts of 1926, for example, produced instructions on how the administration could be simplified. The number of offices must be reduced and the director-general should delegate further decision-making to departmental heads. However, the daily life of the Medical Board appears to have been fairly unchanged until 1947 when the post of deputy director-general was instituted alongside that of director-general, as were three new offices for dental care, legal matters and investigations and social and forensic psychiatry. In that year the Board handled about 50 000 cases, of which about 10 000 were veterinary. These were transferred in the same year to the Veterinary Board.

Many reforms introduced during the 1950s and 1960s had their repercussions on the work of the Medical Board. Among other things the Board was charged to investigate the prices for free and discounted pharmaceuticals under the 1995 pharmaceuticals reform. In 1957 the Cancer Register was started. As early as 1952 the Council for International Health Care Matters (NIH) began its work of co-operating with the WHO and other international organs. In 1959 the Council for Foreign Physicians was instituted and at the beginning of the 1960s there came the new county medical officer organisation which lasted exactly 20 years. The great issue of the 1960s, at least for internal work, was whether the Medical Board should be merged with the then Board of Social Affairs. The Medical Board rejected the idea and thought, as did many bodies to which the issue was referred, that the size of the new authority would entail unnecessary bureaucratisation and lack of flexibility. When the tercentenary was celebrated in 1963 with a ceremonial meeting in the Concert Hall and a banquet for 700 people in the Stockholm City Hall, the Medical Board had about 250 employees. The budget was just over 335 million Swedish crowns (1960). Exactly one century earlier the appropriation had been 172 000 Swedish crowns.

The original Board of Social Affairs, 1912

At about the same time as the tercentenary, in 1962, another civil service department celebrated its fiftieth anniversary. This was the Royal Board of Social Affairs, whose ancestry lacked the patina of the Medical Board, as has been pointed out on more than one occasion over the years. It was during the years before the First World War that understanding of the social context emerged. While social questions - what were called "worker issues" - were dealt with in the public administration, they were dispersed among almost all the ministries, mainly the Board of Trade. It may appear strange today that poor relief came under the Ministry of Agriculture, temperance problems under the Finance Ministry, maladjusted children under the Ministry of Education and Ecclesiastical Affairs, etc. This was why, in 1912, Parliament passed the Government bill concerning a new official department for worker issues. The terms of reference for the new Board of Social Affairs had stated that the Board should acquaint itself with social circumstances and remove, prevent or alleviate unsatisfactory social conditions. In other words there was to be a broad and purposeful social policy, for which multifaceted expert knowledge was required.

The matters which the Board now took over from various quarters were

  • Labour issues in general: the relationship between employer and employee, agreements, labour market issues
  • job security and occupational inspection
  • social insurance issues
  • other social questions such as poor relief, care of foster children, temperance care, emigration and supervision of emigration agencies
  • housing and cost of living
  • social enlightenment

These matters were distributed among five offices. Understandably enough it was the Office of General Social Affairs that predominated. This handled everything that concerned the employer-employee relationship, support of temperance, cost-of-living questions and, in addition, the Board's own staff questions and finances. Gradually new departments for legal matters and administration, statistics and unemployment issues were opened. During the 1920s and 1930s many new laws were passed. These included the 1931 Alcoholics Act, the Health Insurance Act of the same year and the 1937 Act on aliens' residence and work permits. This led in 1938 to the Board being reorganised into an authority purely for social welfare. Questions of job security and health-insurance were removed and new stress was laid on poor relief, child care and the approved schools.

Notions of the 'people's home' welfare system and of family policy were coming into vogue, which involved important new duties for the Board. These included state support for children's homes, day- care centres, play-schools, holiday colonies for schoolchildren and holiday homes. Of the Board's four social welfare offices, the new child care office, in 1947, rapidly became the largest. The Board now had two statistical offices: one for price and social welfare statistics and one for wages and employment statistics.

During the 1940s aliens matters took on new substance. Large numbers of refugees from the second World War came to Sweden and it fell to the Board to manage camps for persons who were not permitted to reside freely in the country in wartime. The Board also had to decide which aliens were to be detained in such camps. In the end, 115 officials were working in the aliens' department when in 1944 it was transferred to the newly-established National Aliens' Commission. During the 1950s social policy was expanded and deepened. Among other things the general supplementary pension (ATP), assistance to students and labour-market questions came to the fore. Much attention was also paid to care of the elderly and the long-term sick, to home help and to child and juvenile care. It was primarily these areas that the Ministry of Health and Social Welfare indicated when talk turned to integration of the Royal Medical Board and the Board of Social Affairs. But when it came to a possible merger with the Medical Board, Social Affairs was hesitant even though it did not directly reject the proposal. There were strong fears that social questions would drown in health and medical care which, it was predicted, would dominate entirely.

Sources

Article by Ia Hillborg in the 1981 estimates issue of Socialnytt (Social News). Socialnytt was assisted in tracking down facts from earlier years by the late Märta Elvers-Hulth. From 1947 Ms Elvers-Hulth was Librarian to the Medical Board and continued after the merger forming the National Board of Health and Welfare in 1968. Following her retirement in 1973, Ms Elvers-Hulth continued to collect material on the Swedish medical system. A large part of this material is now searchable in the Swedish medicohistorical bibliography database (MEDORG).

Director Generals

1968–1979 Bror Rexed
1979–1985 Barbro Westerholm
1985–1988 Maj-Britt Sandlund
1989–1998 Claes Örtendahl
1998–2004 Kerstin Wigzell
2004–2008 Kjell Asplund
2008– Lars-Erik Holm