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Social Determinants of Health

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From:
Brian Hyndman <[log in to unmask]>
Reply To:
Social Determinants of Health <[log in to unmask]>
Date:
Tue, 8 Apr 2008 09:21:32 -0400
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Sadly, it was only a matter of time.


Beware the lesson of the Tory wolf in liberal clothing
Sweden's great social democracy has been transformed for the worse -  
and Britain risks importing the nightmare

Polly Toynbee in Stockholm The Guardian, Tuesday April 8 2008 Article  
historyAbout this articleClose This article appeared in the Guardian  
on Tuesday April 08 2008 on p31 of the Comment & debate section. It  
was last updated at 00:03 on April 08 2008.

The Conservatives are studying how the Swedish right beat the  
long-serving social democrats at their last election. What was their  
magic template? "There is a lot the Conservatives can learn from the  
Swedish Moderates," Cameron said, welcoming prime minister Fredrik  
Reinfeldt in London recently. "How to make bold and lasting change,  
how to reform welfare, in health how to put the consumer in control,  
in education how to put parents in control." He listed the rolling  
international victories of the right: "Everywhere the centre- right  
has the right ideas at the right time!" That evening he took Reinfeldt  
home to dinner to glean the secrets of his electoral success.

So a visit to Sweden to find out what Reinfeldt's conservative  
coalition has done in office may offer a glimpse into what a Cameron  
government might do. First, how did they win? Set the scene back in  
2006 when Goran Persson had been finance minister, then prime minister  
for 12 long years. He was deeply unpopular, leaden, lacking in charm  
and out of touch. His natural successor, Anna Lindh, popular and  
talented, had been assassinated and the social democratic party, as  
well as its leader, seemed incapable of averting what it knew to be  
the coming electoral catastrophe. Failing to eject Persson despite  
disastrous polling predictions, they sleep-walked over the precipice  
with their eyes wide open. Even Moderate party ministers admit there  
was no national swing to the right - only a desire to evict an  
unpopular leader, so the voters did what the social democrats should  
have done. Familiar?

The Moderates only had to make themselves respectably electable and  
wait for the ripe plum to drop. At the previous election they had  
crashed at just 15%, so Reinfeldt, an appealing and eloquent  
41-year-old, had a free hand to change everything. His tactic was to  
adopt virtually all social democrat policy so there was no observable  
difference - familiar? His one key issue was hidden unemployment and  
government inertia over too many people on sick pay.

What has Reinfeldt done? A lot more than voters bargained for. Welfare  
reform has been radical: benefits are cut and so are taxes. Everyone  
in work gets new tax credits: in Britain tax credits are benefits  
aimed at the poorest, in Sweden they are tax cuts for all. National  
insurance contributions have been raised sharply, with the unplanned  
effect that nearly half a million of the lowest paid have walked away  
from the scheme, leaving them nothing if they lose their jobs. Since  
the scheme is administered via the unions, union membership has  
dropped by the same amount. This strikes at the heart of the Swedish  
model which delivered industrial peace and prosperity with 90% union  
membership arranging civilised pay agreements with employers. Generous  
unemployment pay was key, allowing unions flexibility to let jobs go  
in dying industries, encouraging new industries to start up and  
Sweden's GDP to grow faster than most. But the assault on benefits and  
unions puts all this in peril. At the same time, the Moderates  
abolished wealth tax: it wasn't large, but it was symbolic.

This wasn't what the public voted for and polls show Reinfeldt's  
government extremely unpopular. Applying more of the same medicine,  
they hope a third round of tax cuts at the next budget might restore  
their fortunes - though neither tax nor benefit cuts please voters.  
Meanwhile more of the health service is contracted out, with GPs free  
to charge for the first time, raising alarms that they are moving out  
of poor areas to richer places where they can earn more. The prime  
minister's wife, in charge of the Stockholm region's health service,  
has been particularly radical. State-owned Absolut vodka has been sold  
to the French, and state-owned liquor stores are about to be sold off  
too. Museums that were always free now charge high entry fees - for  
British visitors a crisp reminder of the Thatcher years.

Education is where Cameron draws most from Sweden. When last Swedish  
conservatives were in office, in the early 1990s, they allowed anyone  
to set up a "free" school, however small, and claim the state's per  
capita allowance for pupils: voluntary and private for-profit schools  
opened, as well as Muslim and Christian schools. Cameron now plans to  
do the same. The biggest for-profit company - Kunskapsskolan - is  
about to open academies in Britain next year, justified to their  
shareholders as experimental loss-leaders. But if Cameron wins, the  
company will be in prime position to open as many "free" state schools  
as there are parents wanting to use them.

Interestingly, however, this is not a programme the present Swedish  
conservative government is expanding; only about 10% of Swedish  
children attend "free" schools, and Reinfeldt's ministers say their  
energy is directed to improving ordinary state schools. "Free" schools  
have proved socially divisive, attracting more middle-class families  
and ethnic minorities, many have restrictive academic admissions  
criteria, and there is intense unease over new segregated faith schools.

Here is an example of how "choice" can also restrict choice: a former  
social democrat minister tells me he is sad he feels he no longer has  
the choice to send his child to the once socially mixed neighbourhood  
school that he attended. Instead she travels miles away to a "free"  
school, where the brightest children have congregated, making his old  
school much worse. It's an irony that the Swedish conservatives no  
longer promote the "free" schools that Cameron will make his  
centrepiece policy: expect similarly divisive effects.

At present, the Swedes look certain to vote out the right: the  
nation's history is of social democracy punctuated by brief evictions  
as wake-up warnings. This time they voted for a wolf in sheep's  
clothing and are now appalled at what may be permanent damage to the  
successful Swedish model of cooperation between unions and industry,  
with high taxes and a generous welfare state.

Putting up taxes and benefits again is far harder to do, so even a  
modest dose of ideological Thatcherism could break the harmonious  
political ecology that made Sweden one of the most economically and  
socially successful societies on earth. The Swedish social democrats  
have a popular new leader in Mona Sahlin - while the man now most  
reviled is Goran Persson for hanging on like grim death and taking  
this party down with him. Long incumbency requires a dramatic  
political renewal that he could never provide. Cameron is not the only  
one looking to Sweden for lessons and warnings.

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