Authors: Liselotte Eriksson (Umeå University), Lars-Fredrik Andersson (Umeå University), Bernard Harris (University of Strathclyde)
A new historical dataset from Sweden’s health insurance system provides rare insight into everyday illness during early 20th century, a period of rapid social transformation. The findings challenge the conventional image of the “unhealthy city” and reinforce previous research suggesting that living standards in urban areas improved earlier then in rural areas, even in the presence of an “urban penalty” in mortality.
A new lens on sickness, not just survival
Most historical research on health relies on mortality records. They tell us who died, when, and often from what. But they say little about how frequently people were ill, how long they were sick, or which illnesses shaped daily life.
This study breaks that pattern. Drawing on a newly compiled dataset from one of Sweden’s largest nationwide health insurance societies, covering both men and women between 1912 and 1914, the research analyzes recorded sickness episodes at the onset of Sweden’s epidemiological transition. Urbanization and industrialization implied that causes of death were shifting from acute infectious disease toward chronic, human-induced conditions.
An Urban Penalty in Death and a Rural Penalty in Sickness
Although urban populations experienced higher mortality rates, previous research suggests that the epidemiological transition occurred earlier in urban areas, where living standards were generally more favourable than in rural regions. Our work contributes to this research by showing that these advantages also was translated into lower sickness incidence and reduced prevalence of infectious diseases in urban settings, mainly influenza.
Urban residents, men and women alike, experienced fewer sickness episodes than their rural counterparts, even after controlling for age, occupation, and migration status. The difference was driven largely by infectious diseases, with rural areas showing particularly high rates of influenza. Illness duration was also shorter in towns and cities, and shorter among men than women. Influenza’s relatively brief course likely explains part of this gap, but not all of it.
Non-communicable disease rates were similar across regions, and there were no systematic gender differences for these conditions. Instead, gender disparities reflected social structure: pregnancy-related illnesses accounted for much of women’s reported sickness, while workplace accidents weighed heavily on men, particularly rural male workers exposed to greater occupational hazards. Even after accounting for these factors, a persistent rural–urban morbidity gap remained.