När militarisering mötte välfärdsstat : Beredskapsplaneringen av svensk sjukvård 1950–1985

Sammanfattning: This paper studies when warfare meets welfare in the Swedish contingency planning of healthcare in war during the period 1950 to 1985 with the aim of analysing how the planning changed, what caused these changes and how this can be linked to societal changes in the post-war Sweden. The analysis is carried out with the help of a self-adapted stakeholder model where first the change in planning and management is analysed and then seeks causal explanations for the key changes based on three military and three civilian drivers. The starting point for civilian contingency planning for health care in war was the Civil Air Protection investigation (SOU 1936:57). The investigation found that the need for civilian hospitalcare in war had changed because total war had blurred the boundaries between military and civilian health care. The report therefore proposed that a joint plan for hospital care in war should be established. The base of the new organization was the emergency hospitals, which were largely existing healthcare facilities, given that name in a war situation. To recreate wartime planning for health care, a Health Care Preparedness Board (Swe:Sjukvårdsberedskapsnämnden) was established in 1948 responsible for planning of health care in wartime. There were three major turning points in the planning. In 1950 based on experience from the conventional bombing wars of World War II, in 1959 based on the increasingly powerful nuclear weapons and in 1969 due to Sweden ceasing to plan total defence for a nuclear war. The consequences of the first two redesigns involved the wartime establishment of hundreds of small emergency hospitals outside the city centres, while from 1969 the large peacetime hospitals returned as the core of wartime health care. The 1970s and 1980s were characterized by a decentralization of responsibility of planning and wartime management from the state to the county councils (Swe: landstingen). The main causes for the turning points were the development of nuclear weapons and the expansion of the welfare state. The impact of nuclear weapons is demonstrated by the fact that there is a start and an end to the nuclear phase of planning. The expansion of the welfare state meant that the role of the county councils over 30 years went from carrying out orders from the state and the armed forces to controlling both management and planning and where the military's right toissue wartime directives was abolished. This can be explained by the expansion of health care during the same period and the increased power of the county councils that came with the expansion.The study shows that the militarization of Swedish civilian society was strong up until about 1970, but then rapidly declined and it was increasingly the armed forces that had to adapt to the structure and requirements of the peacetime health care rather than the other way around. Again,the reason for this shift is the significant expansion of the welfare state and the peacetime healthcare system, which shifted both economic and political power away from the military to the civilian health care system.