Public health

Thomas Ragnarsson (M)

Madam Speaker! Today we are debating the report SoU20 Public Health. I would like to begin by moving for the approval of the committee's proposal for a decision.

What is public health? It is a broad concept that encompasses most of life. We could drift off properly in this debate, but I will try to stick to two overarching main groups: physical and mental public health.

Madam Speaker! Mental public health has deteriorated over the last decade, and we can state that there are many people in our country who are not doing well. Today we see a steadily growing queue in child and adolescent psychiatry, while the rates of sick leave regarding depression and exhaustion syndrome are high.

I do not believe there is any simple solution to this issue, but we can state that very fundamental things such as education and work play a decisive role. Therefore, it is of the utmost importance that we create the conditions for children and adults to find meaning in their lives through a good education and a job.

Madam Speaker! Sweden has today major problems regarding both school results and unemployment. This cannot be attributed to anything other than a failed policy during the recent terms. This is something that we take most seriously, and we will work hard for a school that delivers what it is set to do. This is found both in the Tidö Agreement and in the budget.

Small amounts of money in a budget can make a big difference, which means that the 20 million that are allocated to Bris actually mean that they can ensure their operations for the coming year.

Madam Speaker! The connection between physical activity and physical and mental well-being is well-documented. Therefore, initiatives in this area are of the utmost importance. Offering children and young people the opportunity to participate in sports and club life through leisure cards can provide them with the entry point to a continued active life in the future. There are clubs that lost 60 percent of their youth activities during the pandemic, and the long-term health effects of that can be very large. In addition to movement and engagement, these activities also provide community and belonging, which is an important part of breaking loneliness and isolation.

Madam Speaker! "The overarching goal of public health policy is to create societal conditions for good and equal health in the entire population and to close the addressable health gaps within a generation." That is what it says in Proposition 2017/18:249, and it still applies. If we can live up to this, the health gains for the individual and for society are enormous.

Another area that has a great impact on public health is the work surrounding ANDTS. The use of alcohol, drugs, doping, tobacco, and gambling obviously affects humans both mentally and physically, and therefore the preventive work within this area is of the utmost importance.

Well-developed vaccination programs have served public health well, and it is no coincidence that we have more or less succeeded in eradicating many of these diseases. Of course, we shall expand these programs as the evidence is in place.

Madam Speaker! I began with the question: What is public health? The more one looks at the question, the more one becomes aware that public health is and is influenced by everything in life. One also sees that simple measures can sometimes have large effects at the other end. That movement and physical activity strengthen the body is quite obvious, and one can also see that the long-term preventive effects when it comes to mental well-being, obesity, diabetes, cancer, and cardiovascular disease are very large.

The efforts we make for increased physical activity yield enormous effects at the other end, and it is clear that the earlier one becomes active, the greater the long-term health effects will be. Thus, it is not said that it does not pay off to start moving in adulthood. It is clear that the health effects provide a return even here.

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Karin Rågsjö (V)

Madam Speaker! Member Ragnarsson listed a number of issues that are part of public health. One issue that he did not touch upon is social class. Something very alarming has happened there.

Women with low socioeconomic status, if I may put it that way – that is, short education and so on – have, so to speak, lost in life expectancy. It is quite serious. It is something that must be addressed in different ways. It also affects their children to a large extent.

If one looks at the children of people with short education, one can see that every fifth child lives in a situation where the income over several years has not covered the most necessary expenses. This, of course, has a great impact on how they feel. In the same group, only 40 percent have a high school diploma - we are therefore talking about the children of the poor women. This will, of course, affect their lives.

I wonder what thoughts are contained in the Tidö Agreement regarding these issues. This is something that is extremely important. Now we are heading into a recession, and we unfortunately see that this group will be hit very hard by higher prices, higher rents, and so on.

Then it is a matter of having a good school. One must also have state subsidies to be able to deliver a good school. If one does not have enough state subsidies for the schools, the children who have the worst conditions will unfortunately again end up in a difficult situation. It will affect public health.

Does Member Ragnarsson have any thoughts on this based on the budget that SD and the government have submitted and the spring budget that we will see on Monday?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Thomas Ragnarsson (M)

Madam Speaker! It is generally known, I believe, that many of the problems we see in society are linked to socioeconomic issues.

We have also seen that in the places where the youth undergo a high school education, the risk of them ending up in bad company, getting into trouble with the law, and the like, decreases enormously.

What we see today is that people often fail in school. The simple solution that is often shouted for is more money. I come from the health and medical care sector myself. In the whole society, people always say: We need more money! But I do not believe that solves the big problem. I believe that we need to look at which resources we actually have at our disposal today and use them in smarter ways. If one does this, one does not need to inject more money.

At the same time, it is not the case that our municipalities do not receive any state grants. But it is about using the state grants in a sensible way. I am completely convinced that by working smarter with the money we have, we could actually achieve much better results than we do today.

Then I apologize, because I forgot what the other part of the question was. But I can return to it if Karin Rågsjö wishes to repeat it.

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Karin Rågsjö (V)

Madam Speaker! The big question was about class differences and health, but perhaps we should have a seminar on this, as it requires more time. But it is an important aspect.

Then there is this matter of money and public health. One can always say that perhaps more money was not needed. But today, one cannot really say that to Lärarförbundet, SKR, Vårdförbundet and so on, because we are facing a rather large crisis. I am quite worried.

Public health has to do with how people feel. If we have a school where, for example, Lärarförbundet comes out and says that they will not manage this – it is not about any individual municipalities but about all of Sweden – it will of course affect the public health for the children who attend the school.

One can fudge and fix and do different things. But merging classes, removing teacher assistants and so on will affect the children who are concerned, and those are often children growing up in areas that are disadvantaged in different ways. In those areas, the school would need much more.

Money always plays a major role in the context. One must not waste money, but one must be able to hire qualified teachers. One must be able to hire assistants for the children who need it. If it turns out that one cannot do that, it will affect public health negatively. It will do so for a quite long period.

School plays a fundamental role when it comes to public health. We all know that. If you leave school today with grades from upper secondary school, you fare quite well.

Then there is the big question of the class difference in health, which increases year after year. I unfortunately believe that with the budget you have presented together with the party you are completely dependent on, the Sweden Democrats, this unfortunately will not work for the families we are talking about. Public health will suffer from that budget and the policy you pursue.

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Thomas Ragnarsson (M)

Madam Speaker! I do not agree with the last point the member states. However, we are in complete agreement when it comes to class differences in society and health. There is as much evidence as anything on that, so there is no dividing line in what we think. But the question is: How do we achieve results when it comes to this?

We must work more proactively within Swedish healthcare. We must increase the knowledge base regarding how one actually improves their health, for example with movement and the diet one eats.

At the same time, many of these class differences have actually arisen from having ended up in unemployment and living a rather isolated life. Through work, one breaks that type of isolation. It is also a way to increase the knowledge base of the single mother or whoever it may be.

I believe that this is very much connected. It is about how we work with labor market issues and school issues to increase the knowledge base.

Then there is this matter of money. I come from the health and medical care sector. It is a specialty within Swedish health and medical care to never stick to a budget. I have not witnessed it being done in 35 years. In fact, I believe that there is money, but we do not use it in a smart way. There are many times when one sees that money is spent on completely unnecessary administration and other things instead of on the core activities, and there is no difference between school and health and medical care.

I would like to assert that there is money to do this, and there are state grants. It is also a matter of the municipalities having to prioritize. That is what we heard in the previous debate.

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Christofer Bergenblock (C)

Madam Speaker! Thank you very much for the speech, Thomas Ragnarsson! I think it was good that the member raised the question of whether we have well-developed vaccination programs in Sweden, because that is the case. We have had well-developed vaccination programs for our children and young people in Sweden for a long time. Eleven different vaccines are offered, and now at the end, we have also supplemented with, among other things, HPV vaccine for young girls. We also have a very good vaccine coverage among our children and young people.

I also noticed that the member said that there is reason to expand the vaccination programs as evidence is in place. This leads me to the question of vaccination of our elderly. We actually have evidence in place that this is important and necessary.

There is currently no comprehensive or coordinated vaccination program for our elderly, and this is something requested by several parties in the Riksdag. In addition to the need for a unified program, a cost-free program is needed to increase vaccination coverage among our elderly. This could involve, for example, seasonal influenza, shingles, and pneumococci. Several of the parties, including Centerpartiet, have submitted proposals for a motion to the government regarding the specific question of whether we should have a comprehensive vaccination program for our elderly.

Madam Speaker! My question to Thomas Ragnarsson is then: Why is this not a priority issue for the Moderaterna and the other Tidö parties?

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Thomas Ragnarsson (M)

Madam Speaker! I thank you for the question. I am speaking about evidence. Yes, it is absolutely correct as the member says: There is evidence that the elderly should get vaccinated. But it still needs to be investigated and calculations made of what things will cost. There is a marginal benefit at the other end of vaccinating. We might avoid hospital admissions and such.

I hope that an investigation will be conducted on what this would entail, and I know that Socialstyrelsen is looking into it. It is therefore not a buried issue.

In the best of worlds, we could offer everything to everyone at all times, but that is not the reality when it comes to the economy, and one has to make priorities. And up to the present day, I think that very good priorities have been made.

Some municipalities have already introduced certain parts. They offer vaccination. I know that there are municipalities that even cover the cost entirely. In other municipalities, one has to pay a co-payment and so on. It differs slightly when it comes to the elderly.

I look forward to an investigation into this area, as it is absolutely necessary. After the pandemic, we actually saw the importance of older people getting vaccinated. It is no coincidence that older people in Sweden were hit very hard by the pandemic. We chose not to admit as many as was done in the rest of Europe, for example, and that was a reason why many died. They did not get the right help. On the other hand, we saw that the vaccinations, when they got started, had an enormous effect.

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Christofer Bergenblock (C)

Madam Speaker! I am pleased that the member hopes that an investigation will be conducted on this in the future, as the member has every opportunity to push for such an investigation to be carried out. If the member is prepared for that, we can, of course, jointly draft the submission to the government stating that this is necessary. As mentioned, many parties want to see such an investigation and want to see a proposal on how a unified vaccination program for the elderly can be achieved.

It is an important question. The member refers to how it can look in individual municipalities - or perhaps it is more in individual regions - when it comes to how one handles both the cost component and the vaccine offers. It is clear that this in itself speaks for an unequal care. What we need in Sweden is an equal care, and then more national governance is needed over what shall actually be offered to parts of the population.

We saw, not least during the pandemic, that the elderly are a vulnerable group. When one enters old age, one does not always perceive that one is vulnerable and that the body has become more fragile. For that very reason, many refrain from important vaccinations, for example regarding seasonal influenza. Therefore, there is an even greater need for precisely a national steering when it comes to this issue.

Madam Speaker! It pleases me, as I said, that the member is positive towards such an investigation. I am, of course, prepared to, on behalf of the Center Party, sign a motion to the government in order to jointly push on the issue.

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Thomas Ragnarsson (M)

Madam Speaker! We can look at the health situation when we talk about public health. We know that the multi-morbid elderly, for example, take 50 percent of all acute resources in society today. And it can be enough that the multi-morbid elderly, for example, get a seasonal influenza for them to suddenly become a patient who perhaps needs to be cared for in intensive care for a longer period. This is obviously associated with large costs and a great pressure on health and medical care.

What is a bit worrying regarding our vaccination programs is that there are vaccine skeptics in society who drive the line that it is dangerous to get vaccinated. As recently as 2016, we had an outbreak of measles because people in certain areas chose not to get vaccinated. They had heard that it was not good and that it was dangerous for the child. We saw a spread in the community directly. It happens extremely fast, that is.

I believe that we should nurture the vaccination programs that we have and ensure that they are manifest in society. But we need to look further into the question. My perception is, namely – there is no theory behind this – that viruses risk being what kills humanity. We stand quite flat when they strike. We got a foretaste of that during the pandemic.

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Karin Sundin (S)

Madam Speaker! Public health issues can be discussed and measured in many different ways. In the report that is currently on the table, issues regarding national plans, vaccinations, allergies, and mental health are mixed together. These are scattered bursts of issues which each individually, of course, are very important in the description of people's health, but which actually do not provide a comprehensive picture of public health.

Public health is about a more cohesive picture of how we live and how long we live in Sweden, and if one were to choose a measure of public health that we should discuss today, it would probably be life expectancy. It has increased significantly just during my own lifetime, and it is a fantastic development. To a large extent, it is due to reduced infant mortality. Swedish children have the best conditions in the world to survive their childhood. It is also about the fact that we who have actually survived our childhood also today have better conditions to live long, healthy lives and have access to good healthcare when we become ill.

But we also have major problems. The conditions for living long, healthy lives differ very much between different parts of our country, between counties, between municipalities, and also between different parts of one and the same municipality.

The shortest straw in expected life expectancy is drawn by the population in Norrbotten County. The women and men living in Norrbotten have the shortest remaining expected life expectancy today. There is a clear gender dimension in this. Women generally live longer than men. We know that. But there is also a very large difference if one compares women with women and men with men.

In Gothenburg, a new equality report has recently been produced. It shows that women in Bergsjön have an expected average life expectancy that is nine years shorter than for women in Norra Älvstranden. I hardly need to say that Bergsjön is a socioeconomically disadvantaged area, while Norra Älvstranden is a more prosperous area.

In my own municipality, Örebro, the differences are even greater. Women living in Vivalla live to an average of 79.3 years, while the average life expectancy for women in other parts of Örebro is well over 90 years - in Lillån 93 years. At most, the difference in life expectancy is therefore more than 13 years in my home municipality.

We see the same pattern of large socioeconomic differences in health and life expectancy among both women and men recurring throughout our country. People who have certain disabilities, hbtqi people, and people who are unemployed or newly arrived have poorer health. Poor people have poorer health. They are sicker and live shorter lives than rich people.

It is not getting any better either. We see that the differences have increased in recent years. So we cannot have that.

Madam Speaker! One of the measures that the previous, Social Democratic-led government took was to appoint a commission for equal health with the task of submitting proposals that could contribute to reducing health inequalities in society.

The investigation and the work resulted in the Riksdag adopting a new overarching goal for public health policy, something we had touched upon earlier in the debate, namely to "create societal conditions for good and equal health in the entire population and close the addressable health gaps within a generation."

It is a goal that commits, and a central question then becomes what is influenceable and what is not influenceable. There are no unambiguous answers as to what constitutes an influenceable health disparity, but what the Commission for Equal Health clearly emphasized was that, in principle, almost all systematic differences in health between social groups are actually influenceable.

People's health, both generally and specifically for very many of our common diseases, is affected by the conditions, circumstances, and environments in which we live. It is about conditions that can be influenced, among other things, through political interventions, not least in welfare and for example through preventive health and medical care.

It is also not possible to ignore that the individual has a very large responsibility for their own health and for the choices they make. But also in that area, society can influence through legislation on, for example, smoke-free environments, the retail monopoly to limit the harmful effects of alcohol, and age limits.

If we are to be able to reach the goal of closing the addressable health gaps within a generation, it requires a policy for greater equality. It requires more socially preventive interventions, and it requires a transition within health and medical care to work more health-promoting and disease-preventive than today. Significantly more adults need to be offered health screenings and receive support in developing healthier lifestyle habits. For this, more money is required for welfare and more money for health and medical care.

It is of course also very important to support sports activities, community life and outdoor life, because we know that all research shows that physical movement, activity and cooperation strengthen the health and well-being of most people. Society's goal must be that more people should participate and that those who move the least today should move a little more tomorrow.

Madam Speaker! If we are to make a difference in the field of public health, a broad but at the same time cohesive effort is required. We have that today based on the new public health goals and the monitoring structure that is now in place. We must stick to those goals and that work. This requires political will, but it also requires economic resources and investments in people's health.

In this context, I want to remind that we Social Democrats proposed twice as much money for welfare and health and medical care as there is in the state budget that the current government is governing the country from.

Instead, the new government has prioritized lowering taxes for those with high incomes. But it is not tax cuts for those living in affluent areas that will increase life expectancy in Bergsjön in Gothenburg, in Vivalla in Örebro, or in any single place in Norrbotten County.

Madam Speaker! I naturally stand behind all the Social Democrats' motions in the field of public health, but in order to save time, I move for approval only of reservation 2, which concerns exactly what I have spoken about here today – that we must close the preventable health gaps within a generation.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Dan Hovskär (KD)

Madam Speaker! I shall begin by moving to approve the committee's proposal in the report.

Involuntary loneliness, a lack of community, and too little movement are serious public health problems that entail negative consequences for people's health and well-being. We Christian Democrats are now joining forces to achieve better public health in the country. The government proposes several initiatives, including a community initiative to break loneliness, not least among the elderly, a leisure card for children and young people, a development of physical activity on prescription, and an initiative on the elderly's opportunities for sports.

Public health is affected by a long series of political measures within, for example, the labor market, the environment, the economy, and the individual's opportunities to influence their own everyday life. We Christian Democrats believe that a great responsibility for health lies with the individual, but the healthcare system, as well as schools and other authorities, must to a greater extent support individuals toward better lifestyle habits such as quitting smoking, reducing alcohol intake, eating healthier, and moving more.

Madam Speaker! A major initiative is now underway in the field of public health. Involuntary loneliness is a societal problem that has serious consequences. Loneliness can lead to both mental and physical illnesses and cost both human suffering and large healthcare resources. Involuntary loneliness also increases the risk of cardiovascular diseases, stroke, dementia, and mental ill-health. Involuntary loneliness brings about great negative consequences for society, especially among the elderly, which has been intensified during the covid-19 pandemic.

To strengthen public health and reduce the consequences of involuntary loneliness, the government proposes a three-year community initiative which amounts to 300 million kronor during 2023. For 2024 and 2025, 300 million kronor are also estimated to be allocated annually for the purpose.

Of the funds, it is proposed that 145 million shall be directed during this year to municipalities and regions for specific measures for the elderly through elderly calls and health calls. The calls shall primarily be directed to elderly persons who do not have home care or live in special housing. From 2024 onwards, 100 million kronor are estimated to be allocated annually for the work.

The Government also proposes that 50 million kronor be allocated during 2023 to counteract loneliness among the elderly. Thereafter, the Government estimates to allocate 50 million kronor per year during 2024 and 2025.

The Government also proposes that the sports movement's work with sports for the elderly be strengthened with 25 million during this year and with 50 million per year during 2024 and 2025. After 2024, the state investment in sports for the elderly is estimated to amount to approximately 70 million kronor.

Furthermore, the government proposes that additional funds be allocated to civil society's work to break involuntary loneliness. During the period 2023-2025, 75 million kronor are estimated to be allocated annually for this purpose. At the same time, the target group should be broadened from elderly persons to also include other vulnerable groups where loneliness can be significant. Just civil society and the association life, such as the sports club, the church or the cultural association, have an important task as meeting places.

The Christian Democrats and the government also propose that 5 million kronor be allocated in 2023 to map the problems with involuntary loneliness and to develop a national strategy in the area. The national strategy is intended to be usable for consolidating forces and strengthening the work to prevent and break involuntary loneliness and isolation in several social groups.

Madam Speaker! A leisure card that gives children and young people the opportunity to participate in sports and association life is also being introduced. An active and meaningful leisure time in community with others is important to counteract physical and mental ill-health and loneliness among children and young people.

Children and young people need to get better access to sports and association life. Increasing children's movement, strengthening fitness, and counteracting sedentary behavior is important here and now. It also lays the foundation for equal health further ahead in life. To safeguard children's and young people's access to sports and association life, the government also intends to introduce a leisure card. Especially children and young people from socioeconomically disadvantaged households shall, through the leisure card, be given improved opportunities to participate in leisure activities.

The Government therefore proposes that 50 million kronor be allocated during 2023 to develop the necessary infrastructure for the introduction of a leisure card for children and young people. In 2024, 731 million kronor are estimated for the introduction of the leisure card, and from 2025 onwards, 792 million kronor are estimated annually for the same purpose. This is an important public health issue, we in Kristdemokraterna believe.

There are great health gains in increasing physical activity in the population. Regular physical activity contributes to improved health, mental well-being, and quality of life. It is therefore important to give more people better opportunities to move. Initiatives to support the use of and adherence to physical activity on prescription make it possible to reach groups that run a particularly high risk of being affected by mental and physical ill-health linked to physical inactivity.

Madam Speaker! The Christian Democrats and the government therefore propose that 50 million kronor be allocated to develop the use of physical activity on prescription, FaR. It is estimated at 75 million kronor during 2024 and 100 million from and including 2025 for this purpose. Physical activity on prescription gives more people the opportunity for improved health and mental well-being. All of this is to strengthen and improve public health.

We Christian Democrats are joining forces to achieve better public health in the country.

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Anna-Lena Blomkvist (SD)

Madam Speaker! Public health, the collective health of a population or in any other larger group of people, is a cornerstone of our healthcare. Public health encompasses all parts of health: mental, social, and physical. If we have a functioning public health work, it is clearly visible in measurements that average life expectancy, self-perceived quality of life, the prevalence of various diseases, or mortality at, for example, childbirth, changes. And likewise, we clearly see if it does not work.

Public health also plays an important role for good well-being and for a healthier population. Public health policy aims to support the individual in making healthy choices, and by detecting and personalizing treatment plans early, many public health problems can be prevented. A continued restrictive alcohol and narcotics policy and preventive work regarding smoking and gambling addiction is important in this context. Here, the ANDTS strategy plays an important role.

Actively working and creating good incentives to get the population into healthier lifestyle habits is important. Sverigedemokraterna believe that the government must take measures promptly and in an effective way to encourage people to eat healthier, move more, and reduce the use of alcohol, drugs, and tobacco products. We politicians in the Swedish Riksdag and members of the Social Affairs Committee have an important function in creating a strong public health policy Sweden that contributes to people having a healthier everyday life and thus also a healthier life. By detecting early, personalizing and individualizing treatment plans and lifestyle habits, many public health problems can be prevented.

The overall goal of the national vaccination program is to improve public health by preventing the spread of infection and building up a good protection against serious diseases in the population. This is something that we in Sweden have been fantastically good at, and as we today vaccinate our children, we reach them regardless of where they live in the country via their visits within child healthcare and school health, but also later via primary care, occupational health, healthcare, and with private actors who vaccinate during different stages in life. But it is not possible today to get a consolidated picture of which vaccinations have been taken, where they have been taken or when they have been taken and how the patient has received them.

How many of you haven't, like, had these small paper cards for your children? I know that my children's records are in at least three, maybe even four, different record systems - and my eldest is 22 years old. The vaccination cards are now packed away in some box from several moves back.

Madam Speaker! The Sweden Democrats believe that we must take measures to produce the IT solutions required to develop a well-functioning vaccination register. In the same way as we are currently working on producing the medication list, a vaccination register would be of great importance for patient safety. The register would follow the patient throughout their entire life and not solely exist via a paper card in a moving box that remains in the attic at your parents' home when you move out.

Madam Speaker! One of the biggest reasons in today's society why more and more people are suffering is mental ill-health.

In today's society, we spend more and more time on social media. Today, our time on social media is governed by advanced algorithms that the media companies use to get us to spend more and more time on their services. And it works; we can probably all agree on that.

Many of us know that we are mapped in detail via social media and that our personal data can be used to influence us to buy a certain product or take a stand on a politically charged issue. Yet we continue to use the services. Why do we do it? We are not stupid. Most of us understand that when a service is free, we are the product. We are becoming increasingly aware of the risk that data about us can end up in the wrong hands and be used in contexts we have no control over, for example, to expose us to advertising or to manipulate us. Despite this, we continue to use social media services even though the risk exists that it violates our privacy.

For many, social media and today's technology have also become a part of our lives. It is more than just a platform to search for and receive information on. It is a way to keep in touch with friends, even a way to be able to have friends.

My son has always been a lone wolf and had difficulty having friends and socializing because of his autism diagnosis. But today, he can use social media to have a friendship with his best friend 15 miles away. Every day after school, they talk and play via FaceTime, where they can play games and talk. He has a friend who wants to "hang out" and play with him every day. He is no longer alone.

But how are we then affected by the large media companies, and how does it affect us mentally? There are several research findings that show the correlation between mental ill-health and the time we spend on social media. The National Board of Health and Welfare has also reported that mental ill-health among children aged 10-17 has increased by 100 percent in ten years. 100 percent!

The more time we spend in front of the screen, the greater the risks of depression, anxiety, and suicidal thoughts, not least among young people. Even though there is no research today that has completely clarified this connection, much suggests it.

Madam Speaker! The Sweden Democrats consider it extremely important that we now, with the new right-wing government, take action on this by studying and reviewing how social media affects our health and investigating specific measures so that the negative impact can be managed effectively.

Madam Speaker! The Sweden Democrats support all reservations but choose to move for approval only of reservation 18 regarding mental health.

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Karin Rågsjö (V)

Madam Speaker! I have a question for Member Blomkvist regarding vaccination programs for the elderly. There is a good vaccination program for children. We believe we need one for the elderly as well.

Today, one can receive a pneumococcal vaccine if one happens to be over 75 years old. It is actually the Left Party's credit; I must say that. I want to stand here and boast a little. One can also take a vaccine against shingles - it costs 2,000 kronor per vaccination occasion - and against TBE and so on. But today, a coherent vaccination program for the elderly is lacking. It is several parties that have promoted this. I intended to ask the member about that.

The vaccination rate regarding pneumococci is quite low in Sweden. It is 36 percent for persons over 65 years old in Sweden. In Denmark, they have reached 73 percent. Efforts have been made to try to vaccinate the elderly, because it is known that many elderly people become very ill from the pneumococcus bacterium.

There were such proposals here that we have gone through when it concerns exactly vaccinations. I wonder what the member thinks the Sverigedemokraterna, who have great influence on the government, can do to get a vaccination program for the elderly started. It was needed.

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Anna-Lena Blomkvist (SD)

Madam Speaker! I thank the member for an important question, the great importance of which we have now seen during the pandemic.

We view positively that an investigation of a national vaccination plan is being conducted. We must achieve equitable care and reach the pensioners, whom we have difficulty getting information to. We must reach out with improved information to all target groups, so we view an investigation of vaccination positively.

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Karin Rågsjö (V)

Madam Speaker! Then you could have joined us, I say to the member. There were some parties that wanted to carry this out.

Another question then. Member of Parliament Blomkvist also highlights the mental ill-health among children and young people. It is high, but the problem is also that there are very few entry points for children who have mental problems of various kinds. One can have a broad spectrum, and not all children can end up in child and adolescent psychiatry. Much of it seems to be so because there are too few other entry points.

But it requires money and a budget to be able to, for example, make school health care more robust and have youth clinics that can receive young people who are feeling unwell but not to the extent that they need to seek out child and adolescent psychiatry.

I am a bit worried for various reasons, Madam Speaker. One is that the state grants from the Sweden Democrats and the government are so low, which everyone has now started talking about. It will not provide better conditions for this group, that is to say children and young people who need different types of help to feel better mentally.

What is also important is that children who are doing very poorly and need urgent help receive it quickly. That is not how it looks today – the queues are enormously long, and there is a lack of entry points for children in general so that they can get help with what they need when they do not specifically need child and adolescent psychiatry.

In what way can we reduce the number of children who are in the queue for BUP, child and adolescent psychiatry?

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Anna-Lena Blomkvist (SD)

Madam Speaker! I thank the member for another interesting question.

I will not go into the state subsidies and sums there. I will say that I am new, and I am not good at sums and all that sort of thing.

But we have a big problem with psychiatry, and we must address it together with both the school and healthcare in order to reach these children. As the member said, not everyone should be funneled straight into BUP. We must create a greater cooperation together.

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Jakob Olofsgård (L)

Madam Speaker! I would like to begin by moving for approval of the committee's proposal for a decision.

At the same time, I want to say that it is the first time I am present here in the Social Affairs Committee's debate on public health. I very much look forward to continuing with this important work, a work that those listening to the debate can hear there is great consensus about. People are wanted well. The human being is at the center, and we all wish people a good life. Then the paths there can be different; that is what we are debating here today.

Personally, Madam Speaker, I bring my own life experience into this work. I have devoted 20 years to civil society's task of supporting and helping people at different stages.

I have a general rule when I meet new people. It might sound a bit strange, but I usually think that I should be kind to them. Shouldn't one always be?

I am not saying this just because I want my colleagues in the committee to be kind to me here today, but I say it because I think about it when I meet new people. I do not know what this person carries, what struggle they carry, what life struggle they carry. It is the case that all people carry something, more or less, big or small. They carry a life struggle, and it can look different. Therefore, one should be kind.

One of two things that I want to highlight here today is the involuntary loneliness, which unfortunately is increasing greatly in our modern society.

That is why it is very important that the government has now given a mandate to the Public Health Agency to develop a national strategy against involuntary loneliness.

According to the Public Health Agency, almost every fourth person over the age of 16 is in some way affected by loneliness and isolation. Involuntary loneliness causes a tough struggle for these people and also entails large costs for society. A mapping of involuntary loneliness shall be carried out, and a national strategy shall be developed to prevent and counteract involuntary loneliness and its consequences.

Can a strategy then help? Can it be the key and the tool for a subject as elusive as loneliness? Yes, it is to start somewhere, and it is to start in the right way with the right measures. The strategy becomes an important part of the work to counteract the immense problem that involuntary loneliness poses for the individual, and also for the surroundings and society. And this can only be done with all social actors - authorities, municipalities, regions, civil society and the business sector - together to prevent and build community and relationships.

Madam Speaker! There is much good already being done in this area out in our municipalities that we shall strengthen. In my home municipality, the municipality conducted an IOP - a procurement with civil society - in a collaboration with a church. All older men over 80 years old who lived around this church were invited to a coffee - for church coffee. It must have been a special experience for the deacon in the church when, suddenly, on an ordinary Thursday morning, a group of lonely men sat there together around a coffee table, invited with the question: Are you lonely? Welcome for a coffee! All that was needed was, therefore, an invitation, a question: Do you want to come for a coffee? And right there, one has succeeded in breaking the involuntary loneliness among older men.

The government is now tasking Socialstyrelsen to, together with the municipalities, counteract involuntary loneliness among the elderly by offering outreach health consultations. The involuntary loneliness among the elderly has not decreased during the pandemic's isolation. But now there are resources to counteract this loneliness in a very concrete way. Sometimes it only takes a health consultation, a question, an invitation to come into a community. It can be under municipal management or in civil society. I heard that a comment in the group with the lonely men was: "I come here because it is my tax money that pays for this coffee. I have a right to this." It is completely okay, as long as one breaks the loneliness.

Madam Speaker! I want to conclude by highlighting one of the most difficult but perhaps most important measures within the area of public health, namely the question of how we can better stop and prevent suicide. There is an enormous sense of powerlessness in the one who has sat down with a person who has decided to take their own life. That darkness and bottomless hopelessness cannot be described with words. It is often not possible to do anything other than sit there and be silent. That is why the government has tasked a special investigator to review certain issues within the suicide prevention area in order to draw lessons after a suicide has occurred. When it has happened, it is of the utmost importance that we ask ourselves why, what went wrong, and what was lacking in society's safety net.

For it is certain that there was something we could have done better. We must nevertheless believe that there is something that can be improved in order to prevent and help. We need to learn, not to assign blame for the fact that it went wrong, but to see what different actors such as school, social services, healthcare, police, or emergency services can concretely do to prevent it from happening again. That, if anything, is what public health is about – that we should live a good life.

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Karin Rågsjö (V)

Madam Speaker! Public health is important. The major underlying issue for me within the area of public health, which I have worked with for a large part of my life, is the large differences that we can see in health and life expectancy which depend on class. Then perhaps it is not enough with individual campaigns about tobacco or obesity, even if they can be good. One must do more things simultaneously.

Madam Speaker! We can now see that women with low socioeconomic status, for example with short education, have had a negative development. In the group, the average life expectancy has even fallen. It is very serious. It should send an enormous signal to a society. At the same time, one can also see that their economic standard has fallen. It has affected the health for them and their children, and it will do so in the long term.

More than every fifth child of people with short education lives in a situation where the income over several years has not been sufficient for the most necessary expenses. In the same group, it is approximately 40 percent who have attended upper secondary school. Then you understand – this is public health. What should we do about it? That is something to consider. Many interventions are required simultaneously, but it definitely does not require cuts for this group, which we will see over the next four years unless something miraculous happens.

Madam Speaker! It is very worrying that the health is deteriorating for this group of women and their roughly 65,000 children who live in economic vulnerability. This is an issue that should evoke enormous commitment and which should have done so for a long time. This is not about a development that has been occurring for six months, but it is a development that has been occurring over a very long period.

SNS has produced a research report called "Hellre rik och frisk" (Better off rich and healthy) regarding family background and children's health. In that report, the researchers go through very many investigations and so on. In the report, it states that children of parents who have the highest income and education have up to 40-45 percent lower probability of ending up in the hospital and becoming ill.

So, a preventive effort is really needed. I believe that different legislation is needed. Public health work is not something we need to work on in the regions or in the municipalities, you know that, but there should be a national public health law, similar to those that exist in Norway, Finland, and Denmark. We should have a public health law that can be implemented, where public health becomes something real, where the regions work with this and where something happens. That is what we want to see.

Moving on to the vaccinations, Madam Speaker. We have a very stable childhood vaccination program. When it comes to specifically childhood vaccinations, we are very high. That is good. There have been tendencies that people do not want to vaccinate, but they have been eliminated, I think.

But then we have vaccinations for the elderly, which I have spoken about earlier here in the exchange: pneumococci for people who are 65 plus, shingles, which is an extremely expensive measure - 2,000 kronor per vaccination occasion, which makes 4,000 - and TBE, which is also an incredibly important vaccination.

Pneumococci are interesting to look at. According to the Public Health Agency, pneumococci are the most common cause of pneumonia for the youngest and the oldest individuals in society. For children, the pneumococcal vaccine has been included in the general vaccination program for children since 2009. From 2022, vaccination against pneumococci for the elderly is also included in the program, but then one must be 75 years of age or older. The Public Health Agency recommends vaccination against pneumococci to persons who are 65 years and older. So there is a difference there of ten years. Despite that, the group is not offered the vaccine in the special vaccination program.

It is interesting to compare countries. Denmark is sometimes praised here for various reasons by different parties. There, they vaccinate people over 65 years old. There, they have a vaccination coverage rate of 73 percent, while we have 36 percent for the same group. I think that is something one can reflect on.

We must do something about this, and therefore we want the government to task the appropriate authority with developing a vaccination program for the elderly. Therefore, I move for the approval of reservation number 12.

Then I thought I would talk a bit about HIV and AIDS, which in the 80s was something you died from. If you got HIV, you were in some way predestined to die from AIDS. Today, thanks to research, we can see that correctly treated HIV is no longer a transmissible disease. There are effective medicines to avoid HIV infection, and one of the more effective are so-called PrEP medicines, which can be used if one is a person in a risk zone.

They have looked at this in the USA and England and seen that it has worked perfectly well, but in Sweden it is a bit more difficult. It is only a number of clinics in Sweden that prescribe PrEP, even though doctors have the ability and opportunity to do so. The side effects are minimal, so this is something that would be great to prescribe to risk groups. One can wonder why it is not happening, whether it is because there are more moral-conservative doctors sitting at the table or something else. There are enormous waiting times to get PrEP treatment all around Sweden. We have tried to work on this for a few years, and now there are more parties doing it, which is good.

Then it is about the fact that the mental well-being of children and young people has deteriorated, as we all know. We also, just as I mentioned earlier, have very few entry points for children and young people within the entire psychiatry. Not all children can end up in child and adolescent psychiatry. It is not possible, rather we must have better entry points when it comes to child and adolescent health. For example, one can equip the youth clinics, have good school health care, and so on. This we shall discuss later during the spring.

I think that mental health is an incredibly important issue, both among adults and among children and young people. There is much more we can do to create more secure pathways into care. It is a prerequisite for catching these children early.

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Jakob Olofsgård (L)

Madam Speaker! I requested the floor because I felt the great commitment to public health from Member Karin Rågsjö and so that we may dwell a little longer on the questions that were raised.

I noticed that the member did not take the floor from me, perhaps for the sake of courtesy because I am new here. It might be different moving forward.

Regarding what the member raised about the socioeconomic differences, I agree with the problem picture that the member highlighted – that we have this in our society today, both in life expectancy and in well-being, especially among children and young people and among women.

The government is now moving forward with an investment in leisure cards. It is an example of a targeted investment that goes precisely to those who cannot afford to start a leisure activity, such as scouting or football activities, or who cannot afford sneakers, football boots, or whatever it may be. I wonder what Member Karin Rågsjö's position is on the leisure card and how she views it—whether it is a good or bad investment.

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Karin Rågsjö (V)

Madam Speaker! I did not request a reply from you, Jakob Olofsgård, because I wanted to be kind.

I think the entire Tidö Agreement is a sad read, but we are positive about the leisure card. There were some from the opposition who were not, but we are. We think it can be a smart idea.

I live in Stockholm, as you hear, and one might wonder where the clubs are. Where are the Scouts, the swimming clubs, and the good football clubs? They are very rarely found in neglected areas, but they are found in more affluent areas. I think this is sad. It must be about trying to direct activities in that way or give them equal conditions.

Participating and playing football costs money, as said. It is football boots and so on, and it can become expensive. For families who are truly living on the margin, support is needed so that children can get out into a context. I believe very much in leisure activities for children - being part of a context in different ways or being involved in playing theater. It does not have to be about sport, it can be learning to play an instrument or singing together - whatever, just that it is a nice context.

We have been very bad at offering this to children in disadvantaged areas, and one might wonder why. One might wonder why the Scouts do not have more activities in Rinkeby, Tensta or Botkyrka. Now I am talking about Stockholm - it became very Stockholm-ish.

Large investments were needed, but economic investments were also needed for the parents who live with the children. If you are a mother or a father and have four jobs to keep the world and life spinning, you have very little time to ensure that your children attend the activities. It is a class issue.

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Jakob Olofsgård (L)

Madam Speaker! Thank you, Member, for the answer! It is clear that not everything in the Tidö Agreement is of no value. This can be seen precisely regarding the leisure card.

The Scouts are not here and cannot defend themselves, but as a former scout, I can invite them to a networking meeting next Wednesday here in the Riksdag, where we will raise exactly these questions – how the Scouts work in vulnerable areas. They are actually on the ball and have seen that they need to be present in the vulnerable areas, as the member pointed out. It is completely right to think that we need to spread the resources that civil society has to vulnerable areas.

The members also mentioned the mental health of children and young people in their speech. It is an incredibly important work that I look forward to us discussing more. This is incredibly important in school, as was mentioned. There, the government has initiatives for school social teams and special educators. There are and are being made initiatives for school. It is very much needed, especially to catch those who perhaps do not have the greatest need to come to child and adolescent psychiatry.

Mental illness can be prevented by offering special teaching groups and by having more adults in the room and special educators who can handle children and young people with special needs. This is also something that is in the Tidö Agreement. I wonder if the member thinks that this also sounds like a good initiative.

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Karin Rågsjö (V)

Madam Speaker! When it comes to the Tidö Agreement, which we sometimes refer to as the Palace Agreement, it is the racist undertones that make one dislike the entire document.

When it comes to the school and what we should do with it, Sveriges Lärare says that with the state grants that have expired, it will become more difficult to maintain even the level that existed during the preceding years. We are facing a crisis in the school, in preschool, and in healthcare. It will also become a crisis within child and adolescent psychiatry.

When it comes to resources, some here say that money is not so important, but money is important if one is to hire staff. Money is important if one is to hire an assistant for a boy or girl who needs an assistant in school. If one cannot do that, it becomes a great burden on the teachers who work there. It is also about public health.

School is the most important instrument we have in Sweden to ensure that children and young people are equipped for life and that they can graduate from primary school and upper secondary school with grades. The children who do not do that can be followed, and then one sees that it goes poorly for them. Therefore, extra investments that are long-term are needed. It is not possible with 5 billion here or 4 billion there, but it must be a solid carpet of means, money, and resources that remains for a long time so that children and young people can have the level in school that they need, where teachers can be teachers and educators and not just assistants, counselors, and everything at once. This cannot be managed as a teacher.

School is the most important thing, and in that regard, the Tidö Agreement has not delivered.

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Christofer Bergenblock (C)

Madam Speaker! I would like to begin by moving for approval of reservation 21 under point 13 on sexual and reproductive health.

In Sweden, we generally have good public health, and we have had it for a very long time. Life expectancy has increased over time, the general assessment of one's own health has generally been good and still is, smoking has decreased over a long period, and many are engaged in the association life in Sweden. Nevertheless, there are challenges even here, and I will focus on two of these challenges.

On one side of the scale, we have for many years been able to see how many young people have increasingly worsening mental health, and not least we can see this among many young girls. On the other side of the scale, we can see that many elderly people also do not receive the support and the help they need to maintain good health. Not least during the corona pandemic, this emerged with very great clarity.

Mr. Speaker! During the autumn and spring, several alarm reports have emerged regarding the situation at state youth homes and, above all, in the care of young girls. Many feel unsafe, violations occur, sexual abuse occurs, and an overuse of coercive methods occurs. This has drawn great attention, and it is an issue that is closely monitored by the Committee on Social Affairs.

The biggest problem, however, is that so many of our youths end up in Sis-homes at all. This is often linked to a long history of poor mental health where society has not been able to help the young person in time. Even worse is when the mental health issues lead to suicide. Suicide is consistently the most common cause of death in the age group 15-24 years.

Centerpartiet sees here a great need to coordinate the agencies that today work with the well-being of children and young people. It concerns maternal and child healthcare, preschool, school, school health services, social services, child and adolescent psychiatry, and youth clinics. But it also concerns association life and civil society. Therefore, we have submitted a long series of proposals in several different committees on how one can strengthen the health and mental well-being of young people. We also look forward to the upcoming national strategy in the area of mental health and suicide prevention. It is important, and it is urgent.

In addition to this, we see a need to strengthen the access to and availability of youth clinics because these play a very important role in strengthening young people's mental well-being and in guiding young people correctly when they have a need for help. Parts of Sweden consist of sparsely populated areas where it can be far to the nearest youth clinic. In other parts of Sweden, there may be geographical proximity, but instead, there are obstacles in the form of norms and social control. Therefore, the youth clinics need to be available in several different forms. This is, of course, about physical clinics, but it is also about mobile clinics and about digital clinics. Here, we from Centerpartiet want a holistic approach to be taken so that everyone has close access to a youth clinic.

Mr. Speaker! We are, for better or for worse, not young throughout our lives. And that leads me to the second part of my speech.

Centerpartiet has several times highlighted the need for a unified elderly healthcare program in order to promote the health of the elderly. In the same way as it is currently a given that we have child healthcare programs to give children a good start in life and prevent future health problems, it should be a given that the elderly also receive the same support.

What then is an elderly healthcare program? It actually concerns three things: conversation, vaccination, and screening. Already today, there are a number of regions working with targeted health conversations in order to prevent health problems in good time as people get older. Region Halland offers health conversations for 40-year-olds. Region Kronoberg offers it for 50-year-olds. And Region Skåne offers it for both 40- and 50-year-olds. These are good examples that we want to build upon. What we want to complement with from Centerpartiet is precisely health conversations from the age of 70 onwards. For many people, it becomes a major shift in life when they leave the working life behind and begin to build up new habits. Thus, it is also an important opportunity for a conversation where one can reflect on eating habits, physical activity, as well as tobacco and alcohol habits in order to prevent such things as can lead to poorer health and diseases. It is also a good opportunity to catch those who need support and help in other ways.

Another way to prevent ill health among the elderly is to develop a national vaccination program against the diseases that we know pose a major risk to the health of the elderly. This includes, for example, seasonal influenza, pneumococci, and shingles. In the same way that we work with children to create protection against dangerous diseases that they might otherwise contract during their lives, we should offer the elderly good protection against the diseases that risk becoming serious and often life-threatening when the body's own resistance has diminished.

Screening for various diseases is also something that must be offered to a greater extent even to those who are older. The risk of developing breast cancer does not cease when one turns 75, but the opportunity for mammography does. From Centerpartiet, we believe that screening programs are needed even for those who are older, for example for breast cancer.

Mr. Speaker! In conclusion, I want to say that the work for good public health must continue within many parts of society. Even though this debate is now taking place within the framework of the Social Affairs Committee's area, it is equally about culture, education, and the labor market. We need, above all, to become better at taking a collective approach to important issues. And public health is such an issue - from childhood to old age.

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Ulrika Westerlund (MP)

Mr. Speaker! One might think that Karin Rågsjö and I have synchronized our speeches. But that is not the case.

Miljöpartiet, like Vänsterpartiet, believes that Sweden needs a public health act, just as other countries in the Nordics have. We need a regulatory framework that more clearly than today clarifies what the responsibility for public health work looks like at local, regional, and state levels. The distribution of responsibility between municipalities and regions in public health issues needs to be clarified, and the connection to the environmental goals needs to be strengthened.

The clearer it is for politicians, civil servants, and residents, the more likely it is that the public health perspective and public health work will be highlighted more and achieve greater impact. The Commission for Equitable Health wrote in its final report about the need for such a clarification and proposed an investigation to review whether existing areas of responsibility are sufficient or whether a public health act can better contribute to the goal of good and equitable health. Miljöpartiet hopes that this can soon become a reality.

Generally, a broad equality-creating policy is needed to achieve the goal of closing the addressable health gaps within a generation. The differences in health between people depending on, for example, where in the country they live or what education they have must disappear. The Government should raise the requirements for all regions to conduct systematic preventive health work. All residents should be able to receive high-quality support, help, and advice to, for example, be able to prevent avoidable lifestyle diseases and be able to be screened for diseases that can be treated more easily if detected in time.

Mr. Speaker! There are many measures that can be taken to improve the health of different groups in the population or to prevent severe illness, and I would like to specifically mention some of them.

Miljöpartiet considers that the government should consider initiatives that ensure increased counseling and prescription of so-called PrEP, that is, treatments that can reduce the risk of HIV transmission, in all regions. It is particularly important that those who belong to different groups who have an increased risk of having the HIV virus transmitted, for example men who have sex with men and migrants from certain countries as well as their partners, receive improved access to this through targeted information. It is also important that the intentions of the Communicable Diseases Act are complied with and that the access to testing for HIV in the regions meets the actual needs.

Men's violence against women and other violence in close relationships is a major public health problem, and the work against this needs to be introduced as a new target area in the national public health policy.

Miljöpartiet considers that the government should task the Public Health Agency with reviewing the needs for vaccination programs for the elderly, which is also an issue that several here in this chamber have raised today. The government should consider whether vaccines and also screenings in line with the expert agencies' recommendations should be free of charge for elderly people over a certain age throughout the country. As it stands now, there is an imminent risk that people's economic situation will become decisive for which vaccines they have access to.

Mr. Speaker! Mental health and suicide prevention is another highly pressing area. In the government statement, the government has indicated that a commission of inquiry shall be appointed every time a person dies by suicide.

This is an issue that Miljöpartiet has pushed for a long time, and we truly welcome this. But I want to take the opportunity to point out that incident analyses also need to be carried out in cases of suicide attempts, not least because the person in question remains alive and can provide a better understanding of what could have been done to prevent the suicide attempt from being made. It will be an important contribution to the preventive work.

Miljöpartiet wants Sweden to be a country where there are good and effective measures for persons with mental illness, mental ill-health, and suicide risk – both direct measures and preventive ones. The national helpline that existed previously fulfilled an important complementary function, and many were shocked when it was shut down.

The organizations Suicide Zero, Funktionsrätt Sverige, and Nationell samverkan för psykisk hälsa have initiated a call to action and a petition to reinstate the national helpline. On February 21, more than 10,000 signatures were handed over to the minister.

Public Health

The Public Health Agency was already given a mandate in 2021 to analyze the need. A supplementary mandate has been reported, and the issue lies on the government's table. The need for the line is very great, and both delimitation issues and technical solutions have been investigated. Miljöpartiet hopes now that the national helpline will be reinstated.

Finally, Mr. Speaker, I want to highlight an appeal that was recently published in Aftonbladet. There were over 130 signatories, including doctors, other healthcare personnel, and researchers. The writers pointed out that the World Health Organization describes climate change as the greatest health threat facing humanity. They also argue that these issues are not being treated with the weight they demand, even though the Public Health Agency itself points out that climate change worsens the conditions for creating good public health in Sweden.

Public Health

The authors have three requests for the Public Health Agency: to communicate more clearly that the climate crisis is the greatest threat to public health, to point out the need for powerful preventive climate measures, and to differentiate between different warming scenarios, so that the public gains knowledge about the difference in health impact at different degrees of warming.

Miljöpartiet welcomes this and other contributions to the debate that in different ways highlight what different types of effects the climate crisis brings and will bring forward. We hope that more contributions of this kind will follow and that awareness of the climate crisis's health effects will increase.

I support all of the Green Party's reservations, but for the sake of time, I move for approval of only reservation 1 under point 1. The reservation concerns a public health law.

The deliberation was hereby concluded.

(The decision was to be taken on 19 April.)

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