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Johan Axel Höjer (August 12, 1890 in Visby - 22 April 1974 in Vällingby) was a Swedish physician and the Director General. He was the son of Professor Nils Höjer and Emmy Höjer. He began to study medicine at the Karolinska Institute in 1908 and became a Licentiate of Medicine in 1916. He went to Paris in 1919, where he became acquainted with the nurse Signe Dahl and they later married in 1920. In addition to his work and social commitment, Hojer in the early 1920s researched on vitamin C and its role in connective tissue cell maturation. He submitted his thesis in Stockholm in 1924 for PhD degree as Studies in scurvy, and then became the Associate Professor of Hygiene in the Physiological Institute at Lund University. He was appointed in 1930 as the city physician of Malmö in 1935 and then became Director General of the Medical Board, a post he left in 1952. During his time in the Medical Board, he made several reforms in terms of preventive care, including family planning, maternal assistance and care of infants as well as the dental services. Hojer was appointed in the UN's expert commission for economic affairs and in its housing commission. He was sent as a special officer for improving medical education in India on the request of Travancore-Cochin state. Hojer was appointed as the Principal of Medical College, Thiruvananthapuram in Kerala a position he served till 1954. After retirement, he worked on international issues, including the effects of the Vietnam War.
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The Hojer Investigation
Axel J. Hojer led Board of Health study in 1948 on the health care reorganization. The study suggested a focus on preventive care and strengthening of provincial medical offices. The proposal was motivated in particular by the fact that the proportion of primary care physicians had declined because of the sharp increase in hospital doctors. The study polemicized Medical Board and Medical Association's view with regard to primary care. Inquiry advocated a polyclinic form, where the reception for outpatient health care would be free and operated by the community. The Höjer study was the first and comprehensive attempt to analyze the problems in outpatient care. It suggested establishment of centers of various kinds. The larger centers would include both specialists and general practitioners and was located in hospitals. The minor ones would have two or more GPs and located in provincial stations. Hojer encountered considerable resistance from the medical professionals. He was exposed to virulent press campaign from colleagues calling for his resignation. As a result of complaints the commission's proposals could not be realized.
Controversies
Hojer the combination of pacifism, socialism, anti clericalism, anti-Nazism and temperance led to political persecution in Sydsvenska Dagbladet and Aftonbladet (Swedish newspapers). He was dismissed from a job as the teacher in the South Sweden Nursing School on the ground that he held a lecture on sexual health. As city physician in Malmö, he tried to address air pollution from Scanian Cement factory at Limhamn in Malmö. Company director threatened Malmö municipality to shift to another location if they followed the town doctor's recommendations.
Concerning the Jewish refugees, he met stiff resistance from the management of Swedish medical establishment. When an ophthalmologist named Daniels, after the German occupation of Danzig had to leave his home and searched for a living in Sweden, the medical professionals in the country sued to ban it citing various reasons. An affront campaign with a hint of anti-Semitism was taken up by the medical establishments. When the Medical Board in 1939 planned to invite 12 Jewish specialty physicians to Sweden, the doctors associations protested suggesting it would lead to unemployment. Bollhusmotet, a protest arranged by the student body at Uppsala University also voiced against accepting Jewish refugees. The royal family intervened, and Hojer was called to the ruler, Crown Prince Gustaf Adolf, with the proposal that Sweden should accept only a small number of Jewish doctors who ran away from Hitler's persecution. "He asked me pleadingly to refrain from proposals and actions, which could bring the unity of the Swedish people in danger. I answered respectfully but firmly - in the background listening Marshal of the Court - that I obviously did not want to increase the problems of government, but I found that the request is primarily aimed to appease the anti-Semitic circles. It would be ignominious if Sweden were to disappoint people in danger. The Crown Prince reiterated his warning. I explained I have in mind the future, and would do it if my conscience asks to do so. We parted without further discussion ". Hojer also asked to increase the number of doctors in the country, by importing Austrian physician in 1950, which again was opposed by the Medical Association.