Structural racism within the healthcare system in Sweden
Racism is something that both today and historically affects people's existence and what opportunities they have in life. There are many levels in a society where racism is visible and is strongly connected to norms about whiteness. It is less debated about how racism takes shape when it comes to healthcare on equal terms.
Sweden has a long history of racism and was the first country to establish a racial biology institution, which opened in 1922. Even today racism is visible in society, for example, through extreme groups that in various ways express oppression against people of colour. Many believe that Sweden is an equal country, where everyone is treated the same regardless of ethnicity. However, this is something that is not always true. The history of racism in Sweden permeates society at various levels even today, including in the healthcare system.
|photo: Elvert Barnes|
In “Racism in healthcare and its impact on patients & caregivers - A Result of the White System” a study conducted by Lovisa Thedéen and Timea Carlsson, they state that American studies have found that black people generally have poorer health than white people. Racialized people have for example a greater risk of mental illness and death than white people. This is also something that is stated in The State Public Inquiry 2005:56 called “The blue-yellow glass house: structural discrimination in Sweden". The inquiry refers to sociologist Beth Maina Ahlberg that has examined refugees' ability to healthcare as well as their experiences of discrimination, both healthcare workers and refugees were interviewed in the study. Ahlberg emphasizes that ethnic discrimination against patients must be seen in the context in which immigrants are involved and which consists of several factors such as housing segregation, unemployment, racist violence, and structural racism.
Ahlberg was struck by the caregivers' perception of culture - immigrant patients were perceived as less "difficult" the more they behaved as "Swedes". Ahlberg points out that we need to ascertain the connections between how different aspects of power - for example, gender, class, race, ethnicity - are socially manifested and constitute different forms of inequality, exclusion, and discrimination. As a result, this can lead to illness and death that could have been affected by the patient care provider relationship, as well as by the unfair distribution of healthcare resources that have sprung from generations of systematic racism.
A controversial case that took place in 2017, shows how racism can look like in reality. A man in his thirties, working as a doctor, originating from Sudan got hurt in a football game, Jan Spangers reports in the article “Stroke was called "cultural fainting”. The day after he called the ambulance but when the nurses were on sight, they had trouble assessing the case. Eitherway, he was taken to the emergency room but there he had to wait for 90 minutes before he got any care by the doctors because of the assessment the nurses did. It was discovered that in a journal, the ambulance nurse wrote that the man was playing unconscious and that it was about “cultural fainting”. Although, there are different points of view if this affected the care the man was given. Because of the wait the brain bleed that the man had was discovered very late and he was cared for a long time in the hospital but later died due to pneumonia.
In the article “Stroke was called "cultural fainting" - now the verdict falls” by Leni Weilenmann you can read about the trial. The district court concluded that the man was discriminated against because his state of health was partly assessed on the basis of ethnic grounds. Although, it was not the nurse that was convicted but the region responsible as they violated the prohibition of discrimination in the Discrimination Act. One of the judges stated that the journal note was provided as proof and was a big part of the trial.
What is it that makes racism continue to affect the quality of healthcare for people of colour?
One thing that contributes to the perpetuation of racism is that racism exists within society's established institutional policies. It is so ingrained that people are not even aware that there is such a thing as racism or that they are racist. In order to be able to inform individuals of the problem, we need to get rid of structural racism. The goal will be that people will realize that they are racist. But on the other hand, society may never be able to change the individuals who have a racist view of people.
The structural discrimination that takes place is mostly based on the policies and laws that Sweden has, which means that a policy change is needed to be able to do something about the problem. Another factor is the hierarchy that exists, class and racism are something that goes hand in hand. For example, racism can be about a black person not gaining access to the labour market or that black people are not represented in the media.
Another problem that we are facing is that the norms about whiteness are constantly maintained. Through norms, we learn what is right and wrong, which can be considered positive to some extent. But on the other hand, norms contribute to us looking at people differently. These norms are visible, for example, in society through the media and advertising. Belonging to the norm also means that you become privileged and get invisible aids that give whites access to all rooms.
All people are affected and influenced by society's racist environment, which also applies to healthcare staff. The care staff must meet the patient's needs. This can mean that caregivers and patient relationships are also coloured by racist structures which in turn affect the patient's health. Understanding and seeing the relationship between health and ethnicity is an important part of understanding the inequalities that exist both in society and in healthcare.
It is also about how white swedes view immigrants' culture, which is at the same time linked to norms. Some have an idea that Swedish culture is the right one and to behave as the norms say is to be right. When immigrants do not behave according to Swedish norms and cultures, they are found to be difficult or unpleasant. Instead of problematizing the system, they blame the immigrants. In order to stop racism within the healthcare system, awareness is needed to be raised as well as listen to the people who are victims of racism.
Article by Agnes Hörlin
Barnes, E. (2020 9 July). Racism is a public health crisis. Wikimedia Commons. Retrieved April 6, 2022, from https://commons.wikimedia.org/wiki/File:RACISM_IS_A_PUBLIC_HEALTH_CRISIS_IMG_5004a_(50097284701).jpg
SOU 2005:56. Det blågula glashuset: strukturell diskriminering i Sverige : betänkande. [The State Public Inquiry 2005:56. The blue-yellow glass house - structural discrimination in Sweden] Stockholm: Fritzes offentliga publikationer.
Sprangers, J. (2021, May 26). Stroke kallades ”kulturell svimning” – nu faller domen. [Stroke was called "cultural fainting" - now the verdict falls] SVT Nyheter. https://www.svt.se/nyheter/lokalt/vast/idag-faller-domen-om-en-stroke-som-kallades-kulturell-svimning
Thedéen, L., & Carlsson, T. (2016) RASISM INOM SJUKVÅRDEN OCH DESS PÅVERKAN PÅ PATIENTER & VÅRDGIVARE - Ett Resultat av det Vita Systemet. [RACISM IN HEALTHCARE AND ITS IMPACT ON PATIENTS & CARERS - A Result Of The White System] [Bachelor's thesis, Göteborgs University.]
Weilenmann, L. (2021, May 26). Fällande dom i fallet med ”kulturell svimning”. [Conviction in the case of "cultural fainting"] Vårdfokus. https://www.vardfokus.se/nyheter/regionen-falls-for-diskriminering-i-fallet-med-kulturell-svimning/