Integration and Public Health: Swedish Experiences of Measures for Better Integration and Public Health

By Kuusela, Kirsti | Forum on Public Policy: A Journal of the Oxford Round Table, Spring 2008 | Go to article overview

Integration and Public Health: Swedish Experiences of Measures for Better Integration and Public Health


Kuusela, Kirsti, Forum on Public Policy: A Journal of the Oxford Round Table


Introduction

Sweden enjoys a standard of living, life expectancy and health status that is among the highest in the world. In the year 2007 life expectancy was 83 years for women and 79 years for men and Sweden's health system is one of the nation's most vital social institutions. Sweden is an "immigrant" country. Together with Germany, the most immigrant dense country in Europe, Sweden is at the same level as the United States when it comes to the number of immigrants in the country. The proportion is also higher compared to large European countries such as Great Britain and France, and far higher than Denmark, Norway and Finland (OECD 2005). Of Sweden's overall population, 12.2 per cent were born in another country (SCB 2005) and the number of foreign-born people in Sweden is estimated to increase in the future.

Sweden is internationally well known for a high level of health, accepting many refugees and being good at integrating them. In reality, the situation is however far less positive. Inequity in public health is a significant problem in Swedish society. Health levels among people born abroad are much lower than that of native Swedes. Immigrants are to a larger extent unemployed, and an extensive number of them are overall poorly integrated into society. Sweden is also one of few countries in the EU, which does not provide health care for paperless migrants.

Immigrants and refugees are exposed to an increased risk of suffering mental and physical illhealth in Sweden in relation to the majority population. There is a significant difference in ill1 health between those born in Sweden and foreign-born. Moreover, there is a difference between men and women, as foreign-born women have the highest ill-health count (Swedish index). The illness prevalence is often worse in "segregated" vulnerable residential areas (SOU 2000:3). As a consequence, the use of health care is expressly higher among immigrants compared to the rest of the population. Sickness is particularly prevalent during the immigrants' first five years in Sweden.

Sweden provides an introduction programme for refugees. The programme incorporates different measures during the refugee's first years in the new country, and takes place in the approximately 200 municipalities receiving refugees. Many refugees who participate in introduction programmes already have a low health status and health promoting efforts are rarely carried out during the introduction period. Indeed, more than 20 per cent of the refugees taking part in introduction programmes are reported sick (Integrationsverket 2006).

Ill-health can be an important obstacle for integration of immigrants and refugees in society, and is a risk factor for exclusion. Low socio-economic status and poverty can also affect the children's health. The health of immigrants is affected by factors on the individual level as well as factors on group level such as societal factors in both Sweden and their home countries. Health is influenced by the structural discrimination present in Swedish society and by exposure of traumas and other shortcomings in the home countries before arrival in Sweden as well (Integrationsverket 2006).

Strain in families and loss of roles, economical and cultural challenges can cause burdens in immigrant identities, when the image of who you were before living in Sweden does not coincide with the image of who you are today (Darvishpour 2003). Experience of war and torture as well as linguistic problems and social isolation are risk factors for suicide among immigrant children (Wasserman and Narboni 2002). However, there are few mental health programmes focusing on children and young persons.

Immigrants live segregated in Sweden. Most of them live in economically vulnerable residential areas in metropolitan Stockholm, Malmo and Goteborg. Many immigrants live in public sector rented flats built during the so-called "Million Dwelling Program" 1965 -1975, when one million flats were built in Sweden. …

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