, 2025-04-18 09:02:00
Is racism a problem in Finnish healthcare? Finland tends to portray an image of egalitarianism, but there are indications it could be falling short in terms of providing equal healthcare to immigrants and people of color, and even when it comes to the experiences of healthcare professionals in the workplace.
A report published last year by the Finnish Institute for Health and Welfare (THL), for example, found that 33% of immigrants surveyed in 2022 said they had not received enough doctors’ appointments to meet their needs, up from 25% in 2018 and higher than the rate among the general population (25%). Some groups fared worse than others: The proportion not receiving enough care was highest among people from the Middle East and North Africa (43%), followed by those from Russia and the Soviet Union (36%).
The survey also found that immigrants faced more discrimination of other kinds — for example, based on gender or income — in social and health services than the general population (9% vs 4%). But these statistics likely underestimate the rate of racial discrimination because Finnish population data do not include ethnicity. To address this, surveys use proxies such as native language or being foreign-born (defined as having both parents or the only known parent born abroad). But that overlooks the experience of Finns of mixed heritage, such as Finnish-born children of Somali or Arab immigrants. The statistics also don’t capture the experiences of ethnic minorities in Finland, such as Sámi or Roma people.
“That’s a challenge with our statistics because ethnicity is basically hidden,” Mona Eid, a development manager at THL, told Medscape Medical News. “There’s been a lot of discussion on how to address that — for example, by asking people to report their ethnicity voluntarily in surveys, an idea, which has to be considered carefully because of historical injustices and misuse. But for now, a lot of experiences of racism don’t show up in the statistics.”
The situation in healthcare reflects a deeper problem in Finland. Respondents from the country to the 2018 Being Black in the EU survey reported the highest (63%) prevalence of perceived racist harassment in the 5 years before the survey compared with the 12 other Western European countries included. The rate came down to 52% in the 2023 survey, dropping Finland to second place behind Germany (54%).
“We talk about how Finland is egalitarian and has the happiest people in the world. But then, at the same time, we have people here who experience discrimination on a daily basis in different fields of life. And somehow these topics aren’t in the same discussion,” said Eid. “The myth of our exceptionality with regard to equality and equity hinders our self-reflection and self-perception when racism and discrimination are discussed.”
Standard of Care
Racism and discrimination can directly affect patient care. “In my project, I spoke with a family of asylum seekers from a region at war,” said Lubica Vysna, PhD, who works at Moniheli, a Finnish network of multicultural associations. “One family member had a lot of mental health issues, and they were not getting any help. The healthcare professionals refused to speak with them in English, so they spoke through an interpreter, but somehow the meaning was lost, and their needs weren’t sufficiently assessed. That person ended up without the help they needed for several months,” Vysna told Medscape Medical News.
Misdiagnosis or potentially dangerous incorrect treatments can result from problems in interpretation — or, worse yet, the lack of it. Hibo Abdulkarim, MBBS, a doctor based in Helsinki, shared the story of a patient who visited the emergency room three times in late 2020 with disorientation and odd behavior that was escalating. On his third visit, he was diagnosed with suspected psychosis and sent for evaluation to be sectioned. While routine blood tests and a CT had been done, none of the doctors who met him used an interpreter, which meant the diagnosis was missing crucial information, such as the patient’s history or assessing his speech and overall orientation. “When he was finally met by a doctor who spoke his own language, that doctor immediately recognized that the case was a severe neurological issue and not psychosis. The patient had worked in a job that required fluent language skills, a fact that could be found in his medical record and should have raised alarms when he couldn’t communicate in Finnish at all,” Abdulkarim told Medscape Medical News.
Abdulkarim added that this case offers an example of the problem of structural racism in Finland. “The issue isn’t only some racist people but a system that allows a certain level of blindness to racism, as well as treating minority patients as second-class citizens,” she said.
Another case was reported by Finland’s national broadcaster in a 2023 article about racism in healthcare. A doctor in the east of Finland consulted a surgeon about a patient with a possible fracture. Because the patient had a Somali background, the surgeon said they did not need strong pain medication or further imaging — but the doctor ordered further imaging anyway and found that the patient did in fact need surgery.
“In Finland, there’s a widely used term, cultural pain, which is often applied to patients reporting pain. It’s the idea that people from certain cultures exaggerate pain,” Ibrahim Ahmed, MD, a Somali-Finnish doctor who works in Helsinki, told Medscape Medical News. “It creates a huge barrier to seeking help and getting sufficient pain management,” he added, explaining that once a patient has had their pain dismissed as cultural, it creates mistrust. “What if someone has depression or something else that’s difficult to talk about? They would think twice about telling the doctor about it.”
Vysna echoed this sentiment. “In our interviews with immigrants, I’ve quite often heard a lack of trust toward health and social services staff. They’re afraid to tell their whole story because they feel they might get judged or face severe consequences, such as being separated from their children.”
Patient Antagonism
The lack of trust goes in both directions. Ahmed shared the story of a patient who was brought in the middle of the night with chest pain and difficulty breathing — serious symptoms that call for immediate admission. Ahmed started with standard questions, and the patient immediately requested a different doctor. “He said he would prefer if the doctor were native-looking,” Ahmed said. “Those situations are very difficult to deal with because the patient doesn’t want you because of your race, but at the same time, you have to remain professional and find a way to treat the patient.”
Fortunately, another doctor was present, so Ahmed handed off the case to his colleague. “But in this case, my colleague had less experience than me, so he ended up asking me what he should do,” Ahmed said. “I took care of the case but indirectly.”
Ahmed also described overhearing conversations involving patients requesting a native doctor when they hear that the one they have been assigned has an Arabic or Somali name. “Then I hear the nurse explaining my qualifications or saying that I speak Finnish well or telling the patient that I am Finnish to make me acceptable to them. It makes you feel small,” he said.
“I would want us to have zero tolerance for that. If you start justifying the doctor, that means accepting the situation, and it’s absurd. Patients shouldn’t choose what kind of doctor they want,” he said.
A Burden on Healthcare
The accumulation of outright racism, microaggressions, and systemic racism takes its toll. Ahmed only remembers a couple of instances where someone has stood up for him at work. “In general, we get zero support for this. In the case of something like a sudden death or other shocking events at the hospital, we get a debriefing. But there’s nothing for this,” he said. Ahmed wanted to specialize as a general practitioner, but because the higher patient volume in clinical settings means more racist incidents, he is now specializing in another field instead.
Finland has an aging population and a shortage of healthcare professionals. But workplace racism and challenges faced by foreign professionals in finding employment hinder addressing this problem. “There are trained nurses and doctors in Finland, but due to their foreign background, their potential is underutilized,” Katri-Leena Mustonen, MHC, a senior planning officer at THL, told Medscape Medical News. “We’re working to train professionals not only in how to interact with patients and clients but also in how to collaborate with colleagues from foreign backgrounds.”
In fact, Finland is losing healthcare professionals that it desperately needs. “I know dozens of specialists and nurses who got their qualifications in Finland but have experienced racism, and so they’ve left the country,” said Ahmed. “People are making choices. The experiences accumulate and accumulate, and at a certain point, they decide they can do their job in better conditions elsewhere.”
Hope for Improvement
Ahmed and Abdulkarim, who are married, are working to counter racism in Finnish healthcare and to spread anti-racist practices and attitudes. They have lectured about racism at universities in Helsinki, and they run an Instagram account where they raise awareness about structural racism in healthcare and how it affects people.
THL and other Finnish institutions are also working to tackle the problem. “We developed an online course on anti-racism for professionals, and it’s been received well,” said Eid. “It’s one of our most popular pages, and it’s been incorporated into staff training in universities and other institutions.”
Eid said Finland’s well-being service counties — the administrative units responsible for the country’s health, social, and emergency services — recognize that discrimination affects their services and have shown a willingness to learn. But they are also facing budget cuts, making it harder for them to respond and adapt.
“There have been changes, but they’re quite slow, and many of them are not immediately perceptible to the people who receive the services,” said Eid. In addition to anti-racism trainings, there is also a growing understanding of the need to provide appropriate communication materials for different groups or to use interpreters effectively for more inclusive healthcare, for example. “I am hopeful, but of course there’s still a lot to be done,” said Eid.
Eid, Vysna, and Mustonen reported no relevant financial relationships. Abdulkarim and Ahmed reported occasionally receiving payments for lectures they give on racism.