Opinion: The Swedish discrimination that dares not speak its name

Opinion: The Swedish discrimination that dares not speak its name
An article by Swedish newspaper Dagens Nyheter exposed how medical staff promised patients they could get 'light-skinned' doctors to treat them. Photo: Cleis Nordfjell/SvD/TT
Until Sweden addresses discrimination honestly, integration debates will remain superficial, writes journalism professor Christian Christensen, after the Dagens Nyheter newspaper exposed how medical staff allow patients to pick only 'ethnic Swedish' doctors.

Few things damage the national self-image, while at the same time generating impassioned defenses of the national good, like accusations of structural discrimination.

While racism, sexism and xenophobia at the individual level are often explained away as personal failures or “exceptions that prove the rule”, evidence of clear and sustained discrimination within public and private social institutions speak to a broader and deeper acceptance of bigotry. It cannot be waived away as some random bad apples spoiling the national barrel.

Over the past few weeks, the issue of structural discrimination in Sweden has been a topic of heated debate.

Two weeks ago, police officer Nadim Ghazale spoke at length on Swedish Radio about his professional experiences. In his talk, Ghazale recounted being asked by colleagues if, because of his immigrant background, he was a “quota hire”. In other words, he was hired simply to increase diversity. Ghazale noted that being an immigrant or a woman in the Swedish police meant having to work even harder to prove yourself to white, male colleagues. And, he continued, “if you are white, Swedish, straight and male – then you are already part of the quota. Congratulations, you got the simplest route.”

The proposal that white, straight, male Swedes have an easier time professionally was met with backlash. Conservative pundits and politicians, as well as large numbers of social media users, denied the existence of structural discrimination in Sweden. Every country has racists, they argued, but the suggestion that Sweden was, and is, anything other than a largely colour-blind meritocracy is simply incorrect. One politician from the Moderate Party even tweeted that it was “white, Swedish men” who had built the nation with their “blood and sweat”. He later deleted the tweet.

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Only a few days after the national debate about Ghazale’s comments, Sweden’s Dagens Nyheter newspaper published an explosive story detailing widespread structural discrimination at public and private medical and dental offices throughout Sweden. After multiple cases of patients refusing to be treated by non-white staff had been exposed, the newspaper decided to do an investigation into how such requests were handled at the national level. For the piece, journalists called local medical offices posing as patients who had just moved into the area.

In the call, the “patients” said that they wanted to have “ethnic Swedish” doctors and dentists treating them. Disturbingly, in over half of the cases where there was diversity in the available staff, medical and dental offices went along with these clearly racist requests, promising callers that they could get “ethnic Swedish” or “light-skinned” professionals to treat them, or giving them advice on how to avoid staff who did not fit their demands.

As disturbing as they are, Ghazale’s personal experiences in the police and the Dagens Nyheter story are nothing new. Back in 2018, Swedish Television did a story about the racist treatment of staff at Swedish pharmacies, and how many of the managers either refused to condemn, or openly enabled, racist comments and requests from customers. Despite these repeated stories from staff members working across multiple industries, the denial at the national level about the extent to which structural discrimination exists is marked.

Most importantly, of course, these stories point to a broad acceptance of racism and discrimination that must be confronted openly. But, these stories also speak to other key issues so often discussed in Swedish politics and society: namely “quotas” and “integration”.

One of the most common criticisms levelled against efforts to bring more diversity into Swedish organisations and businesses via hiring practices is that such efforts go against the ideal of a society based solely on “merit.” That argument, however, is based on the myth that candidates with minority backgrounds are somehow less qualified than non-minority candidates. It is also based on the myth that the professional playing fields are equal for all employees, regardless of skin colour or ethnic background.

As the Dagens Nyheter story illustrated, staff members at medical offices were literally giving potential patients advice on how to avoid non-white doctors and dentists. Under these circumstances, it is naïve to think that the professional playing field is not tilted dramatically in favour of the white doctors and dentists in those offices. And, it is equally naïve to think that such practices do not exist in many other areas of Swedish professional life.

Over and over we hear the phrase “failed integration” in relation to immigrant communities in Sweden. In most cases, however, this failure is explained as the result of poor policy, poor effort on the part of immigrants or a combination of both. Again, the stories presented in this article point to a third, under-discussed factor impacting integration: discrimination. Even when immigrants to Sweden (or their children) are well-educated and eager to enter the workplace, they face discrimination solely on the basis of their name or appearance. This reinforces the idea that, no matter what these residents and citizens do, they will never be accepted as full, equal members of Swedish society.

As Sweden approaches elections in 2022, the issues of discrimination and integration will take more and more space in public debates. Integration, most often presented as one-way, is actually a two-way street. Until the issue of structural discrimination is addressed openly and honestly, however, such debates will remain at the superficial and self-serving levels.

Christian Christensen is a professor of journalism at Stockholm University in Sweden.


Member comments

  1. True, It’s hard to get into medical schools in Sweden. It is also not that easy to become a medical professional in Sweden if have a medical degree from another country. It is a long process starting with learning Swedish, clearing medical exams, working under the supervision of a senior doctor, and only then you would eventually become an independent professional who would be allowed to, for example, prescribe medicines. So basically, the immigrant doctors have to study medicine twice – first in their home country and then here in Sweden. If some people use race as a proxy for competence etc., then they clearly don’t understand what immigrant doctors have to go through to become approved professionals in Sweden. But I don’t think this is the issue in all the cases in the DN story. The author has rightly pointed out that integration is not a one-way street. All the onus is not on immigrants. It seems as if people are not even willing to accept that immigrants face discrimination in Sweden. Such attitudes are one of the reasons that the integration debate will just remain a one-sided debate without any real progress.

  2. It’s really hard to get into medical and dental school in Sweden, and in North America.
    But not in many foreign lands where medical school spots go to those with connections, political or otherwise, and those who pay. So, given this, it’s possible to wonder if people are requesting local doctors and dentists based on their impressions of the underlying training and qualifications – and they are using skin tone as a proxy or marker. If so, then it is possible such requests aren’t so much about race, but are perhaps more about underlying assumptions of skill and training.

    Thoughts on this possibility?

    1. Hi Jack,

      I agree with you, racism is not necessary an issue here. Being an immigrant myself, I am tired to hear that Swedes are racists during all these years I have lived in Sweden. Swedes have a lot of cultural and other issues that I really do not like but to call them racists is a way too much. It has become popular to blame other people when you fail than to seek what can be wrong in what you do.

      Regarding some patients’ requests to have ethnic Swedish doctors – it might be many reasons to it not necessary connected to racism. One of them is the language. My first years in Sweden were very hard like for any immigrant. I remember when I worked as personlig assistent for an old Swedish man with physical disabilities and severe health problems. My Swedish was not as fluent as it is now, he talked quietly and not that clear that I could understand everything. Very often I had to ask two or three times to repeat what he was telling to me. Myself I was afraid that if something happened to him I would not even understand what he needs and how to deal with that. Would it be right to call him racist if he asked for an ethnic Swede to take care of him? I don’t think so. It is important to understand that he also wants to feel secure with people around him and to be sure that these people understand what he needs.

      Let’s be fair, many immigrant doctors do not speak as good Swedish as it might be necessary. A couple of months ago I visited a doctor whose Swedish was ok for basic conversation but all the time I felt that she didn’t get what I was asking her as her answers were not really about my questions but something different. Moreover, sometimes I had to ask her to repeat because of her heavy accent. That moment I just wanted to go to a Swedish doctor. Strange enough for me as I even do not trust Swedish doctors because of really bad experiences in the past. I think that the Swedish health care system is very poor in competence and of low quality. Only people with minor health problems or problems that represent a “standard” case for the Swedish system can appreciate health care in Sweden. All my serious problems were just ignored here, and I had to go abroad to seek reliable medical help. I will not even mention ridiculously long queues and no possibility to choose a doctor.

      When I saw who wrote this article above… well… no wonder why we have one-sided journalism in Sweden.

    2. There are many more objective proxies for competence (grades, certificates, university ranking, years of experience…); if a patient cannot ask for a doctor using any of those proxies, how are they allowed to use a proxy solely based on their presumptions on what is happening in foreign lands?
      In Iran for example, it is actually quite difficult to get into medical schools, there’s a central exam for the universities and only ~2% of the (~500,000) participants manage to get into a medical program.

      1. Hi,

        I agree that there are other and perhaps more effective proxies, as you suggest.

        But all I’m suggesting – and I know you guys are having troubles with this – is that Swedes might not be raging racists. And that they might have other, and perhaps even reasonable, intentions when requesting a “local doctors” over foreign doctors.

        And with regards to med school admissions, you’ve named Iran as a country that where med school admissions are difficult. This might be true, and probably is true. But I could respond by naming dozens of nations where medical school admissions is a joke, and acceptance to med school is little more than recognition that you are a member of the middle class or upper classes and that you either know someone, or that your parents can pay the tuition fees.

        In fact, I know numerous Canadians and Americans who were rejected from med school Canada and the United States (they weren’t even remotely close to securing a spot), and who then attended med school abroad. Their parents could afford to pay the high international tuition fees.
        I don’t know about you – but I’m apprehensive about letting Jeff Spicolli (lead character in fast times at Ridgemont High) perform surgery. But it happens all the time.

        And with regards to proxies – I agree that the university attended is a good indicator.
        When in my home nation, for example, I will often casually ask my doctors what med school they attended. I want to know if it was a top med school, or a low-tier. But my decisions after that depend on the procedures required. If they are treating me for something minor, a small skin rash for example, I wouldn’t worry much about the answer. But if I have a serious issue, and I required something such as eye surgery or perhaps abdominal surgery, I’d like a doctor who attended a top med school. There is a reason why people make a big fuss about the Mayo clinic, Harvard Medical school, Columbia medical in New York etc. In Canada, I would look for graduates of the University of Toronto, Queens University, and of course McGill University in Montreal – top medical schools with high admission standards vs. some other universities.

        But, I should note, it is very hard for your average and every day citizen to differentiate between one foreign nation and another (iran vs. the Dominican Republic for example). And they certainly wouldn’t know the reputations of the universities in all the different countries, and the admissions policies. And with this, I again suggest that it is possible that many Swedes may sometimes use race as a proxy for something else – qualifications and skill – and that perhaps Swedes are not the big bad racists that the article and you seem to be suggesting. In fact, when taken within this context, their requests might be at least somewhat reasonable.

    3. “If so, then it is possible such requests aren’t so much about race, but are perhaps more about underlying assumptions of skill and training”.

      And so the reinforcement of common tropes regarding race continues. Even if true, your comment ignores the reality that there exists a Swedish Medical Association which regulates and issues licenses for medical practitioners from other countries who wish to practice in Sweden. Such an organisation would also probably take care of reports of malpractice and strike off any medical professional who did not meet standards of practice and ethics which were required for the country.

      In my home country, UK, doctors and nursing staff come from all corners of the world and in the main are valued enormously for the contribution they make to caring for patients. We are all the more better for it and many of our highest regarded surgeons are not of “White British” ethnicity. Swedish people may need time to adapt and come round but to make excuses like they have judged professionals from other countries to be less capable is a poor show that only reinforces racism.

      Those are my thoughts.

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