Foreign Policy Magazine: The hidden flaw in Sweden’s anti-lockdown policy

The government expects citizens to freely follow its advice—but not all ethnic groups have equal access to expertise

STOCKHOLM—Sweden quickly became an object of the world’s attention for its decision to forgo a government-mandated lockdown to combat the coronavirus pandemic. Instead the country chose to lean on its high-trust culture and tradition of citizens independently following authorities’ recommendations.

But there was one major overlooked problem with that approach—one that’s increasingly reflected in the country’s medical data: Sweden’s distinctive national culture and traditions, and the government’s efforts to amplify and support them, aren’t equally accessible to its increasingly diverse residents. The most segregated segments of the population are not as tuned in to the mainstream culture or to authorities’ messaging around the pandemic.

Sweden’s Public Health Agency recently conducted a survey, the results of which were published on April 14. It showed that a disproportionate number of immigrants, in particular from Somalia, Iraq, and Syria, were among the COVID-19 cases registered at Swedish hospitals. For instance, while Somali Swedes make up just over half a percent of the national population, so far they make up nearly 5 percent of hospitals’ confirmed cases.

The agency’s figures came hot on the heels of a survey by Stockholm health authorities, which showed that some of the capital’s immigrant-dense suburbs were among the hardest hit by the virus. The Rinkeby-Kista district in the north was the worst affected, with 238 confirmed cases as of April 6. That is the equivalent of 47 cases per 10,000 residents, which is more than three times higher than the regional average of 13 cases per 10,000 residents.

“In the future, we’ll need proper research to figure out how this situation came about,” said Per Brinkemo, who worked as a journalist for 20 years before becoming involved with integration issues, working with a Somali community organization in the Rosengard suburb of Malmo, Sweden’s third-largest city. He believes there is a general unwillingness among Swedish authorities to consider how cultural differences impact people’s behaviors.

After writing the book Between Clan and State: Somalis in Sweden in 2014, Brinkemo toured the country, holding seminars for bureaucrats and local politicians about its basic thesis, namely that Somalis’ and others’ integration has often been marked by a clash between “the extremely collectivist structures of the native culture and the hyperindividualism of Sweden.” But there is a strong aversion in Sweden for the government or authorities to differentiate between people of different ethnic backgrounds, Brinkemo said. “It’s a well-intentioned attitude but can prove dangerous.”

Sweden’s Civil Contingencies Agency, which is responsible for public safety and emergency management, has acknowledged that there were delays in translating information about the virus to other languages. Over the past few weeks, the agency has rolled out a campaign to get information out to immigrant communities. “Better late than never,” Brinkemo said, while also insisting that information needs to be not just directly translated but also conveyed in different ways to different groups.

Brinkemo described the challenges involved in trying to inform immigrants in Malmo about the Swedish welfare state. When he arranged public seminars at a community center, hardly anyone attended, despite written advertisements—until he and his colleagues personally called people to invite them, after which the seminars were full. “I was baffled, but my Somali colleagues weren’t surprised. They explained that they come from a society with a strong oral tradition, that they have little experience of interacting with public agencies in their home country, and tend to trust information that comes directly from a known source,” he said. “By contrast, here in Sweden, we are accustomed to written communication. We generally trust that official information is correct, and we’re used to interpreting authorities’ instructions and know how to act on it.”

Brinkemo believes that when the government and expert authorities convey information and guidance around the COVID-19 pandemic, it will likely not filter through to a large share of the immigrant population. Partly because many do not follow Swedish media and partly because the language used is abstract and presumes a particular outcome with regards to how people will act on it.

Indeed, the subtleties of bureaucratese are not always self-evident to native-born Swedes, either. When the state epidemiologist Anders Tegnell was asked at a press conference to clarify what a recommendation from the Public Health Agency, which is central to formulating Sweden’s strategy, entailed, he replied: “What we are talking about here is the Swedish culture, how Swedes interpret recommendations from the authorities. I think most people see it [a recommendation] as a very clear advice on how to do this in the best possible manner. … By contrast, if you use the Swedish word for ‘shall,’ that means there is a legal obligation to do something, and that’s why we instead use the word ‘recommended’ quite a lot.”

Tegnell agrees that one needs to address different groups in different ways. “Any country with some form of public health strategy in place knows that and when it comes to immigrant communities, we have established good communication with them, for instance in relation to the national vaccine program,” Tegnell said, adding that it is too early to draw any conclusions as to why some foreign-born Swedes run a higher risk of contracting COVID-19.

“There are many parameters at play,” he said. But he balks at the idea that the Public Health Agency’s reliance on a set of norms that have taken centuries to cement is in any way a factor in explaining why Swedish citizens born in Africa, the Middle East, and elsewhere are now overrepresented in the statistics of COVID-19 cases. “I think that’s a conclusion you definitively cannot draw yet,” Tegnell said.

Many in Sweden’s immigrant-dense areas agree that there is a complex set of factors involved, with cultural differences being just one aspect. In the northern Stockholm suburb of Tensta, Somali-born Ahmed Abdirahman was among the first to note that the coronavirus was spreading in his community. “Many foreign-born Swedes live in segregated suburbs where up to 80 percent of residents have immigrant backgrounds,” Abdirahman said. “For instance, in Stockholm more than half of Somalis live in just a single district, so it’s not surprising that once the virus started spreading in that area, Somalis quickly became overrepresented in the statistics.” Abdirahman added: “There are also relatively high levels of ill health and household crowding in these suburbs, and multigenerational households are quite common due to low-income levels. In addition, the potential for exposure to the virus is high since many hold so-called low-skilled jobs, for instance as taxi drivers.”

Last week, Abdirahman, who is well-known in political circles for organizing a high-profile annual political festival that takes place in a Stockholm suburb, met with Sweden’s deputy prime minister, Isabella Lovin. She said she regretted the fact that sufficient measures were not taken in time and mentioned some new initiatives, such as the city stepping in to offer accommodation for elderly people to help them self-isolate.

But for the writer and activist Nuri Kino, who has been focused on the pandemic’s impact on immigrants and in particular on his own community of Assyrians/Syriacs in Sweden, it is still hard to get certain messages across to the authorities and the media because of a prevalent fear of stigmatizing immigrant communities. “I’ve tried to raise the alarm over the fact that many of those who live in these hard-hit areas work in nursery homes and as home carers and they do not have enough protective equipment,” said Kino, who himself ran a home care service firm for two years. “I understand this is a sensitive matter because it can lead to a blame game, but there’s a risk factor here that we should at least consider.”

In early April, Swedish media reported that a third of all elderly care homes in Stockholm had recorded cases of COVID-19. On April 16, the Public Health Agency said a third of all COVID-19 deaths in Sweden—at the time, there were 1,333 confirmed fatalities—had occurred at care homes. While a large proportion of the workforce at those homes is made up of immigrants—28 percent are foreign-born, and in Stockholm the figure is 55 percent, according to the National Board of Health and Welfare—drawing a link here would be “purely speculative,” according to Tegnell.

He said there is an ongoing inquiry examining why the virus has entered Sweden’s elderly care system and until it is concluded “we’d best not point fingers.” He does not rule out the need to impose different measures in different parts of Stockholm in the future to meet the specific challenges in various areas. However, the prevailing principle of public health in Sweden seems likely to remain “freedom under responsibility,” according to which as long as a majority takes individual responsibility for following recommendations, there is no need to rob everyone of basic liberties.

For Brinkemo, the author, it cannot be presumed that everyone in Sweden—whether native or foreign-born—intuitively grasps that principle, but it is something that can be learned, he said. A sign that it is happening within immigrant communities is that many have, indeed, taken it on themselves to spread the messages of social distancing and the recommendations issued by the authorities, from Somali Swedish doctors posting informative videos on Facebook to local celebrities using their social media channels to talk about the pandemic.

“That is really the way forward—trusted sources breaking down the bureaucratese and communicating with people orally rather than through official pamphlets and posters,” Brinkemo said. “All we can hope for now is that it will be part and parcel of the national strategy when the next pandemic comes around.”