What Would Gunnar Myrdal Say? Sweden, the Right to Health and Ethnic and Racial Minority Migrants

Abstract: In the 1940s, Swedish Nobel laureate Gunnar Myrdal noted a disconnect between the American creed (liberty and justice for all, equality) and the status of African-Americans (marginalization, disenfranchisement, segregation). Decades later, a similar disconnect is currently reflected in Myrdal's Sweden. The state of health for ethnic and racial minority migrants clashes with Swedish policy dictated by its anti-discrimination legislation and international human rights treaty obligations. Those who are not born in Sweden and who are not ethnically Swedish are more likely to suffer from poor mental and physical health. For documented migrants, the contrast between law and status is most dramatic. Domestic Swedish law is fairly consistent with what is required by Sweden's treaty obligations regarding the right to health and anti-discrimination. Nonetheless, discrimination and adherence to societal mores impede these migrants from attaining the highest possible standard of physical and mental health by creating conditions that foster unemployment and social exclusion - two important underlying social determinants of health. For undocumented migrants, both Swedish law and Swedish practice are inconsistent with Sweden's treaty obligations. For these migrants, care is unsubsidized and limited to immediate and emergency situations. Care is difficult to access and prohibitively expensive in many cases. For asylum seekers and failed asylum seekers who are not in hiding, their legal rights are more akin to undocumented migrants than legal Swedish residents. Domestic law entitles them only to subsidized care that cannot wait or emergency care. For all of these groups, a lack of cultural competence amongst caretakers may have a detrimental impact on the quality of care given when it is accessed. Consequently, Swedish compliance with international law regarding the right to health for its ethnic and racial minority migrants is mixed with triumphs and challenges. In order to conform its practice and legislation to its treaty obligations, Sweden can look to domestic and international examples of good practice. These examples include more progressive legislation for undocumented migrants, making cultural competency a priority, involving ethnic and racial minority migrants in the health care process and identifying and targeting specific disparities. Ultimately, bridging the gap between treaty obligations and ethnic and racial minority migrants' health status will have a positive impact on the entire population.