Poor integration puts the Nordic welfare model at risk
Allan Krasnik is the director of the Danish Research Centre for Migration, Ethnicity and Health at the University of Copenhagen, as well as the project leader for Coming of Age in Exile (CAGE), one of the projects funded under NordForsk’s Nordic Programme on Health and Welfare. Launched in 2015, the CAGE project is looking at issues relating to the health and welfare of refugees who come to the Nordic region – a highly relevant topic for all of the Nordic countries, both today and in the years to come.
“We have a theory that the integration of refugees into the Nordic societies, as well as their state of health and entry into working life, depend on the services they receive after they arrive. The CAGE project will perform comparative analyses across the Nordic countries to study the development of health and socio-economic inequities among refugees who have come to the Nordic region in recent decades,” explains Professor Krasnik.
“Studies show that refugees find it difficult to get an education at the same level as the majority population in the country they come to and to achieve equal working conditions. Perhaps most importantly, many of them have health problems, especially mental health challenges that make daily life a struggle. We need to address this situation appropriately if we are to maintain today’s societies as we know them,” he says, and adds:
“Since this is the first time that a Nordic research project links together health, education and working life, we have a unique opportunity to shed light on the complex issues that this project addresses. It will be very interesting to look at the various practices used in the Nordic countries.”
A contentious field characterised by prejudice
The increasing flow of refugees to the Nordic countries has aroused many strong feelings. Krasnik states that it is an important responsibility to study such a contentious field.
“The challenge is to analyse and shed light on the topic without stigmatising refugees, since there are many prejudices and stereotypes about this group. It is our task to bring nuance to these ideas and ensure that stakeholders in the field get the knowledge they need to act in a rational, effective manner,” he says.
“Many decisions in recent years have been taken on the basis of prejudice, and health policy in particular has been misused in order to promote other policy objectives. For example, several Nordic countries have been reticent to maximise services for refugees to prevent their countries from being seen as an attractive destination. In this case, there is a risk that the quality of healthcare services provided to refugees already in the country will deteriorate because politicians are seeking to achieve something different. Therefore, it is important that our findings are conveyed clearly and unambiguously so that they are not misinterpreted or deliberately misunderstood by others,” says Krasnik.
The wrong measures may have serious consequences
While it is hard to predict what the exact consequences for society will be if measures for refugees and migrants do not meet their mark, Krasnik is certain that they will be serious.
“If refugees continue to come to the Nordic countries, which we have to assume they will, the consequences will be serious if integration is not successful. It is critical that the Nordic countries identify which measures work best and are most effective. If we do not manage this, it will lead to enormous economic and social problems for society, and we risk having a society in conflict with itself,” says the professor before citing an example:
“Existing research shows that people who have experienced trauma after fleeing their homes are difficult to integrate into society. It is therefore important to quickly identify who this applies to when they arrive in the country and implement measures, but this seldom happens. It would be wise to have psychologists and healthcare workers available, but this is also a question of priorities. If we choose not to increase resources in this area, society will suffer in the long term. This means that we will see other, more serious problems, in addition to much higher costs, than if we provide good treatment at an early stage.”
Registers and policy analyses will provide insight
The CAGE project will use a variety of methods to gain the best possible insight. First the researchers will focus on collecting data from the Nordic registers on refugees’ state of health and level of education, as well as the employment measures in which the refugees participate. They will also perform policy analyses of the various solutions chosen and conduct qualitative case studies during the course of the project.
“Information from the registers enables us to compare refugee data from the entire Nordic region. This can be a challenge at the national level because many subgroups may be quite small, making it difficult to draw conclusions,” says Krasnik.
“The difficulty is that it takes time to gain access to the registers. There are strict requirements relating to the transfer of data for individuals across national borders, and the countries have different practices for this as well. Fortunately, we have a good dialogue with the Nordic statistics bureaus, so I am confident that we will reach an agreement on the legal and ethical obstacles and find a solution that simplifies the process in the future. Then Nordic researchers will have access to information from all of the countries so they can perform analyses on data from the Nordic region as a whole, which is very logical since we have so much in common,” he explains.
Claire Mock-Muñoz de Luna is a PhD fellow working on the CAGE project and helping to gather policy documents and perform the ongoing analyses of the solutions chosen in the Nordic region. “It will be interest-
ing to view the situation in the context of the policy documents because the Nordic countries have similar practices in many areas, especially in health and welfare, but have implemented widely divergent policies regarding refugees in general. We will also conduct qualitative case studies by means of interviews with refugees in Norway and Finland,” says Ms Mock-Muñoz de Luna.
The Nordic region can provide Europe with answers
By employing a Nordic perspective, the CAGE researchers hope to generate important knowledge about how the Nordic countries can receive and take care of refugees in the best possible manner.
“Since policy and practice are different, we can see what happens when countries that are very similar to each other choose different refugee policies, and the different consequences this will in turn produce. The CAGE project can hopefully help to generate more knowledge about the effect of these different choices on the integration of refugees into the Nordic countries,” explains Krasnik.
“The influx of refugees into Europe in recent years has led to a high demand for research in this area, and the rest of Europe is looking with great interest to the Nordic countries. Both the EU and WHO are interested in having more projects that study the issues we are investigating,” he continues.
Favourable towards Nordic cooperation
In addition to working with a highly relevant research project, both Professor Krasnik and Ms Mock-Muñoz de Luna are enthusiastic about working with their Nordic colleagues.
“There will always be differences when various research institutions are involved, but our experience so far in the CAGE project has been very good. I had worked with some of the researchers before, but now we have all gotten to know each other well, and our collaboration to date has been very beneficial. I would go so far as to say that I think of them as friends,” says Ms Mock-Muñoz de Luna with a smile.
“The Nordic region has a common cultural and organisational background which means that we work in research in the same way and we often agree about the issues and parameters around us. In EU cooperation, on the other hand, it can take much more time to work through cultural differences and work methods. Many of them also have a different approach to deadlines and work plans than we have in the Nordic region,” adds Krasnik.
Good health leads to better integration
The underlying assumption of the CAGE project is that poor health limits integration because people with health problems find it difficult to study, which in turn makes it challenging for them to gain a foothold in the labour market. At the same time, Krasnik thinks the dialogue in the Nordic countries on issues related to health and social challenges is not good enough.
“The CAGE project wants to learn how we can continue to provide high-quality welfare services to everyone, including refugees, and it is critical that we are able to do this if we want the Nordic societies to develop harmoniously. For example, healthcare workers are asking for further education so they can get a better cultural understanding of and insight into diseases that are not as common in the Nordic region,” he explains.
“But the Nordic dialogue on this issue is non-existent. There is a lot of discussion about border control and police cooperation, but health has not had a high profile in the Nordic debate. Hopefully our research will change this so that we can bring politicians and decision-makers with various perspectives into the discussion,” Krasnik continues.
NordForsk gave life to the CAGE project
Professor Krasnik says that they could not have carried out the CAGE project without NordForsk’s Nordic Programme on Health and Welfare.
“NordForsk’s role has been critical. Without NordForsk, it would have been impossible to establish cooperation across national borders and thus gain access to researchers who have the expertise we need to find answers to these complex questions,” he says.
“At a time when refugees and migration were not in the headlines, NordForsk was already on board and understood the importance of the topic. Now it has become a high-priority issue in society, and thanks to NordForsk the Nordic region will have access to information that will be crucial in the coming years. I hope they will continue to play a leading role in this important research area,” concludes Krasnik.
About Coming of Age in Exile (CAGE)
Coming of Age in Exile (CAGE) is a research project funded under NordForsk’s Nordic Programme on Health and Welfare.The CAGE project performs comparative analyses across the Nordic countries to study the development of health and socio-economic inequities among refugees.
The project is headed by Professor Allan Krasnik of the University of Copenhagen. It was awarded NOK 30 million in 2015 and is expected to conclude in 2019.
About The Nordic Programme on Health and Welfare
The Nordic Programme on Health and Welfare was launched in 2014 with the overall goal of improving health in the Nordic countries by finding solutions to societal and public health challenges through high-quality
research. The programme has an overall budget of nearly NOK 300 million and has issued four calls for proposals thus far. The fourth call, issued in summer 2016, was targeted towards projects utilising Nordic register data to answer research questions addressing grand societal challenges relating to health and welfare.
The Nordic Programme on Health and Welfare is a collaborative effort between the Academy of Finland, the Danish Council for Independent Research | Medical Sciences, the Icelandic Centre for Research (Rannís), the Research Council of Norway, the Swedish Research Council for Health, Working Life and Welfare (Forte), The Swedish Research Council and NordForsk.
The interview was first published in NordForsk Magazine 2016.
Text: Tor Martin Nilsen
Photo of Mock-Muñoz de Luna and Krasnik: Terje Heiestad/NordForsk
Photo of reception centre for refugees in Kirkenes, Norway: Cornelius Poppe/NTB scanpix