Health care services for the Sami - Updated

In 2016 Centre for Care Research published a summary of knowledge on health and care services to the Sámi population in Norway. During the years passed by since then, new research has been carried out and published on this topic, along with novel development work. These new works have now been reviewed and are presented in this revised summary of knowledge.

The rights of the Sámi as an indigenous people in encounters with health and care services are regulated by international conventions and national legislation. It is regarded to be of great importance that health and care service personnel possess knowledge about social, historical, and cultural factors which may be of significance in encounters between Sámi people and health and care services. In Norway, the political goal has been to provide culturally adapted services to the Sámi population within the established services instead of designing specific services to this group. Cultural safety is a term which has had an increased use and has sailed up as a key term in the literature in the field of health and indigenous people the recent years. The term encapsules cultural understanding and sensitivity from the side of health and care personnel in encounters with Sámi culture.

Overall, there are few indications of difference in health condition, presence of diseases and use of health care services between the Sámi and the majority population in Norway. One difference, however, is that the Sámi population is less satisfied with health and care services. Parts of the literature focuses on that the Sámi have a different understanding of health, illness, and treatment than the majority population. However, there are sound reasons for being careful to view this as a truth that applies for all Sámi. There is also literature which points out that Sámi people communicate about health and diseases in indirect ways and through metaphors. During the last five years, some new literature has been published which point to a discrepancy between health and care personnel´s expectations of Sámi culture and their experiences in actual encounters with Sámi patients in clinical practice. As an example, employees on the one hand can give accounts like “Sámi do not talk about mental health issues”, even though their real-life experiences on the other hand tells them that Sámi people indeed do talk about mental health issues. Some parts of newly published research, recommend that health care institutions, in alliance with employees, should facilitate and contribute to critical reflections on culture and how this concept is being used within different health care professions.

Experiences of the process of assimilation into Norwegian culture and stigmatization (be it self-lived or those of others), might have implications in encounters between Sámi and health care services. However, research does not unanimously support the notion that these kinds of experiences have impacts on self-experienced health. The body of literature in this field illustrates that identity is a complex concept. Furthermore, in some of the newly published literature, it has been pointed out that health care professionals´ construction of Sámi identity and stereotyping as a group, which lead to the attribution of certain (group) characteristics, which in turn has consequences for the quality of health care services offered to the Sámi.

In the period 2016-2021 some new literature has focused on Sámi persons suffering from dementia and their encounters with health care services. When it comes to the diagnosing of dementia, in the most resent guidelines from health authorities it is underscored that if educational, linguistic, or cultural hindrances make safe examinations or cooperation difficult, and in cases where the specialized health care service has better competence, it is of beneficence if the general practicians send the patient to specialized health care with the purpose of testing for dementia. The need for interpreter services is also in the guidelines underscored as important to be aware of. The literature also points out the importance of health and care service personnel being knowledgeable about Sámi languages and cultures when encountering Sámi persons with dementia. This is not least important because, as parts of the more recent literature underscores, persons with dementia after a while can lose their non-native language(s), and therefore in many cases lose the ability to communicate in Norwegian. Recent studies have also found that health and care personnel experience that facilitating the physical surroundings of care institutions in ways which reflect the Sámi culture can be of beneficence, as this may help induce a feeling of recognition and safety, especially for patients with dementia. The same applies for choosing menus for meals in the institutions.