Teemu Ryymin

Effecting Equality: Norwegian Health Policy in Finnmark, 1945–1970s

Abstract At the heart of “the Nordic model of welfare” is a strong will for national integration and social equality between citizens and regions. It is commonly held that that “homogeneity ethnic” is one explanatory factor behind the Nordic model of welfare. On the contrary, we claim that it is the political will to treat the population as homogeneous that influenced the creation of the model, not any factual ethnic homogeneity (which is, after all, a historical fiction, also in the Nordic context). Thus, the pursuit of integration and the strive for regional equality have challenged local autonomy and cultural diversity while at the same time underpinned arguments for a regionalization of politics and, to some extent, for ethnic particularization. Drawn between a strong state and local authority, universalism and particularization, welfare and health policies have reshaped the relationship between center and peripheries and between the majority and ethnic minorities. The integration of the county of Finnmark into the national system of institutionalized welfare in Norway after World War II constitutes a good case to investigate not only the will, but also the ability, for national integration and equalization along the dimensions of centre–periphery and majority–minority relations, not only because of the countys position furthest to the north, but also because it held the largest minority populations. This article examines Norwegian policies to establish and effect equality between Finnmark and other regions in the field of health care facilities from 1945 until the 1970s, and the attempts to establish equal access to health services between the Sámi minority and the Norwegian majority population in Finnmark. It sheds light upon how the immanent conflict between the ideals of a national, universal welfare policy and particular measures in favor of the Sámi was conceived in the period. (The authors expected multi-culturality to be clearly visible in the sources. It was, but only with regard to one minority group, the Sámi. The Kvens were not discussed by the policy-makers in the period.) Furthermore, it has been argued that in the shaping and implementation of Norwegian health policies in the first years after World War II, primacy was given to expert knowledge. A particular point of interest in this article is how this primacy manifested itself in the choices of political strategies of universalism and particularism within the field of health policy in this particular geographical setting.

“Tuberculosis-threatened Children”: The Rise and Fall of a Medical Concept in Norway, c .1900–1960

The relationship between children and tuberculosis became an increasingly important focus of attention during the early twentieth century. Internationally, various aspects of the history of the struggle against childrens tuberculosis have been studied by, among others, Linda Bryder and Cynthia Connolly, who have particularly devoted their attention to the construction of the category of “pre-tuberculous children” and its practical consequences in terms of policies of institutions and prevention in Britain, the United States, Germany and France in the interwar years.1 In this article I discuss the development of a similar concept in Norway, where childrens tuberculosis became a significant part of the efforts against the disease especially in the 1920s. I pay particular attention to how an international corpus of knowledge about the relationship between children and tuberculosis that was established in the early 1900s was implemented in the Norwegian anti-tuberculosis work in the first half of the century. In Norway, the category that was created to identify children at risk of tuberculosis was straightforward: the “tuberculosis-threatened child” (“tuberkulosetruet barn”). How was this category constructed by medical research, and did it result in similar practices in Norway as elsewhere? Whereas Bryder and Connolly focus mainly on the establishment of the category of “pre-tuberculous children” in the early 1900s and the subsequent practice in the 1920s and 1930s in the institutions developed to deal with such children, I shall discuss the wider social, economic and medical developments in Norway that transformed the concept and its related practices from the late 1930s to the 1950s. Norwegian tuberculosis mortality peaked around 1900 with approximately 6,000 deaths (31 per 10,000 inhabitants) a year. During the 1890s, medical doctors had struggled to raise the states consciousness about the severity of the problem, and in 1900 the Norwegian parliament passed a national Tuberculosis Act that defined the general structure for a public health campaign against the disease. The Act was primarily based on a strategy of isolation of disease carriers that was derived from an understanding of the diseases bacteriological origin. According to the Act, people deemed potentially dangerous sources of infection, particularly if they lived under conditions that did not permit isolation in their own homes, could be committed to institutional care, by force if necessary. On the basis of this legislation, the state and several voluntary associations, notably the Norwegian Womens Public Health Association (Norske Kvinners Sanitetsforening, NKS, established in 1896) and the Norwegian National Association against Tuberculosis (Den norske Nationalforening mot tuberkulose, established 1910), undertook to combat tuberculosis by building institutions and organizing educational campaigns. The population was to be informed about the infectious character of tuberculosis and the ways of transmitting the disease, and educated to follow a hygienic way of life.2 Tuberculosis was to be fought by bringing light, fresh air and cleanliness into peoples homes, and by making them stop spitting. The message was spread through lectures, exhibitions, films, newspaper articles and so on, and medical doctors and other representatives of the civil service, such as teachers and priests, played a key part in this work. The work of medical doctors, who dominated the administration of the National Association, was supported by local voluntary associations, who assisted the pursuit of the “tuberculosis-free home” by employing voluntary district nurses, supporting those stricken by the disease and their families, and not least, funding and running local institutions (nursing homes) which were to be used to isolate sufferers in an advanced stage of the disease.3 The state undertook to finance and run large-scale sanatoriums, which were to provide the opportunity to cure patients in early stages of tuberculosis, and also contributed to the costs of the nursing homes. How was the specific problem of childrens tuberculosis dealt with within this general framework?

Creating Kvenness: Identity building among the Arctic Finns in northern Norway

In this article I will examine some aspects of identity building among the Arctic Finns or Kvens in Norway in the 1980s and 1990s. During these decades, the Kvens started to organize themselves on ethnic lines. The main organization, Norske Kveners Forbund (the Association of Norwegian Kvens), is engaged in the creation of ethnic markers, such as a common proper name, differentiating elements of common culture, and a common history or a myth of origin. While being successful on some fronts, the strategies chosen by the Kven Association have also created conflict within the Kven community. The identity‐building process and the nature of the elements used to accomplish it will be seen in relation to the movements’ strategies towards the Norwegian authorities, as based on a model borrowed from the Sami movement, and related to the ongoing debate in Norway, Sweden and Finland about indigenous peoples’ rights to land and water resources. Like nationalism, modern ethnic associations and networks seek to emulate a politically useful and emotionally satisfactory Gemeinschaft in a historical situation where such communities have to be created because they do not already exist. (Eriksen 1993: 144)

Civilizing the “Uncivilized”: The Fight against Tuberculosis in Northern Norway at the Beginning of the Twentieth Century

Abstract The anti-tuberculosis campaign conducted in Finnmark, north Norway, between 1914 and the Second World War was informed by shifting scientific, social and ethnic notions pertaining to the disease itself, the region of Finnmark, and its population. This article focuses on how the Sámi were represented by the medical establishment, how that image of the Sámi influenced the form and the content of the fight against the disease, and how the anti-tuberculosis campaign was connected to the state minority policy of the period. The understanding of tuberculosis and the ways of combating it underwent several changes during the period, particularly during the economic crisis of the 1920s and 1930s. The initial emphasis on the role of culture, more specifically ethnicity and language, was gradually replaced by a more medicalized focus in the fight against the disease. As the notion of tuberculosis as a disease of civilization was replaced by an understanding of the disease as an infectious one, on a par with other infectious diseases, the earlier strategy of civilizing the “uncivilized” Sámi in order to protect them from tuberculosis was replaced by a more epidemiological approach in tuberculosis prevention.

From equality to equivalence

Abstract This article investigates a shift in the justifying ideas in Norwegian public health and immigrant policies. Between 1970 and 2009, equality was gradually supplanted with equivalence as the main principle evoked in policy formulation. Potentially, this opened for more differentiated public health policies for immigrants and the indigenous Sámi. The specific needs of minorities were acknowledged, and the need for linguistic and cultural competence in health services was emphasized. However, only a few specific measures were introduced to meet the needs and challenges of ethnic minorities, and the concrete measures implemented largely mirrored the services aimed at the majority.

Narrating the Arctic Finns: Samuli Paulaharju's representations of the Kvens

How have the Kvens – the eighteenth- and nineteenth-century Finnish-speaking migrants in northern Norway – been represented in Finland? This article discusses the imagery of the Kvens found in the works of the Finnish author Samuli Paulaharju, one of the most influential Finnish authors engaged in the Kven question in the period between the wars. The main questions to be addressed are, first, why was Paulaharju interested in the Kvens? Second, what kind of images or representations of the Kvens did he create in his books about these “Finns of the Arctic Ocean”? Third, how suitable are these books as historical sources about the Kvens?