The Finnish experience; a presentation of the guide for the health care professionals by Miranda Vuolasranta

Dear Chair person,
Ladies and Gentlemen
Dear colleagues

Iīm glad today, when testifying this conference aimed to Roma women and their access to health care services. Iīm also pleased to see our chair Mrs. Josephine Vershpaget from Netherlands chairing this part of conference. I have a feeling, that this event has itīs special mening for her, because she was one of the first pioneers about ten years ago, who raised up in day-light in the affairness of international community, the miserable living conditions, social exlusion, unequal treatment, lack of basic servicies and human rights of Roma, when she made the first Council of Europe report on the legal position of Roma in Europe 1993.

After that, she chaired seven years the Specialist Group of Roma/Gypsies MG-S-ROM, which has succesfully produced information and prepaired CoE/Committee of Ministers General Recommendations aimed to improve the living conditions, education, housing and embloymence opportunities of Roma in Europe.

Currently MG-S-ROM is prepairing, among other things, a recommendation aimed to give guidelines to the 45 Council of Europe member states, on how to improve the Roma /Gypsies and Travellers access to health care and equal treatment in Europe.

I wish, that you would still use the rest of the morning to give your comments and proposals on this draft recommendation, as mrs. Verspaget did do yesterday. We all certainly do agree, after yesterday interventions and listening the findings of Ms. Pomykalas report, that the need of Romas access to health care sevices is crying and urgent, and that, it can not be ignored any more in our civilized and modern societies.

Iīm grateful of the privilege and opportunity to present here today one positive example of cooperation between Roma and authorities. How the governemt can, if there is enough of good will and expertise, promote mutual understaning and fight against the discriminatory barriers which the grass-root level inividuals do meet, when trying to get help in their health cricies, particularly if they happened to belong to a marginalised and poor minority.

The Roma, Gypsies and Travellers form a group of approximately 8-10 million people in Europe. They are to be found in almost all 45 Council of Europe member states and indeed, in some Central and Eastern European countries, they represent over 5% of the population.

General Features of the Finnish health care system

In Finland the organisation and financing of health care has been considered for a long time a public resonsibility. The main responsibililty for organizing health care lies with the local authority; municipalities across the country. The obligation of local authorites to organize these services is based not only on legislation, but aslo on a long tradition. The social protection and health care system has been built up over several decades. It is caractericed by universality of benefits.

It is primarily residence in the country, that qualifies a person for social protection and healh care. The social protection system has quaranteed social cohesion fairness and equality. Everyone in Finland has the right to social protection and health care regardless of their abililty to pay, social status or place of residence. The principle of equality is firmly incorporated into the social protection and health care system. Health services are funded mainly from taxation and partly from central governements grants.

The Finnish developments in Roma guestions

The Finnish Parliament held their first discussions of Gypsies already in the beginning of last century. 1956 the Counsil of State decided to establish an expert-body, located in the conjunction of the ministry of social affairs and health, having responsibility to promote the living conditions of Gypsies. At that time, it was composed of representatives of the central governement administration, researches and one Roma member. At the end of 70s this expert body influenced strongly on the improvement of Romaīs housing conditions affording Roma families possibility to become sedentary instead of travelling. The Council of State renewed the decree of this expert-body several times during the decades and currently this body is called “The Advisory Board on Romani Affairs”, having half of itīs 18 memberīs coming from the national Roma organisations.

During 90’s the Constitutional Act of Finland was renewed and in that connection Finland recognised Roma as a traditional minority having right to maintain their own culture and language. This led to many other legislative chances on the field of education and access to all public servicies. In the beginning of the 90’s a Roma Education Unit was established. Shortly after itīs creation it started to work in the National Board of Education.

This reqocnition of the existence of Roma as one population group of the society in the Finnish administration, gave plattform for a common work, which took visible shape on the serie of guide-books produced to various occupation groups responsibly to offer basic public servicies to the people, including Roma.

This serie of guide-books aimed to share information about Roma their origin, language and their cultural values. The needs, fears and waitings of Roma on the arena of public services. On the other hand these guide-books aimed also to draw attention to the existing fears and barriers of prejudices among local authorities responsibly to provide the public servicies. The guide-books aimed also to give advises and tools how to work out and open contradictive situations, when Roma culture and majority rules and practicies dosent meet each other.

Too often the solution is to cut-up the discussion and close the door in front of Roma, stating that, we dosenīt serve Roma today, you canīt pay, you are too dirty and smelling, you do disturb the other clients or patients, you dosenīt behave in the right way. These excuses are efficiently still today preventing Roma to get the same treatment and services as majority in many regions of Europe.

Most majority (non-Roma) people do not know much about the Romani culture although the Roma have lived in Europe for centuries. It is often difficult for us to accept people who behave differently, who do not meet our norms. The strange and the unfamiliar often confuses us. We speak about equity but for many that means similarity.

To tackle with these questions, was the purpose of the first guide-book “The Roma and health Care Services – A guide for the health care professionals”, which aimed to help the health care professionals to understand the Roma better in hospitals, medical centres, maternity and children clinics and the school health care personnel.

While Europe is getting increasingly multicultural and international it is important to first familiarise oneself with the different ethnical and linguistical population groups of the country. That will also help to understand other people (and their cultures) who come from all around the world. It is quite difficult to understand and appreciate a foreign culture if one does not have enough information on that culture. Correct information diminishes prejudice.

The service and customer staff may daily meet with many different kinds of people. In order for them to be able to relate to their different clients and their cultures in a positive and correct fashion, they need proper information concerning the background of their clients.

The subject in this guide-book has been handled from the inside: from the Roma point of view. To Roma, a good caretaker is professional, co-operative and friendly. Positive attitude is important. A caretaker can have a good relationship with Roma by being open and warm.

The Roma hope their cultural background is taken into consideration, in the care taking. In order to be able to fulfill this wish the caretaker needs correct information, that helps to build a positive attitude towards the different patient. Proper information on ethnic minorities should be included in the training of the health care staff. Due to their lack of knowledge many caretakers are shy to approach a Roma patient. Aspects of Romani culture should be discussed throughout the training on suitable connections.

The cleanliness and chastity customs of the Romani culture as well as the importance of the family and the kin can cause many problems and confusions. After receiving information on the Romani culture many hospitals have been able to meet the customs of the Romani culture with respect and flexibility.

Synopsis of the roma and health services

The Guide is divided to two parts: an introduction section of Roma orgin, language and main cultural caractars. The second part is presenting the Roma view on good health care, problems related to health crises in family, beeing laid in hospital, operations and other treatment, role of the family, relatives, friends and rest of the Roma community in case of sickness and death, funerals, fears and prejudice on Roma side towards sicknesses and health treatments.

This first Guide-book was made by The Finnish National Board of Educationīs, Roma expert group on 1993. The guide-book was up-dated during the 90’s together with the ministry of social affairs and health Roma advisory board. Still today, it is one of the most interested guide-books used freguently also by social and health care schools and even universities having courses on how to meet patients coming from Roma minority but also other migration groups.

A translated copy of this guide-book, in English, is available on the tables near entrance. Mrs. Pomykala who personaly visited 15 countries when making the research of Roma Women and their access to health care services, took note in her recommendations of the guide-book, as one example of the positive measures which could be unertaken and used as a model in other countries also.

Ladies and gentleman

We humans have different cultural values, modes of living, ways of thinking and acting, rules of conduct. Those – our roots – guide our everyday living, expectations and actions. The meaning of our cultural background is emphasised when two people meet in different situations.
This clear and practical guide is meant to promote mutual understanding in between different cultures. The guide offers expert Roma knowledge on the baseīs of the Romani culture and the Roma. It describes the colourful experiences of the Roma and the centuries-old culture.

I talk especially about the situations where Roma meet each other and non-Roma. It offers advice on what should be taken into consideration and how to act in those situations.

The guide encourages getting information, asking when needed and challenges the non-Roma meet the Roma, our fellow human beings and the spectrum of cultures with an open mind.

General features on Roma women and health care

After this presentation you may wonder if we in Finland do have any problems related to Roma, particularly Roma women and access to health care. Unfortunately I have to answer, yes Roma do still meet racism on daily basis.

IRWNs president Soraya Post told us yesterday how her mother was forcely sterilizied on 50s. My mother managed to escape from a Swedish hospital after giving birth to my youngest sister of our five children. A year after that, she was strerilized in Finland waiting, for twins, which was aborted at the same time. This happened in the beginning of the 70s. She was illiterate and did not understand what really happened to her. Many times the Roma in Finland, and as I know elswere also, are extremly afraid of hospitals and all kind of treatment. They leave the hospitalīs as soon they are capable to go with two feets often without permission from the doctors. We Roma do still lack information on preventing health care, maternity, importance of child-vaccinations etc.

The Roma women meet frequently double discrimination phenomen, they are prohibited entrance to public places and denied employment because of their ethnic background, traditional dresses and gender.

Roma/Gypsies and Traveller are confronted with racism and discrimination still today throughout Europe. What is important to be noticed in my positive Finnish example is two extremly important pointīs:
- first, the governement and national health authorities have safeguarded access to all basic social benefits and health care, equally to all resident members of the country – also Roma, regardless of their social or economic position or belonging to certain population groups;

- Secondly, the Finnish governement has enabled the Roma possibility to participate on equal footing with majority, in all levelīs of society in matters concerning Roma.

Particularly the Ministry of Social Affairs and Health and the National Board on Education functioning under the Ministry of Education has concertly stretched an open and cooperative hand to Roma.

Democracy development does not mean only creation of cosmetic legislation and ratifience of international treaties, which are not imlemented on practical terms. In the long term policy development, the national infrastructure has to meet the needs of all population groups in societies. Functioning public services are the firm of the citizens well-beeing and a guarantee of progress and well-fare of the wole society.


    Dear representans of this conference,

Iīm finishing my contribution by reflecting a little bit the task of this institution. In future, access to social rights will remain a priority of the Council of Europe amongst Roma and Travellers: children, women, elderly, migrants, and refugees.

Governments should guarantee the implementation of the national policies and European standards. When contacts between the authorities and Roma communities are not easy, mediators should be put in place. Incentives for local authorities who make efforts to implement reforms might be a solution to be envisaged and discussed at the national levels, but also in this conference.

When referring to Council of Europe actions at local level, we should not forget the possibility for local authorities to obtain a loan from the Council of Europe Development Bank (with the support of the ministries of Finance) for project development. The Council of Europe Development Bank has conducted successful projects in Spain, and I would like to inform participants that we are currently running under our joint programme with the Bank, projects in the field of housing and health in Bulgaria (Plovdiv, Sofia).

With the almost accomplished enlargement of the Council of Europe and future enlargements of the European Union, there should be no more room for excluded and marginalized groups within a socially and culturally united Europe.

I thank you Mrs Chair person, for giving me the opportunity to address this Conference;

and I am at the disposal of participants for any questions they may have regarding the topic of my presentation.

Thank you.