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This study assessed the prevalence, reasons, and factors associated with refraining from seeking needed health care among the Sámi population in Sweden. Using data from a 2021 health survey, 3,658 individuals participated. Descriptive and regression analyses were applied to summarize the data and determine the magnitude of associations between independent variables and refraining from health care. Results showed 19.9% of participants refrained from seeking needed health care. Common reasons included lack of time (25%), problem resolution (16%), long wait times (16%), and uncertainty about where to seek care (13%). Factors associated with the higher prevalence of refraining included being a woman, being under 65, having lower income, experiencing economic stress, belonging to a forest reindeer herding community, and residing outside Sámi homelands. Interventions should be designed to address healthcare access inequities among vulnerable Sámi subgroups. Further research is needed to understand these disparities and reasons for refraining from care in non-pandemic contexts.

Bakgrund: Sveriges regering har nyligen antagit en nationell strategi för psykisk hälsa och suicidprevention, där samiska perspektiv för första gången inkluderats. I rapporter om ungas psykiska hälsa, och samisk folkhälsa, saknas dock unga samers perspektiv. Den här rapporten fyller den kunskapsluckan, genom att undersöka och belysa unga samers hälsa och välbefinnande i Sverige,med särskilt fokus på psykisk hälsa.

Metoder: Rapporten har tagits fram i nära samverkan med den samiska ungdomsorganisationen Sáminuorra och bygger på kvalitativa data insamlade 2024 och kvantitativa data insamlade 2021. Totalt deltog 15 unga samer i intervjuer(15–30 år), 16 i webbenkäter (15–30 år), och 364i en befolkningsbaserad folkhälsoenkät (18–29 år). Kvalitativa data har analyserats med tematisk analys. Kvantitativa data har analyserats med deskriptiv statistik och skillnader mellan grupper har undersökts genom bivariat regressionsanalys.

Kvalitativa resultat: Genom analysen identifierades ett huvudtema och fyra underteman. Huvudtemat ”Det är hemskt och magiskt samtidigt” handlar om hur den samiska identiteten innebär både positiva och negativa sidor i de ungas liv. Detta återkommer i alla underteman. Undertemat ”Livsbalans” belyser hur unga samer (liksom andra unga) upplever stress och försöker få goda levnadsvanor och relationer att fungera för bättre välmående. Deltagarna beskriver stolthet i undertemat ”Samisk identitet”, men också utmaningar kopplade till att ta den samiska kampen – att försvara och förklara sin kultur för andra. Detta återkommer i ”Samhällets spelregler”, som också speglar hur bristande stöd och förståelse från majoritetssamhället försvårar livssituationen, samt hur rasism, diskrimineringoch kränkningar underminerar välmående. Slutligen visar analysen i ”Vårdens villkor” att deltagarna upplever att den svenska hälso- och sjukvården behöver stärka sin kunskap och tillgänglighet för att unga samer ska kunna få likvärdig vård och stöd.

Kvantitativa resultat: Analysen av kvantitativa data redovisas beskrivande som andelar (procent) av unga samer och jämnåriga i Sverige, fördelat på kön och totalt samt om skillnader mellan grupper var statistiskt säkerställda. En kort sammanställning visar att:

• Ungefär tre av fyra unga samer rapporterade gott psykiskt välbefinnande (76,7 procent) och bra allmän hälsa (74,4 procent). De totala andelarna skilde sig inte mellan unga samer och andra unga i Sverige.
• Unga samiska kvinnor rapporterade mindre ofta bra allmän hälsa (68,6 procent respektive76,6 procent), mer ofta att de fått en depressionsdiagnos av läkare (29,9 procent respektive22,4 procent) samt hade mer ofta försökt ta sina liv (18,4 procent respektive 9,9 procent), jämfört med andra unga kvinnor i Sverige.
• Unga samer var mindre ofta stillasittande merän 10 timmar dagligen (24,6 procent respektive 35,2 procent) jämfört med andra unga i Sverige, men hade annars mindre sunda levnadsvanor (åt mindre ofta grönsaker/rotfrukter och snusade mer) samt var mer ofta överviktiga.
• De allra flesta unga samer har någon att anförtro sig åt (84,4 procent) eller be om hjälp från om de behöver detta (95,8 procent). Dessa andelar skiljer sig inte från andra unga i Sverige.
• Unga samer har oftare än andra unga i Sverige svårigheter att klara sina löpande utgifter(23,7 procent respektive 17,8 procent).
• Sex av tio unga samer har upplevt diskriminering eller rasism för att de är samer och var fjärde har upplevt detta under det senaste året. Det är mycket vanligare att unga samer än andra unga i Sverige upplevt att de blivit behandlade på ett sådant sätt att de känt sig kränkta på grund av den egna etniciteten under de tre senaste månaderna(25,7 procent respektive 3,4 procent).
• Endast 11 procent av de unga samerna upplevde att vårdpersonalen vid deras senaste besök hade tillräcklig kunskap om samisk kultur och livsvillkor för att kunna ge bra vård, och var tionde ung same har avstått från att berätta om sin samiska identitet i ett vårdmöte, trots att de själva upplevt att det haft betydelse för att bedömningen ska bli rätt.

Slutsatser: Rapporten visar att de flesta unga samer har god hälsa och ofta tillgång till särskilda resurser som stärker deras hälsa – det vill säga den ”magiska” sidan av unga samers liv. Detta är till exempel den stolthet, trygghet och det sociala nätverk som har sin grund i den samiska identiteten. Samtidigt visar rapporten också på ”hemska” sidor såsom unga samers större ekonomiska sårbarhet, samt stora utsatthet för rasism, diskriminering och kränkningar mot dem för att de är just samer. Det finns också en del hälsoområden där unga samer har sämre hälsa än andra, och mest allvarligt är att de unga samiska kvinnorna oftare saknar bra allmän hälsa, oftare rapporterar att de fått depressionsdiagnoser och oftare gjort självmordsförsök, jämfört med andra unga kvinnor i Sverige. Detta är områden där samhället måste göra mer för att förverkliga unga samers lika rätt till god hälsa och välbefinnande.

Rapporten fyller kunskapsluckor och skapar bättre förutsättningar för att det samiska och svenska samhället ska kunna stötta och stärka unga samers hälsa och välbefinnande, samt prioritera insatserna där de behövs bäst. Deltagarna har själva lämnat många goda förslag som kan förväntas stärka unga samers hälsa, inklusive genom att skapa fler trygga samiska mötesplatser och öka möjligheterna att få lära sig och tala samiska. Det omgivande samhället bör också öka sin kunskap om det samiska och motverka rasism mot samer, så unga samer slipper utsättas och försvara sig. Unga samer behöver också en lättillgänglig hälso- och sjukvård där personalen har den kompetens som krävs för att de ska bli förstådda på lika villkor som andra.

Background: The Swedish government has recently adopted a national strategy for mental health and suicide prevention, which for the first time includes Sámi perspectives. However, reports on young people's mental health and Sámi public health lack the perspectives of young Sámi. This report fills that knowledge gap by examining and highlighting the health and well-being of young Sámi in Sweden, with a particular focus on mental health.

Methods: The report was developed in close collaboration with the Sámi youth organisation Sáminuorra and is based on qualitative data collected in 2024 and quantitative data collected in 2021. A total of 15 youang Sámi participated in interviews (ages 15–30), 16 in online surveys (ages 15–30), and 364 in a population-based public health survey (ages 18–29). Qualitative data were analysed using thematic analysis. Quantitative data were analysed using descriptive statistics, and differences between groups were examined using bivariate regression analysis.

Qualitative results: The analysis identified one main theme and four sub-themes. The main theme, "It is terrible and magical at the same time," describes how Sámi identity involves both positive and negative aspects in young people's lives. This is reflected in all sub-themes. The sub-theme "Life balance" highlights how young Sámi (like other young people) experience stress and strive to maintain good living habits and relationships for better well-being. Participants expressed pride in the sub-theme "Sámi identity," but also challenges related to defending and explaining their culture to others. This is echoed in "Society's rules," which also reflects how lack of support and understanding from the majority society complicates life situations, and how racism, discrimination, and harassment undermine well-being. Finally, the analysis in "Conditions of care" shows that participants feel that the Swedish healthcare system needs to strengthen its knowledge and accessibility to provide equitable care and support for young Sámi.

Quantitative results: The analysis of quantitative data is presented descriptively as proportions (percentages) of young Sámi and peers in Sweden, divided by gender and total, and whether differences between groups were statistically significant. A brief summary shows that:

• About three out of four young Sámi reported good mental well-being (76.7%) and good general health (74.4%). The total proportions did not differ between young Sámi and other young people in Sweden.
• Young Sámi women reported good general health less often (68.6% vs. 76.6%), that they had received a depression diagnosis from a doctor more often (29.9% vs. 22.4%), and more often had attempted suicide (18.4% vs. 9.9%) compared to other young women in Sweden.
• Young Sámi were less often sedentary for more than 10 hours daily (24.6% vs. 35.2%) compared to other young people in Sweden, but otherwise had less healthy living habits (ate vegetables/root vegetables less often and used ‘snus’ more), and were more often overweight.
• Most young Sámi have someone to confide in (84.4%) or ask for help if needed (95.8%). These proportions do not differ from other young people in Sweden.Young Sámi more often than other young people in Sweden have difficulty managing their ongoing expenses (23.7% vs. 17.8%).
• Six out of ten young Sámi have experienced discrimination or racism because they are Sámi, and one in four has experienced this in the past year. It is much more common for young Sámi than other young people in Sweden to have felt insulted because of their ethnicity in the past three months (25.7% vs. 3.4%).
• Only 11% of young Sámi felt that the healthcare staff at their last visit had sufficient knowledge of Sámi culture and living conditions to provide good care, and one in ten young Sámi has refrained from disclosing their Sámi identity in a healthcare encounter, despite feeling that it was relevant for an accurate assessment.

Conclusions: The report shows that most young Sámi have good health and often access to specific resources that strengthen their health – the "magical" side of young Sámi's lives. This includes the pride, security, and social network rooted in Sámi identity. At the same time, the report also highlights "terrible" aspects such as young Sámi's greater economic vulnerability and significant exposure to racism, discrimination, and harassment because they are Sámi. There are also some health topics where young Sámi have poorer health than others, and most seriously, young Sámi women more often lack good general health, more often report receiving depression diagnoses, and more often have attempted suicide compared to other young women in Sweden. These are areas where society must do more to realise young Sámi's equal right to good health and well-being.

The report fills knowledge gaps and creates better conditions for the Sámi and Swedish societies to support and strengthen young Sámi's health and well-being and prioritise interventions where they are most needed. Participants themselves have provided many good suggestions that can be expected to strengthen young Sámi's health, including creating safer Sámi meeting places and increasing opportunities to learn and speak Sámi. The surrounding society should also increase its knowledge of the Sámi and counteract racism against Sámi so that young Sámi do not have to be exposed and defend themselves. Young Sámi also need accessible healthcare where staff have the competence required to understand them on equal terms as others.

Introduction: Depression is a leading cause of disability globally, with disparities evident across gender and ethnicity. Indigenous populations, including the Sámi people in Sweden, face compounded disadvantages due to intersecting social inequalities. This study aimed to estimate the differences in depression prevalence across different intersectional groups defined by Indigenous status and gender in Sweden.

Methods: Data on participants (N = 19,839) aged 18–84 years were obtained from two cross-sectional surveys conducted in 2021: the SámiHET study and the Health on Equal Terms (HET) survey. Depression prevalence was assessed using self-reported doctor-diagnosed depression. Four intersectional categories were created representing Sámi women, Sámi men, non-Sámi women, and non-Sámi men. Intersectional disparities (joint, referent, and excess) were estimated to examine the combined effects of Indigenous status and gender on depression prevalence.

Results: Sámi women reported the highest prevalence of depression (26%), while Sámi men had the lowest (12%). The joint disparity in depression prevalence was 10 percentage points (pp) (95% CI: 8.4 to 12, adjusted), reflecting a higher prevalence of depression among Sámi women compared with non-Sámi men. Most of the joint disparity was explained by the referent disparities for Indigenous status (-2.6 pp, 95% CI: -4.7 to -0.49) and gender (9.7 pp, 95% CI: 8.5 to 11). The excess intersectional disparity, reflecting the compounded effects of being Indigenous and gender, accounted for a third of the joint disparity (3.3 pp, 95% CI: 0.48 to 6.1, adjusted).

Conclusion: Sámi women experienced a disproportionate burden of depression due to intersectional disadvantages. These findings highlight the importance of culturally sensitive mental health strategies and the need for further qualitative research to explore their lived experiences.

Background: Decolonisation has become a global health priority, addressing inequities rooted in colonial histories that continue to shape power dynamics and knowledge systems. Nordic global health programmes bring together students and faculty from diverse backgrounds in a region defined by inclusive ideals but shaped by underexamined colonial legacies. This context offers a valuable setting to examine how decolonial perspectives are integrated or overlooked in global health education.

Objective: To explore students’ perspectives on decolonisation in global health education, focusing on their understanding, experiences, and views on potential pedagogical change. Methods: A qualitative study involving 72 students from Nordic countries and other world regions, enrolled in global health programmes at 11 academic institutions across five Nordic countries. Fourteen focus group discussions were conducted, and the data were analysed using qualitative content analysis principles.

Results: Students shared nuanced understandings of systemic power imbalances in global health practice and education and expressed the need for structural changes. They identified gaps in curricula and pedagogy, including limited integration of decolonial perspectives and inequities in knowledge production. Students called for more inclusive and culturally relevant curricula that reflect diverse contexts. They emphasised student agency in shaping education while acknowledging barriers such as institutional biases and inconsistent faculty engagement.

Conclusions: Decolonising Nordic global health education is a long-term process requiring sustained institutional commitment. Student-informed strategies include embedding reflexivity into curricula, engaging with Nordic colonial histories, and designing reciprocal international learning arrangements. While context-specific, these findings may inform broader efforts to decolonise global health educational practices.

Introduction: The consumption of sugar-sweetened beverages (SSB) is a significant public health issue linked to various diseases like diabetes, obesity, and hypertension. SSB include flavored beverages with added sugars, and their high consumption is prevalent worldwide. Notably, there is limited research on SSB consumption within Indigenous communities, including the Sámi, the only Indigenous group in the European Union. The aim of this study was to estimate the prevalence of SSB consumption and identify associated risk factors among the Sámi population in Sweden.

Methods: The research utilized data from the SámiHET survey. A total of 3,658 Sámi aged 18 to 84 responded to the survey, which included questions on health outcomes, lifestyle behaviours, and socioeconomic data. SSB consumption was assessed by frequency of intake, and sociodemographic, socioeconomic, and sociocultural factors were analyzed to identify associated risk factors. Prevalence ratios and their 95% confidence intervals were estimated, using sampling weights to enhance generalizability.

Results: The study found that 29.5% of participants reported consuming SSB at least twice a week. Men and younger individuals displayed higher consumption patterns. Statistically significant associations were also observed with lower educational levels and belonging to mountain reindeer herding communities. However, economic stress and income levels were not found to have a statistical association with SSB consumption.

Conclusions: The research highlights a substantial consumption of SSB among the Sámi, similar to national levels but lower than other Indigenous groups globally. Factors like gender, age, education, and specific sociocultural contexts (e.g., belonging to a reindeer herding community) were significantly associated with SSB consumption. Culturally adapted public health interventions targeting youth and men and increasing health literacy among the entire Sámi population are recommended to promote better health but also to prevent future chronic diseases.

This paper outlines the methodological approaches to a multi-site Circumpolar case study exploring the impacts of COVID-19 on Indigenous and remote communities in 7 of 8 Arctic countries. Researchers involved with the project implemented a three-phase multi-site case study to assess the positive and negative societal outcomes associated with the COVID-19 pandemic in Arctic communities from 2020 to 2023. The goal of the multi-site case study was to identify community-driven models and evidence-based promising practices and recommendations that can help inform cohesive and coordinated public health responses and protocols related to future public health emergencies in the Arctic. Research sites included a minimum of 1 one community each from Canada (Nunavut,) United States of America (Alaska), Greenland, Iceland, Norway, Sweden, Finland. The approaches used for our multi-site case study provide a comprehensive, evidence-based account of the complex health challenges facing Arctic communities, offering insights into the effectiveness of interventions, while also privileging Indigenous local knowledge and voices. The mixed method multi-site case study approach enriched the understanding of unique regional health disparities and strengths during the pandemic. These methodological approaches serve as a valuable resource for policymakers, researchers, and healthcare professionals, informing future strategies and interventions.

Background: Ethnic discrimination is acknowledged as a social determinant of health for Indigenous populations worldwide. This study aimed to investigate embodiment of perceived ethnic discrimination among the Sámi population in Sweden.

Methods: A population-based health study was conducted among the Sámi population aged 18-84 years in 2021. Perceived discrimination was assessed by three variables: exposure to threat, humiliation treatment and ethnic discrimination. To capture current physical health, complaints of headache, back pain, stomach pain, sleeping problems, dizziness and tiredness were used. An overall somatic complaints score was created by summing up the six individual symptoms. The magnitude of the association between the independent variables and the outcomes was summarised with the β coefficients and prevalence ratios using 95% credible intervals (95% CrI) for inferential purposes.

Results: Overall, 4.3% reported to have been exposed to threat, 26.1% to humiliation and 11.2% and 32.3% to ethnic discrimination in the last 12 months and beyond 12 months, respectively. After mutual adjustment, threat (β=1.25; 95% CrI=0.88 to 1.60), humiliation (β=1.29; 95% CrI: 1.14 to 1.44) and the two categories of discrimination (β=0.92; 95% CI: 0.64 to 1.21 in the last 12 months and β=0.68; 95% CI: 0.54 to 0.83 beyond) remained significantly associated to the overall somatic complaints score. Similar results were found for individual complaints.

Conclusions: This study has shown a strong relationship between different expressions of perceived ethnic discrimination and a series of somatic complaints among the Sámi in Sweden. Efforts to alleviate interpersonal and institutional discrimination against the Sámi would contribute to improve their health.

Aims: To assess the association between experiences of discrimination and mental health among the Sámi population in Sweden.

Methods: Cross-sectional study among the self-identified Sámi population living in Sweden in 2021, registered in the electoral roll of the Sámi Parliament, the reindeer mark register and the ‘Labour statistics based on administrative sources’. The analysis was based on a final sample of 3658 respondents aged between 18 and 84 years. Adjusted prevalence ratios aPRs for psychological distress (Kessler scale), self-reported anxiety and depression were estimated for four different forms of discrimination (direct experience of discrimination, offended because of ethnicity, historical trauma, and combined discrimination).

Results: Higher aPRs of psychological distress, anxiety and depression were observed in women experiencing direct discrimination because of their ethnicity, having been offended because of their ethnicity, and those with a family history of discrimination. Among men, higher aPRs for psychological distress were observed in those experiencing the four different forms of discrimination, but not for anxiety. Depression was only detected in the case of having been offended. Adding experiences of discrimination was associated with a higher prevalence of negative outcomes for all the indicators in women and for psychological distress in men.

Conclusions: The observed association between experiences of discrimination and mental health problems would support a gender approach when considering ethnic discrimination in public health policies concerning the Sámi in Sweden.

Introduction: Improving the health of Indigenous adolescents is central to addressing the health inequities faced by Indigenous peoples. To achieve this, it is critical to understand what is needed from the perspectives of Indigenous adolescents themselves. There have been many qualitative studies that capture the perspectives of Indigenous young people, but synthesis of these has been limited to date.

Methods and analysis: This scoping review seeks to understand the specific health needs and priorities of Indigenous adolescents aged 10-24 years captured via qualitative studies conducted across Australia, Aotearoa New Zealand, Canada, the USA, Greenland and Sami populations (Norway and Sweden). A team of Indigenous and non-Indigenous researchers from these nations will systematically search PubMed (including the MEDLINE, PubMed Central and Bookshelf databases), CINAHL, Embase, Scopus, the Informit Indigenous and Health Collections, Google Scholar, Arctic Health, the Circumpolar Health Bibliographic Database, Native Health Database, iPortal and NZresearch.org, as well as specific websites and clearinghouses within each nation for qualitative studies. We will limit our search to articles published in any language during the preceding 5 years given that needs may have changed significantly over time. Two independent reviewers will identify relevant articles using a two-step process, with disagreements resolved by a third reviewer and the wider research group. Data will then be extracted from included articles using a standardised form, with descriptive synthesis focussing on key needs and priorities. This scoping review will be conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.

Ethics and dissemination: Ethics approval was not required for this review. Findings will be disseminated via a peer-reviewed journal article and will inform a broader international collaboration for Indigenous adolescent health to develop evidence-based actions and solutions.

I denna debattartikel menar vi att Jonny Hjelm presenterar en förvrängd och förenklad bild av samisk hälsoforskning i sin debattartikel i Svenska Dagbladet 6 december 2024, vilket både underminerar det komplexa kunskapsläget och försvårar det viktiga arbetet för bättre samisk hälsa. Hjelm förminskar allvaret i psykisk ohälsa och självmord bland samer genom att selektivt välja och misstolka forskningsresultat. Han bortser också från aktuella data som lyfter fram förhöjda risker för suicidalt beteende bland samer i Sverige, särskilt bland unga samiska kvinnor. Vi framhåller Norges stöd till samisk forskning som ett föredöme och kritiserar Sveriges brist på resurser och grundfinansiering. För att förbättra samisk hälsa krävs ökat samhällsstöd, inte ideologiskt färgad kritik som undergräver det arbete som vi och våra kollegor bedriver.

In this opinion piece, we argue that Jonny Hjelm presents a distorted and oversimplified view of Sámi health research in his article in Svenska Dagbladet on December 6, 2024. This misrepresentation undermines the complex state of knowledge and hinders the important work of improving Sámi health. Hjelm downplays the seriousness of mental health issues and suicide among the Sámi by selectively choosing and misinterpreting research findings. He also disregards current data highlighting elevated risks of suicidality among Sámi in Sweden, particularly among young Sámi women. We point to Norway's support for Sámi research as a model and criticize Sweden's lack of resources and basic funding. To improve Sámi health, increased societal support is needed, not ideologically biased criticism that undermines the work we and our colleagues are undertaking.