PHM-North America had an exciting conversation with Simone Granberg, Sebastian Gunnesson, and Mia Appelbäck, from Sweden, who are fighting back against their government’s decisions to cut health services in their communities. Mia is a physician and activist with PHM-Scandinavia. Simone and Sebastian have participated in years-long occupations of their local hospitals in the towns of Dorotea and Sollefteå in the north of the country. Listen to their stories below.
The Swedish welfare state has become a lucrative market for private enterprises as the majority of these services are state-financed and provide secure profits. This potential for profit has driven the growth of privatization through practices such as outsourcing public services and the increased presence of private health insurance, primary care clinics, and hospitals.
Sweden is often held up as model of what universal health care should look like everywhere: affordable, accessible, quality care for all. However, the public healthcare system and welfare state in Sweden is being slowly dismantled by austerity measures and privatization.
At the national level, the Swedish government has been divesting from public health services. Locally, county authorities implement austerity packages and centralize services in order to cut costs. Local health services are often cut and moved to larger facilities which are owned and operated by private companies. As a result, many people are seeing health services in their communities moved farther away to larger towns or cities.
Dorotea and Sollefteå are located in rural areas in the north of Sweden. People who live in these areas are disparately impacted when county governments (county council) decide to withdraw services from or completely close local hospitals. When the much needed health care in these rural communities is cut, rather than up to a 30 minutes drive, people must now travel to the next closest clinic or hospital which could be over one or two hours away. This is not only the case for primary care but also for emergency services.
Dorotea: Fighting to keep health care in the community
…for me it is a given that I fight for Dorotea. It is me who lives here and even I can be affected by this. But first of all [healthcare] is a given for all who live here. –Simone Granberg
Dorotea is a town of about 1,200 people in the county of Västerbotten. In October 2011 the county council proposed an austerity plan that would close the cottage hospital (sjukstuga), which serves as a primary care clinic, offers emergency services, and has an emergency ward with overnight beds. The plan would also discontinue ambulance services in the town of Åsele (replacing it with an emergency car for minor emergencies), about 40 minutes away, which also served Dorotea. The action would save a little over half a million USD but would deny people health care in their own community, with the closest services being at least an hour away.
The hospital closed in January 2012. Soon after, a small group of people were impacted by the decision began to reach out to residents of Dorotea with the goal of organizing a response. Simone was one of those contacted, and she began informing others of the situation and the need to organize. This outreach resulted in a meeting of about 500-700 people. A wide range of people, including private citizens and representatives of businesses and schools, showed up to plan how they would fight the government’s proposal. At that meeting, the people decided that they must occupy the hospital.
I didn’t even need think about it, it was a given on my part that I would be there on the day we were going to occupy the cottage hospital. I didn’t really know what it was all about but we were going to occupy the cottage hospital and naturally I was going to be a part of it. –Simone Granberg
On 31 January 2012, protesters gathered at the Dorotea hospital and began the occupation; 50-100 protesters were on site for twenty-four hours a day each day. The local government was heavily adversarial and initially responded by having security presence to “contain” the occupiers. But after about three weeks, realizing the occupation would continue and that it was expensive, the local government withdrew security. They then placed strict rules on the protesters in an effort to squash the occupation, restricting protesters’ movement. For example, protesters were forbidden from using coffee pots and kettles or warming food.
During this time, the government, although invited, did not meet with or directly communicate with the protesters to address their cause. Because of the government’s unwillingness to engage in any dialogue, the group determined it was necessary to force a referendum to make the people’s voice heard. It would be the first ever referendum concerning healthcare in Sweden.
Achieving the referendum was challenging for the protestors. The large number of votes needed, 20,500 (10% of the county population), required an incredible amount of travel across the whole county. The county council also frustrated the process. They engaged in a long debate to determine how the question on the referendum would be worded. They also were slow to agree on a day to hold the vote, suggesting Mother’s Day as an option and rejecting the option to hold the vote in conjunction with one that was already-planned. In the end, protestors were successful and collected 24,801 signatures.
The referendum was held on 8 September 2013, one year and eight months into the occupation. For the referendum to be viable, the county council required that at least 50% of eligible voters cast a vote. The protesters won the referendum with 88% of the vote, but it ultimately failed because only 29% of eligible voters voted. Even though the referendum failed, the strong majority vote against the closure of the hospital placed pressure on the county council to address the situation, and the occupation continued.
As long as we do not get any positive news and a promise of improvement we will stay where we are. We don’t plan on having sat here for three years unnecessarily.” –Simone Granberg
In February 2015 the county council declared that the occupation was illegal, on the grounds that it was a danger to patient safety, and threatened to have law enforcement to remove occupiers from the premises. The occupiers refused to abandon the occupation, and this action by the government incited more solidarity and rising pressure from the community. Then, instead of arresting the occupiers, the county council and municipal government switched gears and entered into negotiations to reopen Dorotea’s cottage hospital.
In response to the initiation of these negotiations, protestors decided to stop the occupation. So, in April 2015, after a total of three years and four months, the occupation ended.
Simone explained, however, that the struggle did continue. In response to the initiation of negotiations, occupiers rented a room elsewhere in town where they could continue meeting and monitoring healthcare issues. They regularly invited politicians to report to them on the negotiations until an agreement was reached.
It’s a matter of human rights and humanity. Of course you have to fight! -Simone Granberg
After months of negotiation, the county council and municipal government reached an agreement to reopen Dorotea Hospital with 24-hour care. On 12 September 2016, the cottage hospital began to receive patients again with four observational beds paid for through the county council and one bed for those awaiting placement for long-term care (korttidsplatser) funded by the municipality of Dorotea.
Sollefteå: Defending maternity services in a wave of cuts
On the night that we decided to occupy, we made a choice: We won’t listen to the politicians anymore. –Sebastian Gunnesson
In Västernorrland county, the hospital in Sollefteå serves an area of about 52,500 people. During their 2014 campaign, the Social Democrats promised to keep open three emergency hospitals in the region and that the Sollefteå hospital would go untouched. They went back on these promises after they came into power.
In August 2015, the county council put forth a proposal to cut orthopedics and emergency surgery at the Sollefteå hospital. Closing emergency surgery would force people needing emergency care to travel to Sundsvall which could be a drive of up to 2.5 hours away for some people.
At that point, on 10 October 2015, people from towns that would be heavily impacted by these cuts organized a protest in Kramfors which 15,000 people attended. The proposal was not withdrawn, and another demonstration, with the same large turnout, was held in Härnösand in April of 2016.
Despite this large public mobilization and continued public opposition to the cuts, the county council proposed more cuts in September of 2016. This time it proposed to cut many women’s health services at the Solleftå hospital, including labor and delivery, meaning women would have to travel long distances to give birth. The county council, with the Social Democrats holding a majority, voted to cut labor and delivery services at Sollefteå hospital on 26 October 2016.
In response, and inspired by the occupation a few years before in Dorotea, activists decided that they must occupy the hospital. On 30 January 2017, 400 people showed up to to the hospital to begin the occupation. Since the beginning of the occupation, there have been about 2,700 different people occupying the Sollefteå for 72,000 hours over the past year and nine months (at the time of our interview in August 2018). At the beginning there were about 10-15 occupiers present at all times. But adjustments had to be made for the Occupation to continue. Now, the group is onsite continually, rotating by shifts of 5-20 people.
Because of the large demonstrations early on and media coverage, the occupation and has gained national attention and solidarity from politicians and celebrities. A nonprofit organization called Sollefteå Hospital of the Future has formed and takes a large role in organizing. The occupation also inspired the rise of more groups who fight for a full service hospital in Sollefteå.
This occupation has called attention to necessity of labor and delivery services, especially in rural areas, at a national level. The national government has begun to invest more in maternal health care, but the Västernorrland county council has not restored these services in Sollefteå. In the elections of 9 September 2018, the Social Democrats lost 34% of their support in the region and the new Healthcare Party (Sjukvårdspartiet Västernorrland, SJVP) won the most votes. With the new leadership, talks will begin to reopen labor and delivery services at the Sollefteå hospital.
I do really hope for Sweden’s sake that we get a government that acts on their promises. That they actually invest, and not divest, in healthcare. And that taxpayer money goes back to the people and not into the pockets of very rich capitalists. –Mia Appelbäck
How did they do it?
The Dorotea movement benefited from being organized in a small town of 1,200 people. Organizers made personal contact with their neighbors. As Simone said, she was first contacted via text message and began to reach out to others in the same way. There was also high involvement from people living in the surrounding towns who would be impacted by the hospital’s closure. After the occupation began, the movement, which called itself Doroteaupproret, began to organize and share news through their Facebook group which is still active with over 2,700 members.
“It kind of organized itself on the internet.” -Sebastian Gunnesson
Sebastian explained that many different groups came together to put up posters and place advertisements in the newspaper to mobilize people to attend the first demonstration in Kramfors to respond to cuts at the Sollefteå hospital. Those who had the initial idea to occupy the hospital began a Facebook group to organize. Through this group they were able to gain a broad reach and issued a press release to organize a planning meeting. After this meeting and the decision to occupy the hospital, the group initiated the main Facebook group to organize the ongoing occupation, Ådalen 2017, and it grew to 2000 followers in two hours. While not many people showed up to planning meetings, through the Facebook groups they were aware of what was going on and when and where to show up.
To combat misinformation and lack of information, Sollefteå organizers conducted research and provided factual information to the local people regarding the county’s finances and budget. They examined and analyzed the region’s saving suggestions and were able to find and expose miscalculations. They also found corruption among politicians and other officials going back five years. This work helped local people realize and understand what was happening to their health services and to themselves and family members as patients.
One of the challenges for Dorotea was that their small group had to reach out to and educate people from all over the county, especially in order to gather enough signatures for the referendum. They canvassed their neighborhoods and set up booths or tables at different in public spaces and events across the county in order to let people know what was happening to the Dorotea hospital and to collect signatures. They also went to universities, with more dense crowds of students, and were able to get a larger number of signatures in shorter time. By chance, at one university, they spoke with a physician who was a member of the medical board. He shared the petition in his network which raised awareness and garnered support for their cause and more signatures to trigger the referendum.
Sustaining the Occupations
The Occupation in Sollefteå has had no police presence, and from the beginning they pledged that theirs will be a peaceful protest. Dorotea occupiers, on the other hand, faced an initial security presence and were threatened with removal in February of 2015 when the occupation was deemed illegal. Simone, as the face of the occupation in media was targeted by the government, but she says that the attention on her was good for everyone else. When the municipal government began to try to identify occupiers for law enforcement purposes, they stopped with Simone.
Later the Dorotea municipal government placed restrictions, for example, on whether occupiers could use the coffee makers and kettles or use microwaves to warm food. To overcome this, the local community organized to bring hot coffee, food, and drinks to the occupiers daily. Similar support was seen in Sollefteå, although there were no restrictions on occupiers. A local company donated a refrigerator and a television. Local pizza shops, on their own initiative, organized and made a schedule to deliver pizza to occupiers daily for a month. Supporters also donate money which is used to buy breakfast for those who spend the night at the hospital.
It has been key for both occupations to have involvement and support from a diverse group of community members. At demonstrations and at the occupations, children are often on site. To make sure the occupations sustain when some may have to go to school or work, pensioners and retirees occupy during the day. Everyone’s engagement has been a valuable contribution to strengthening and sustaining these movements.
Simone and Sebastian are passionate about maintaining quality, equitable healthcare and the right to health in their communities. Living in rural areas and paying higher taxes than many other parts of Sweden, they both feel that they should be treated equally as the rest of the country.
Mia emphasized that these occupations have had an impact on the national discourse about austerity and how the government at all levels relies on this as an excuse to cut funding to public services. She reflected:
We are talking more about austerity now. Sometimes I wish it would be put into a more political stance, that this is actually a political choice and not necessarily about not having enough money. –Mia Appelbäck
We asked Simone and Sebastian if they felt that occupation is an effective strategy, and these were their responses:
It is vital that people mobilize. Between elections, it feels as if people can’t do anything to make change as politicians have all the power. But using this mechanism to engage people, to agitate, can make citizens’ voices heard when they are dissatisfied with decisions the government is making. If you live 230km away from the nearest town, you also have the right to healthcare, and you must be able to stand up for that. It’s not just saying politicians aren’t doing anything; you must actually react—with occupations, referendums. We fought for our hospital and we succeeded. –Simone Granberg
It’s about democracy. It’s about centralization. The powerlessness you feel and the sadness you feel in knowing that a bigger city can eat the smaller in the name of democracy. Or that someone has promised something to you and then they let you down–or they act very cold… this is a way for us to get control of our own destiny. And to feel pride. There’s a lot of shame and sadness in being fooled, and that energy has to go somewhere. You have to let it out in some way. Otherwise people will vote for very right wing politicians… This is a way for us to get our hospital back and also to show we are worth something, that we have value in this part of the country… We stand up and take back our hope for the future. –Sebastian Gunnesson
Doroteaupproret Facebook group
Sollefteå Future Emergency Hospital Facebook group