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The Impacts of Cultural Norms on the Success of Healthcare Policies

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Linda-Marie Sundstrom
October 8, 2020

As major cities continue to report weekly Coronavirus statistics, one clear result is that minorities are more gravely impacted by the disease than their white counterparts. These health outcome disparities are causing many to re-examine current healthcare policies and priorities. Some are looking to other countries, such as Sweden, for models of equitable healthcare policies that could possibly be emulated. Could the successful socialized healthcare policies in Scandinavia be “air lifted” to the United States and create similar results here? Can the success of a healthcare policy in one country guarantee successful implementation in another?

Looking at policies and processes in isolation may only present us with part of that answer. Understanding the underlying cultural norms of the originating country can provide additional insights into the possible “transportability” of that policy. Our research team identified two relevant cultural norms historically prevalent in Scandinavian society as a basis to compare Scandinavian and American cultures. An analysis of these norms may provide a baseline for potential outcome predictions. We identified two little-known aspects of Scandinavian culture that may provide a key to understanding the successful cultural foundation and framework of their public health policy: 1) The Law of Jante and 2) Lagom.

The Law of Jante

The Law of Jante (pronounced yan’ tay) is not an actual “law.” It is a list of long-standing cultural norms compiled by Aksel Sandemose in the 1930s. It codifies social concepts in Scandinavia that have become deeply engrained in the culture. Their children are raised with the following ten values/norms. Note: “You” refers to the citizen, “we” or “us” refers to those in charge (i.e. the administration or government).

You’re not to think you are anything special.
You’re not to think you are as good as we are.
You’re not to think you are smarter than we are.
You’re not to imagine you are better than we are.
You’re not to think you know more than we do.
You’re not to think you are more important than we are.
You’re not to think you are good at anything.
You’re not to laugh at us.
You’re not to think anyone cares about you.
You’re not to think you can teach us anything.

This list demonstrates strong cultural norms focused on benefitting the collective, not the individual. This could obviously affect services and policy outcomes desired and expected.

Lagom

Lagom is the concept that, “A bite is as good as a feast.” In other words, self-imposed moderation. Abundance and excess are not valued. Rather, self-control and moderation are prized. A research assistant recently shared a story of an event from his high school days in Scandinavia. He explained he and his friends were standing in front of the school and someone drove by in a flashy sports car. The boys looked at each other in amazement and exclaimed, “Why is that necessary?” To them the sports car was a symbol of excess and not a practical purchase—and certainly not valued. The founder of the Swedish company IKEA, Ingvar Kamprad, drove a 1993 beige Volvo 245 Wagon until he passed away in 2018. Again, this mindset of moderation would affect services and outcomes desired and expected by the individual.

The Impact of Culture on Policies

When exploring successful policies in Scandinavia, the cultural infrastructure, in this case emphasizing collectivism and moderation, must be considered when looking at policy “transportability.” When they receive healthcare services, they approach the system with different individual priorities (“they” are nothing special), and with modified expectations (“they” are not as important as the collective). Moderation means not taking too much, leaving the availability of services for others. There is not a cultural norm of personal priority. The norm is voluntary personal sacrifice that will benefit all.

Cultural norms in the United States, including those we teach children, are almost the opposite of Scandinavia. All children are individually special and smart. We are raised to be fiercely individualistic, with a belief that all things are possible for us personally. Our personal hard work and dedication entitle us to reap personal benefits, even to excess. Can a healthcare system that succeeds in a country where collective norms such as Jante and Lagom prevail, succeed in a country where cultural norms value individual benefit, personal success and personal entitlement? Our research is continuing to identify key aspects that could aid or hinder transitioning policies from one country to another.

If you have thoughts on this topic, I would be interested in hearing from you. If you have any questions or would like more detailed information, please feel free to reach out to me as well.


Author: Dr. Linda-Marie Sundstrom is a former Fulbright Scholar who taught Public Administration in Ukraine at a university under the Office of the Ukrainian President. She worked for two decades in local government, and has taught in Masters of Public Administration Programs for nearly two decades. She is currently the MPA Program Director for California Baptist University in Southern California. Email: [email protected]

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