An Effort to Save the Nordic Welfare State

Finland’s First Regional Elections

By: Karolina Lång

Like many other western countries, Finland is facing the challenge of an increasing elderly population. Combined with a global trend of urbanization, many smaller municipalities in sparsely populated areas of Finland have found it challenging to adequately organize public health care services while dealing with the shrinking size of its working age, tax-paying population. After lengthy discussions and repeated attempts spanning several governments, in 2021 Finland succeeded in passing major healthcare and social welfare reform.
 
Finland offers an extensive array of free public health care services at a local level, ranging from universally free maternity clinic visits to specialist doctors and practical aids (such as blood glucose meters for diabetics, and other aids for those who have chronic illnesses).
However, even before the onset of the Covid-19 pandemic, the country’s public healthcare system was under significant strain. Health and social welfare reforms were necessary not only as part of an effort to preserve the status quo of the Scandinavian welfare state, but also to be able to offer digital solutions and other new services.
 
Finland’s new healthcare and social welfare reform essentially shifts the responsibility to provide healthcare, rescue services, and social services from individual municipalities to a new county-level structure, called wellbeing service counties. Today, there are 309 municipalities in Finland, and these will be divided into only 21 counties. The capital of Helsinki and the Åland Islands will be excluded from the new county structure, since they will organize their healthcare independently from the counties in the future. Excluding Helsinki from the new county structure was motivated in part by the fact that Helsinki alone has a larger population than any of the new counties. But leading politicians in Helsinki also actively opposed joining the reform. Concerns in Helsinki were mainly financial, but city officials have also maintained that certain populations in the capital, like immigrants and homeless inhabitants, have unique healthcare needs that are best addressed at the city level.
 
Each of the counties will be led by a county council, which were elected in the first-ever regional election on Sunday, January 23, 2022. In the future, regional elections will be organized concurrently with municipal elections to encourage participation.
 
Topics that have been up for discussion leading up to the elections have centered on whether the new counties should have a right to taxation; how mental health and sexual and reproductive health services should be organized; and if every municipality can and should afford to have a health care centre. The new counties will also be the employer of public healthcare, emergency, and social workers, which has led to a discussion about securing equal wages for employees who previously worked for separate municipalities with different wage levels. However, an important question that has received less attention in the public debate concerns the organization of rescue and emergency services as a part of the healthcare and social welfare reform.
 
In the weeks leading up to the election, there was public criticism that the pandemic would affect voter turnout, which could be a threat to democracy. Only 26.4 percent of citizens eligible to vote used their voting right during a week of advance voting, and the voter turnout altogether was 47.5 percent. Compared to other national elections in Finland, where voter turnout typically ranges from 50-70 percent, this number is rather low.
 
There were also concerns that citizens in cities and more populated municipalities would have an unfair advantage in the election, since each county is a single electoral district in its entirety. This was reflected in a poll by the Finnish broadcasting company YLE ahead of the election, where responders stated that they were more concerned that the candidate on their county council represents their own municipality than by which political party the candidate represents.
 
The National Coalition party, which is the main opposition party in Finland, won the election with 21.6 percent of the votes. The Social Democrats, led by Prime Minister Sanna Marin, and the Centre party jointly came in second, with 19.3 percent and 19.2 percent respectively. Because the capital of Helsinki did not take part in the elections, election results might not be reflective of general electoral trends. This could be observed especially for the Green party, which has traditionally been most successful in Helsinki and other large cities. In this election, they gained only 7.4 percent of the votes The nationalist Finns Party also gained less support than in other elections, with only 11.1 percent of the vote.
 
While the National Coalition Party originally opposed the healthcare and social welfare reform, ahead of the election the party managed to convey a pragmatic approach towards addressing major election themes, with a focus on a sustainable economy. Instead of having health care centers in every municipality, the party emphasized that the reform would bring access to services and no new tax on the county level. Evidently, this message spoke to the Finnish people.