Unemployed residents in Finland have had the opportunity to get their physical health checked by a nurse or doctor for free since 2011, but few are aware of this basic right.
In 2016 Finland's central organisation for the unemployed launched an EU-funded project called Terveydeksi (roughly: For health), which reaches out to long-term jobless people; finding them in bread lines and community centres and directing them to the services they could require.
Over the past two years the NGO has made about a hundred visits to such locations to inform the unemployed -- particularly the long-term unemployed -- of their right to basic health care. Project head Katriina Lehtovaara says the figures aren't all in yet, but that the data they have is clear.
"These people's daily lives are harsh, and information is scarce. Not everybody has the strength or the ability to find things out on their own," she says.
Finland's employment centres are tasked with directing jobless people to seek medical check-ups, and organising such care is the responsibility of each municipality.
Scant information risks lives
The central organisation for unemployed people has already found more than 20 municipal websites which do not include information about local health services, while some 70 municipalities have updated their sites to include such information.
Surveys show that the unemployed are often faced with waiting times of between one to two months for an appointment with a nurse, but waiting times vary by location. In some regions health centre appointments are available within a week, while in others waiting queues can be up to three months long.
Sometimes, Lehtovaara says that after a jobless customer is ignored, organisation case workers are forced to call the municipal authority themselves.
"It's a twisted situation when [civil servants] don't help and need to be contacted [by others] on behalf of people in need," Lehtovaara says.
During the group's one hundred-plus outreach efforts at bread queues and community centres across the country, workers managed to get some 400 unemployed people appointments at health centres. One in four of those who met with medical staff ended up being treated for serious conditions.
"In some cases the customer has to be sent straight to the emergency room. It can be anything from high blood pressure to untreated diabetes," says Lehtovaara. "If someone doesn't have a lot of money it may be impossible for them to buy medication."
Years of neglect
Legally, an unemployed person's fitness for employment needs to checked by a physician after the individual has received unemployment benefits for 300 days - or after being jobless for an entire year. For those under 25-year-old the period is six months, and the Ministries of Economic Affairs and Development and Social Affairs and Health are responsible for ensuring these requirements are met.
If this unemployed jobseekers don't receive the legally-mandated health services, local job centres, the benefits agency Kela and the local municipality must collaborate to attend to the individual's health care needs. In practice however, people may go without health services for years on end.
"The periods can get really long," says nurse Sari Armila from the Porvoo health centre, where the system works better than in other regions. "I remember a person who unemployed for 20 years before coming in for a check-up."
Each patient gets to spend an hour and a half with Armila as she gives them a thorough checkup..
"It might sound like a long time, but sometimes it's not even enough."
Jobless at risk
Unlike in other municipalities, health checks on the unemployed in Porvoo are registered with a national code as a statistical aid.
Employment office data indicate that some 5,000 unemployed people were directed to medical care via job centres in 2016. In the first half of 2017 alone some 4,500 people were sent to be checked.
A recent government report estimates that only about 10 percent of unemployed people receive a medical examination.
Furthermore, researcher Peppi Saikku from the National Institute for Health and Welfare (THL) says that truly reliable figures on the number of medical exams are unavailable.
Saikku says that THL would consider it acceptable if 20-40 percent of unemployed people made it to the doctor's or nurse's office.
"We're talking about a very heterogenic group of people with highly varied needs," Saikku says. "It's important to me that care be given based on individual needs, not churned out as routine."
Unemployed people are more likely to have health issues and illnesses than people with jobs. For some the gratis medical examination may be the first step towards employment.