High living standards, free education, free health care. What’s the catch?

The other day I saw a video of someone extolling the virtues of Greenland’s living standards and free health and education systems over other ‘developed’ nations and I felt a stir of dissent. It is likely that most people probably think the living standard in Greenland is significantly lower than it actually is. Measured using GDP per capita – one of the common ways of measuring standard of living – Greenland ranks lower than the US, Denmark, or Australia, but higher than the UK, France, or Japan, for example. It’s about on par with Germany, Belgium, or Canada. (Though it’s worth noting, in this context, that about a quarter of Greenland’s GDP is an annual block grant from Denmark).

It’s also true that Greenland has free education and health care, which is great. But being free doesn’t mean that Greenland’s education or health systems are of the same, or a higher standard than other developed nations. For example, Greenlanders are eligible for free education including university education, both in Greenland and in Denmark. That is fantastic. Unfortunately, however, the standard of primary and secondary school teaching in Greenland does not, on average, compare favorably. That is one of factors that translates into poor student performance. Of the one in seven kids who progress past the manditory 10 years of primary education, more than 70% require supplementary courses before they can even be accepted for further study. Of those who do progress, fewer than half complete high school and those who do are generally significantly behind their Danish counterparts in both Danish and English language skills, which makes it difficult to progress to university education – even without tackling the significant cultural and social challenges of moving to either Nuuk or to Denmark, to continue education. The drop out rates from university are typically around 50%.

As for health care, Greenland has established a remarkably comprehensive system, given its remoteness, sparse and widely dispersed population in small communities, limited access to qualified professionals, and low tax base to financially support such a system. Despite these challenges, Greenland has one large and quite well resourced hospital, in Nuuk, and smaller clinics in other cities and communities. There is a dedicated helicopter retrieval service (and access to fixed-wing transport) to bring patients in to Nuuk from the communities all around Greenland. And there is a dedicated service to bring patients to Denmark for specialist treatment or surgery that can’t be obtained in Greenland. There are also great initiatives targeted at improving systems to meet Greenland’s specific needs – online and phone-based supplementary medical services, and programs targeting healthy eating and living to reduce illness and disease through prevention. And my personal experience has been that the qualified health professionals working at the hospital in Nuuk – including increasing numbers of Greenlandic professional staff – are very competent. Overall, health care in Greenland  is considerably better than I would’ve expected given the limited resources and practical contraints Greenland has. And all of this is free of charge to Greenlanders, which is fantastic. But Greenland still has practical and logistical constraints that cannot be fully overcome. It’s difficult, probably impossible, to fill all the gaps with the resources available.

For example, even in Nuuk, if you break your arm – even your back – on a weekend, there’s a fair chance you’ll be sent home with paracetamol and asked to come back for an X-ray on Monday when the radiologist is on duty. If, instead, you break your arm in a small community somewhere on the coast, it might take days longer if there is bad weather and the helicopter can’t fly, which is not uncommon. If you injure yourself and need physiotherapy, you will only get it if your case is severe. If it’s a mere torn ligament, for example, you may never see a physiotherapist as there simply aren’t resources enough, and there are usually no private alternatives. If you have a lump in your breast and need a mamogram, or a biopsy, you will need to wait for an appointment with the specialist who visits Greenland about every six weeks. If you have a stroke, you will receive stroke recovery treatment including physiotherapy in Nuuk (although best not to have a stroke on a Friday because you may not be monitored by a health professional over the weekend). But once that initial period has passed and you have to return to your smaller community, there will be no ongoing treatment. If you can’t physically manage alone, the best you might hope for is that you’ll get a place in an old folks’ home where basic living services will be provided. But there’s also a fair chance that you won’t and it will be up to the good will of your family or friends to take care of you. These are all real examples just from my personal knowledge.

Health and education in Greenland are free at point of use but we do, of course, pay for them through very high taxes – typically 42%. And that’s fine. I haven’t heard anyone complain about the high taxes because, yes, it is definitely worth having free health and education systems that are available to all. And both health and education are high priorities in Greenland, and both continue to improve, which is excellent. But don’t imagine they approach the standards of most developed nations.

They don’t.