Gaining health : analysis of policy development in European ...

ished, however, differences between social groups have
increased.
At 3.1 per 1000 live births in 2005, the infant mortality rate
in Finland remains one of the lowest in the world. According
to WHO estimates, on average, Finns can expect to be
healthy for about 90% of their lives.
In 2002, NCD accounted for at least 80% of all deaths in
Finland, with CVD accounting for almost 41% and cancer
for almost 22%. Overall, although CVD occur less frequently
than previously, CVD mortality is still slightly higher in
Finland than the EU average and is a particularly problem in
men aged 25–64 years. Deaths from cancer, however, are
relatively lower. For example, the standardized death rate
(SDR) for trachea/bronchus/lung cancer in 2004 was 26.0
in Finland compared to 36.7 in EU countries prior to May
2004. With the ageing of the population, however, there is
a greater prevalence of cancer.
Efforts at tobacco control have shown results, with the
level of smoking declining, as have changes in eating habits.
Partly owing to binge drinking, however, particularly in men
(30% of drinking occasions for men), alcohol abuse remains
a growing health risk. Obesity is also increasing as a health
issue.
A quarter of Finns’ disease burden and sick days are due to
psychiatric disorders. The number of people suffering from
dementia has increased. There has been considerable success,
however, in bringing down the suicide rate.
1.3. The main features of the health system
Finland has a compulsory tax-based health care system
providing comprehensive coverage for the entire resident
population. At the national level, the Ministry of Social
Affairs and Health (MSAH) issues framework legislation
on health and social care policy, norms and guidelines,
and monitors their implementation. At the local level, the
municipal health committee, council and executive board, as
owners of the PHC centres and hospitals, plan and organize
health promotion and health care.
The decentralization of the late 1980s and the abolition
of the National Boards of Health and Welfare in 1991, to
be replaced by the National Research and Development
Centre for Welfare and Health (STAKES) and other smaller
agencies, was a response to a general demand from the local
level for greater independence. This does not, however,
appear to have been an unqualified success. Unviable small
local units were given responsibility for policy and planning
for which they did not have the capacity or resources and,
although they were largely freed from what they felt to be
the domination of the MSAH and the National Board of
Health, they lost much of the support they had previously
received in the form of guidelines and the expertise of
Board officials, who had spent much of their time travelling
the country. Furthermore, this change coincided with
the economic crisis and ensuing budget cuts. Consequently,
considerable inequalities were created.
The 1972 Public Health Act aimed to shift the focus from
hospital to PHC, offering strong financial incentives to
attract physicians to PHC. A key feature of the system is
the municipal health centre, staffed with physicians, nurses,
physiotherapists and social workers and providing a full
range of primary care services. In contrast to many countries,
more than 20% of doctors are GPs working in health
centres. To improve continuity of care, attempts were later
made to develop a personal doctor system, with each GP
being responsible for a certain population, but this does not
appear to have been completed. According to the OECD,
the ratio of nurses to physicians is the highest in the EU.
Nurses traditionally make home visits, and home care is
reasonably well developed for older people and children.
Federations of municipalities form 21 hospital districts, responsible
for arranging and coordinating specialized care.
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases