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

mination and active participation in international decisionmaking.
This analytical approach of defining goals and objectives
and looking for politically feasible means of achieving them
was already apparent in the health field by the mid-1970s
and early 1980s. Simultaneous with the rapid development
of health care, and partly due to the North Karelia project
(see below), the need for intersectoral action for public
health was clearly recognized. A rare combination of factors
came together: economic growth allowed a tremendous
expansion of government funds; activists from the 1960s
had been co-opted to key administrative posts, and there
was enthusiasm for planning. As stated by one such activist
“The era was characterized by dynamic growth, rational
planning and the development of egalitarian social policies”
(5) with the Nordic-type welfare society as the clear goal.
Finnish experts were active in the development of the Ottawa
Charter and the WHO Health for All policy. Finland
not only joined the “world’s largest study of heart disease,
stroke, risk factors and population trends”, the WHO
MONICA Project, but gave considerable long-term support
by acting as the Project’s data centre from 1984 (6).
Coincidently, the elected head of the WHO Regional Office
for Europe was a Finn, Dr Leo Kaprio, who had been quick
to recognize that Health for All held promise for countries
at all levels of development (7). When the WHO Director-
General, Dr Halfdan Mahler, asked Finland in 1982 to act as
a pilot country in adapting the Health for All policy at the
national level, this was quickly accepted; this internationally
agreed policy with its underlying values of equality in health
and participation in decision-making; its focus on PHC; and
the promotion of health through intersectoral action fitted
well with the country’s own aims and objectives.
Following three national seminars to discuss the concept
and its implications for Finland, MSAH appointed a steering
group to draft a national Health for All policy. There
was no precedent in Europe for Finland to follow and the
first draft was extremely long. A much shorter version (8)
was therefore prepared and discussed by Parliament in
March 1985, gaining support across political parties. Based
on these agreed directions, in 1986 MSAH published a
national Health for All 2000 strategy (9), the first of its kind
in Europe.
So began a sustained effort, surviving changing coalitions
and governments. In 1993, following broad consultation, the
original policy was revised and approved by the Government
and was revised again in 2001. A group of highly
talented, like-minded people were in influential positions in
the health sector bureaucracy, which no doubt facilitated
this innovative action. How far this enthusiasm trickled
down to become action at the local level is less clear (10).
It was not all plain sailing. Inadequate resources had been
provided for implementing and monitoring progress. MSAH
and National Board of Health officials were expected to
handle the implementation and monitoring of progress
in the Health for All policy, on top of their usual duties,
and fatigue set in. Judicious use was made of WHO when
energies were flagging. Twice, teams of outside experts
coordinated by WHO were invited to review progress in
the development of the policy (11) and of health promotion
policies (12), thus revitalizing interest.
International collaboration was ably used to support and
legitimize innovative approaches to policy development
promoted by key actors in Finland. At the same time, Finland
pushed issues of concern to it on to the international
agenda, including the explicit inclusion of mental health in
the definition of health during the first Finnish EU presidency
in 1999, and health in all policies (13) during its 2006
presidency.
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases