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

Chapter 4
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2.1. Broad policy for health – Health 2015 public
health programme
The current broad policy for health in Finland is the Government
resolution on the Health 2015 public health programme
(14). This is complemented by Strategies for social protection
2015 – towards a socially and economically sustainable society
(15). (A policy to tackle inequalities in health is currently
being prepared by the new Government.) 2
2.1.1. How things started
This umbrella policy is a continuation of long-term efforts
stemming from the 1972 law that strengthened the legal
basis for health promotion, through the early 1980s when
the Health for All policy shifted the focus from health care
to health. Health 2015 refers directly to the objectives set
in the first 1986 Health for All strategy and progress made,
or still to be made, in their achievement, and states: “The
WHO’s more recent global Health 21 programme and the
programme for the European Region based on it provided
the foundation for Finland’s new Health 2015 programme”
(14). The revised Constitution, effective March 2000,
required the Government both to ensure health services
and to promote health. With this in mind, the government
programme states that the promotion of the population’s
health and functional capacity was to be a factor guiding
all public decision-making and activities. Article 152 of the
EU Treaty of Amsterdam also influenced this position, and
reference is made to the increasing impact of EU decisions
on health and the need for a stronger international dimension
in new health policy initiatives.
The main objectives defined 20 years previously, “to give
people a longer and healthier life and to reduce health differentials
between population groups”, were seen as still being
valid. There is, however, one significant shift in approach.
2
Since the completion of this case study, a national action plan has been
formulated (16). This is linked to Health 2015 and includes actions to
tackle risk factors for NCD such as smoking and alcohol abuse, lack of
exercise and poor nutrition.
For the 1986 strategy, following intensive consultation, it
was decided to set quantified targets only where appropriate:
on scientific grounds owing to the complexity of issues
such as reducing inequalities; and on political grounds since
it was thought that politicians would not be comfortable
setting targets in areas over which they had little influence.
In contrast, Health 2015, based on “research and expert
opinions”, sets quantified targets for improving the health of
different population groups (children, young people, young
adult men, people of working age and those over 75), plus
targets relating to the whole population, health services, the
environment and reducing inequalities.
Decentralization in the planning and management system
was also said to have led to a reconsideration of the use of
health targets in policy-making (17). It was expected that
the targets could only be reached by developing healthy
public policy, action in various settings and throughout
the life cycle. Much of the action was to come from the
municipal level, which still tended to be in a “cutting mode”
following the economic crisis of the early 1990s.
2.1.2. Awareness building and the consultation process
Before turning to the latest experience, it is helpful to
consider previous consultation efforts. The Health for All
process in Finland in the early 1980s was initiated by leading
government officials in the health field. Although municipal
and professional organizations, as well as other sectors,
were involved through seminars and expert meetings, “the
exercise remained to a large extent a synthesis of expert
views on health policy development, which were then
filtered and mangled through the political process” (5). The
draft policy was circulated for comments for three months.
The long first draft was considered politically unmanageable,
and a team in MSAH led by the Minister reformulated
the report for Parliament in 60 pages. The MSAH strategy
that followed was more extensive, with the explicit inten-
Case studies: policy development in countries for tackling noncommunicable diseases