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

tion of making the reasoning more meaningful to other actors
involved.
The 1991 report of an external WHO review group (11)
several times mentions inadequate participation by the
public and actors in other sectors that would need to
implement the strategy. This was hardly surprising, since
there were no models from which to learn, Finland being
the first test case in Europe. No additional resources had
been designated for policy formulation, coordination or
monitoring of implementation. “A lot of normal advisory
boards and expert groups were used, some necessary
special research was commissioned, but no extra budget
or work-time allocated” (5). Following the parliamentary
discussion, which considerably raised awareness, the energy
of heavily pressed government officials was spent in drafting
the implementation strategy rather than working with
stakeholders, “in paper work and not people work” (5).
It was realized early in the process that some of the momentum
had been lost and, in order to revitalize efforts, it
was decided to attempt an internal revision of the strategy
parallel with a review by external (WHO) experts. In June
1991, a broad-based and high-powered Steering Committee
was set up for the implementation and follow-up of the
Health for All 2000 programme (9). Apart from representatives
of MSAH, the Committee included representatives
of the ministries responsible for education, agriculture,
trade and industry, transport and the environment; of
organizations with responsibilities for welfare, public health
and health education; and of cities, rural communities,
academia and the health professions. Their mandate was
to assess progress in implementation of the Health for All
2000 strategy and to make provision for its revision and for
better coordination of the activities of different sectors in
achieving its objectives.
The revised strategy (18) took clear note of the WHO review
group’s criticisms and provided for closer collaboration
between municipalities and NGOs, for better participation
of the public on administrative bodies and for training to
improve such interaction. It is interesting to note that, following
a request of the external review group to interview
health professionals, the nursing profession was thereafter
represented on health planning bodies. Their exclusion up
to then had not been intentional: in the absence of a stakeholders’
analysis, they were simply overlooked.
The whole process continued to be heavily expert-led, as
was the accepted way of working. Indeed, members of the
WHO external review group, who came from different
parts of Europe, had been impressed by the apparent public
trust of and confidence placed in experts and civil servants
in Finland.
In 1997, an Advisory Board for Public Health was set up
by the Council of State to renew the Health for All policy.
The Board was chaired by the Permanent Secretary of
MSAH and included representatives from various ministries,
regional health care administrations, research institutions,
NGOs and health professionals’ associations.
The Board published reports on inequities in health and the
life-cycle approach to health promotion. A series of seminars
was organized with very broad participation, leading to
the drafting of a consultation document (Health 2015); this
was sent out for comments at the end of 1999 and adopted
by the Council of State in 2001.
Perhaps surprisingly, given the intention of working across
sectors, only MSAH was given explicit responsibilities in the
document, with little detail on what other sectors might do.
2.1.3. Values and principles
Finland’s health and social policy is clearly founded on the
Nordic welfare model, influenced by a sense of cohesion, a
common (protestant) ethic and a very high value placed on
education. The central features of this model (19) are:
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases