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

Chapter 4
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• the principle of universality
• a strong public sector
• tax funding
• citizens’ rights grounded in legislation
• equal treatment
• social benefits of a relatively high level.
With regard to income and wealth distribution, Finland is
one of the most egalitarian societies in the world. Even during
the severe economic crisis of the early 1990s, strenuous
efforts were made for the survival of the Nordic welfare
state, although the level of benefits was less generous than
in the past and the universalistic nature was weakened.
On the whole, however, masses of people were prevented
from sliding into material poverty and multiple deprivation
and income differentials were kept largely under control.
Finland has an excellent information base and strong
research resources that facilitate the reflection of possible
inequalities in health. The availability of epidemiological data
has made it clear that, despite persistent efforts, health
gaps between certain socioeconomic groups continue to
grow. This has been partly exacerbated by growth in the
share of the highest income decile and persistent long-term
unemployment. The Health 2015 public health programme
therefore states that “another aim will be to reduce inequality
and increase the welfare and relative status of those
population groups in the weakest position. The objective
will then be to reduce mortality differences between the
genders, groups with different educational backgrounds,
and different vocational groupings by a fifth” (14).
All the Finnish policy documents examined for this study refer
to the Nordic welfare state and the reduction of health
inequalities as being central goals of Finnish policy. A 2004
report by MSAH examined how inequalities in health are
tackled in England, the Netherlands and Sweden in order
to “introduce experiences gained in these countries to the
Finnish audience, and to assess whether lessons could be
learnt” (20).
Adherence to the principles of the Nordic welfare state
provides a clear general framework for policy development
at a national level in Finland, a situation not so easily evident
in other countries. Nevertheless, although the equality principles
have been so clearly stated and over a long period
of time, it is more difficult to discern the policy interventions
intended to narrow the gaps, particularly in relation
to NCD. There is also some concern that in recent years
the Nordic model has become rather shaky and that lower
standards are being tolerated.
2.1.4. Setting the agenda
The long history of developing Health for All policies in Finland
created a particular way of thinking, as did the North
Karelia Project that gained worldwide fame. The young, talented
leaders of those movements originally set the agenda.
Since key bureaucrats do not change with changing governments,
they have been in place for three decades and are
now approaching or have just reached retirement age. It
is not clear who their “heirs” might be. However, although
the personal leadership qualities of such key actors might
not necessarily have been replicated, it is probable that the
system prevalent in Finland of facilitating on-the-job training
and of moving staff between research, the academic field
and the bureaucracy will ensure that experienced people
emerge from among the cohorts of younger experts.
The small population of the country and easy personal
contact strengthen a system that allows for open discussion
of the challenges and an approach of “continuation plus
change” to deal with them.
Another important condition for agenda setting was Finland’s
accession to the EU. Finland was acutely conscious of
the possible challenges and opportunities for health in join-
Case studies: policy development in countries for tackling noncommunicable diseases