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

Chapter 4
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Broad use is made of “recommendations” and “guidelines”.
For example, expert committees have made recommendations
regarding healthy food, high blood pressure and
cholesterol, dietary guidelines, and goals for mass catering in
relation to the fat, salt and sugar content of meals provided.
HIA is seen as a vital tool for avoiding negative influences
on health and picking up opportunities for health promotion.
MSAH and the Prime Minister’s office are to produce
guidelines for HIA of central government decisions and
compile models for HIA at municipal level and in business
and industry. In Finland, environmental impact assessment
has been mandatory since 1994 and should include the
impact of ”health hazards”. At the same time, social impact
assessment has been carried out. In the Finnish language,
this has a narrower meaning than “social” in other countries,
referring to social protection and social services, and
has been carried out mainly by Gallup-type reporting on,
for example, whether people were willing to pay more for
services. It is suggested (21) that HIA might possibly be carried
out as part of a broader “human impact assessment”
and in 1999, MSAH published a handbook on the assessment
of social and health impacts.
2.1.6. Structures and processes for implementation
The previous method of top-down guidance through earmarked
resources made the Government, in the view of a
bureaucrat of the time, “almost able to dictate” to the municipalities.
This system was abandoned in the early 1990s,
when the municipalities demanded more freedom. Under
the present system, the centre sets overall policy direction
and provides expert support for local-level policy development
and training. There is considerable doubt as to its
success, however, owing to ensuing inequalities, and in some
cases a serious lowering of standards, in services provided.
MSAH is to coordin ate and monitor the implementation of
Health 2015 at national level. In addition, the multisectoral
Advisory Board for Public Health, set up in 1997, has two
subgroups, one to support the municipal level and one to
deal with intersectoral action at national level. The permanent
standing committees of MSAH dealing with issues
such as alcohol, drugs and chemical safety include important
NGOs and are the locus of intersectoral action.
STAKES and five smaller agencies were founded in 1992,
following the dismantling of the previous National Boards
for Health and Welfare. STAKES’ original mandate did
not include health promotion, but over the years such
tasks have gradually increased. With the reorganization
of the state alcohol monopoly (ALKO) in 1996, functions
related to sociological alcohol studies were transferred to
STAKES. When the Finnish Centre for Health Promotion
was strengthened and given the task of supporting citizens,
STAKES was asked to support municipalities in developing
health promotion strategies. Support to municipalities takes
the form of helping prepare decisions for the allocation of
health promotion funding; assistance in formulating policies;
developing indicators and reporting; and training for
interactive ways of working. One of STAKES’ first health
promotion activities relevant to NCD was contributing to
the development of social impact assessment.
STAKES assists MSAH in health policy analyses, which in
1996–1997 included a review of intersectoral policies in Finland.
Although it is widely accepted that STAKES has carried
out valuable policy-related research, there is less consensus
on how far it has been able to carry out its role of supporting
the local level. The role and function of the institution is
therefore presently being re-examined.
All urban and rural municipalities in Finland are members
of the Association of Finnish Local and Regional Authorities,
which also provides services to joint authorities. The Association
not only promotes the interests of local authorities
and seeks to influence related legislation, both at the
national level and in the EU through its Brussels office, but
provides information, guidance and training and facilitates
opportunities for discussion through its networks.
Case studies: policy development in countries for tackling noncommunicable diseases