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

2006. The report stresses the need for health promotion
strategies to be included in the government programme,
noting that, although national investments in preventive
measures have slightly increased, at the municipal level they
have actually decreased.
2.4. Policies for specific NCD
2.4.1. Heart health
Following the groundbreaking “Framingham study” (27) in
the United States, from which the concept of risk factors
for CVD was born, Finland was one of seven countries
included in an international study that tried to explain the
variation in death rates from coronary heart disease in
different countries (28). Interest was triggered by the exceptionally
high rates of CVD in Finland in the early 1970s.
The North Karelia Project had already started in 1972, and
when WHO organized the MONICA Project in the early
1980s to measure CVD and risk factor trends in a standardized
way, three areas in Finland, including North Karelia,
joined the Project (see below).
In 1988, the Government appointed a multidisciplinary
committee to prepare a national programme for coronary
heart disease prevention, dealing with food and nutrition
among other topics. In the Finnish tradition of looking for
consensus and resolving conflict, negotiations ensured that
losses to the state budget from cuts in one area were made
up for in another, as for example in balancing price changes
of dairy products and tobacco (11).
Another facilitator in tackling specific diseases or their risks
is the very strong role played by NGOs in Finland. This is
due to their size and influence and the fact that they frequently
include top national experts among their members.
In 2007, for example, the Finnish Heart Association had
over 85 000 individual members, 19 regional societies and
240 local societies, and its president was a world-renowned
expert in health promotion and Director-General of the
National Public Health Institute (KTL).
In November 1997, the Finnish Heart Association, in collaboration
with MSAH, organized a consensus meeting
that led to the formulation of a policy for promoting heart
health. In 2003, the Finnish Heart Association began work
revising this and formulating the Action Plan for Promoting
Finnish Heart Health for the Years 2005–2011 (29). Representatives
of dozens of different interest groups participated
in its preparation. Four working groups, under the supervision
of a small management group, focused on health promotion
at different stages of the life-cycle. They produced
extensive background reports, which were crystallized into
50 action proposals for the whole population and different
age groups. The main goal is that in 20 years, CVD will
no longer be a health problem for working-age adults and
people will enjoy healthier, active lives.
Over the years, collaboration has been achieved not only
between NGOs and the state but also with the private sector.
One interesting development was the 2000 launching
by the Finnish Heart Association and the Finnish Diabetes
Association of the “Heart Symbol”. The right to use the
Heart Symbol can be given in six product groups, including
milk and dairy products, edible fats, meat products and
bread, cereals and cereal products. Products where fat and
sodium are not a problem (such as fruit and vegetables)
are left out of the system. Manufacturers can apply to use
the symbol subject to a charge that is used to maintain the
process. By September 2006, 28 companies (277 products)
had applied to use the symbol, showing consumers quickly
and simply the healthier choice.
The necessary database for raising awareness and taking action
on heart health has been available for many years, and
experience of tackling CVD was probably a key to taking
similar action on other NCD.
2.4.2. Cancer
Voluntary action for tackling cancer began in 1936 when the
Cancer Society of Finland was founded, funded by a large
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases