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

Chapter 4
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private donation. There are now 12 regional cancer societies
and 4 patient organizations with over 140 000 individual
members.
The Finnish Cancer Organizations, which includes the
original society, the Finnish Cancer Registry, the Cancer
Foundation, the Foundation for Cancer Research and the
Foundation for the Finnish Cancer Institute, is now one of
the largest public health organizations in the country.
Efforts originally concentrated primarily on helping poor
cancer patients, including the running of seven hospitals,
later transferred to the public sector. Attention shifted in
the 1960s to patient organizations and the Finnish Foundation
for Cancer Research was founded in 1969. The Cancer
Society was one of the driving forces in the nationwide
antismoking campaign.
By the 1970s, NGOs and public authorities were already
working together in national working groups to develop
cancer control programmes. The Finnish Cancer Registry
provided valuable epidemiological data for this purpose.
Hospice and palliative care gained ground in the 1980s. By
the 1990s, health promotion campaigns had been modernized
and emphasis was placed on evaluating the quality and
effectiveness of various screening methods, so that only
screening shown to be effective would be funded.
Cancer control is considered to be mostly well-planned and
well-implemented, and developments in the reduction of
cervical and breast cancer have been very good (30). Of
the EU countries, Finland now has the lowest death rate
for all cancers in the population aged 0–64 years. There
is some concern, however, that scientific results are not
always taken into account quickly enough in the planning
process.
2.4.3. Mental health
Finland, like most countries, has a long history of isolated
mental hospitals located away from urban developments.
The mental health legislation of the 1950s led to a doubling
of these institutions, so that by the early 1970s Finland and
Sweden were among the countries with the highest bed
ratios for mental patients in the world (over 4 beds per
1000 population). About 50% of these institutions were
new, built during the previous 20 years, but they were not
easily accessible. The stigma associated with mental illness
was still strong.
By the late 1960s and early 1970s, many industrialized
countries were questioning such institutionalized care. New
drugs made possible new ways of providing treatment outside
institutions. The WHO Regional Office for Europe was
among the early advocates for raising public health interest
in mental health services in the Member States.
In late 1970s, the National Board of Health published an
expert report and recommendations for the development
of mental health services, including proposals for disease
prevention and mental health promotion. The epidemiological
analyses carried out, and the evaluation of existing
mental health institutions, indicated a need for only 0.6
beds per 1000 population for institution-based psychiatric
care. In fact, two thirds of the existing beds were being
used for non-psychiatric patients, including chronically ill
older people in need of good basic somatic care, social support
and housing. This report formed the basis for mental
health policies for the next few decades.
When PHC was totally reorganized through the 1972
Public Health Act, however, mental health services were
not included. To compensate for the lack of a mental health
component in primary care, a new role for psychologists
was developed. They were given the task of promoting
mental health in schools and day-care centres together with
Case studies: policy development in countries for tackling noncommunicable diseases