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

In addition to the more traditional epidemiological work,
various hypotheses were tested that could not have been
done with one population alone. The Project also began to
work as a national demonstration programme for chronic
disease prevention and influenced action in other countries.
This shows how decisive input by a relatively small country
to an international project can reap considerable domestic
benefit and contribute to international thinking.
Finland also became a member of the WHO Regional Office’s
CINDI programme established in 1984. The aim of this
programme is to develop and evaluate intervention strategies
and methods for chronic disease prevention. In Finland,
the CINDI programme is coordinated at the Department of
Health Promotion and Chronic Disease Prevention at KTL,
which is a WHO collaborating centre for NCD prevention,
health promotion and monitoring. Finland plays an active role
in the CINDI programme, organizing international meetings
and training seminars on integrated NCD strategies and
prevention. There is also close collaboration with the Baltic
countries through the FINBALT health monitoring system.
2.5. Policies related to risk factors
Unlike the broad policy directions defined in the umbrellatype
policy documents, those concerning specific NCD and
their risk factors tend to be more action-oriented or are
reflected in legislation.
2.5.1. Tobacco policies
Tobacco control has been one of the success stories in Finland.
The need to reduce smoking was recognized as early
as the 1950s, when 76% of men smoked. In 1961, Parliament
requested the Government to take strong measures
to reduce smoking and to consider legislative action. The
need for health education was recognized in the 1972 Public
Health Law. In the same year, the Tobacco Control Act
designated 0.5% of tax revenues from tobacco products to
be used for anti-smoking research and education (this was
raised to 0.75% in 1995).
The 1976 Tobacco Act was passed unanimously by Parliament,
setting the stage for restricting sales to minors, a
total ban on advertising, smoke-free public premises and
smoking prohibition on most public transport. This law
was amended a number of times, most notably with the
Improved Tobacco Control Act that came into effect in
1995. This legislation involves many sectors in reducing the
yields of certain harmful substances, reducing exposure to
tobacco smoke for smokers and non-smokers alike (particularly
in the workplace, where smoking was prohibited
except in one-person offices or in special smoking rooms)
and promoting health education, smoking cessation and
related research.
According to information from interviews carried out
for this study, the long-term strategy was to “give each
new parliament (every four years) something new, always
keeping within the limits of what was acceptable to the
population, but continuously ratcheting up tobacco control”.
Since the prime movers in MSAH were in place over a long
period of time, they successfully kept up the pressure.
In 1978, a special health education office was established at
the National Board of Health and became an active focal
point for national anti-smoking policy. In 1992, the office
was moved to MSAH, where the work continued. Responsibilities
for enforcing the regulations are divided at the local
level between public health and occupational protection
authorities and the police, and at the national level between
MSAH and the official state prosecutor.
The original Finnish Health for All policy (9) stated boldly
that “Refusal to use the price weapon means a conscious
adoption of responsibility for several thousands of cases
of cancer and unnecessary cardiac deaths”. Issues related
to pricing policy options, however, were regulated by the
Ministry of Finance and its role and that of the Ministry of
Trade and Commerce have tended towards protecting
the interests of industry rather than health. This has largely
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Case studies: policy development in countries for tackling noncommunicable diseases