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

Chapter 4
56
materials or to check on the use of such materials provided
by food producers.
In 1988, the Government appointed a multidisciplinary
committee to prepare a national programme for coronary
heart disease prevention, which dealt with food and nutrition
among other topics. The National Nutrition Council
prepared an action plan for the implementation of the food
and nutrition aspects. What was particularly interesting in
relation to creating partnerships for health was that MSAH
agreed that the National Nutrition Council would be more
effective if the main control came from the Ministry of
Agriculture and Forestry. That Ministry chaired the Council
and had the right to approve the names of its members.
Fifty years later, this configuration still operates effectively,
providing expert recommendations and guidelines and
acting as an intersectoral body to promote collaboration
among various stakeholders. Furthermore, there was an attempt
through negotiation to ensure acceptable trade-offs
for the various partners. For example, MHSA showed that
the gain in life expectancy, which would increase the cost of
pensions and other benefits, could be counterbalanced by
saving lives in “productive” age groups.
New dietary recommendations were introduced in1989 and
goals were set for mass catering, which plays an important
role in Finland. Perhaps influenced by the cold climate for
much of the year, Finland has a strong tradition of providing
hot meals in institutional settings. Since the 1940s, free, hot
school lunches have been provided to schoolchildren and
today the great majority of 11–15-year-old schoolchildren
report eating a meal in the school canteen every day. Some
40% of economically active women and 35% of men eat a
hot lunch at the workplace (42). Workplace canteens are
supported by tax agreements and subsidies. By offering
models for healthy eating, catering services have supported
national dietary recommendations.
The latest action plan was launched in 2003. While the
role of the Government is mainly restricted to guidance
and information, the role of municipalities and NGOs is
emphasized. The Finnish Nutrition Recommendations were
renewed in 2005, based on the latest Nordic Nutrition
Recommendations approved in 2004 by the Nordic Council
of Ministers. Recommendations on physical activity are also
included in the new version.
Two issues are currently high on the agenda: the prevention
of type 2 diabetes and obesity, particularly among children.
The Finnish Diabetes Prevention Study, started in the late
1990s, “was the first randomized study in the world to
show that the onset of type 2 diabetes can be delayed and
even avoided by lifestyle modifications among middle-aged
individuals with impaired glucose tolerance” (43). Recommendations
from this study have been incorporated in the
National Programme for the Prevention and Care of Diabetes
(DEHKO 2000–2010). The issue of obesity is becoming
so serious that one expert interviewed considered that
sugar might be the next target for taxation.
One factor hindering the implementation of a strong
nutrition policy is that the food industry is becoming more
northern European than Finnish. As Finnish firms export
more products to the Baltic countries, for example, it
becomes difficult to persuade them to accept restrictions
within Finland that are not necessarily required in other
countries. On the other hand, Finland is also affected by
what has been called the “wellness revolution” (44). One
third of magazines refer to health issues, and particularly
to nutrition and physical exercise. At the same time, the
“wellness” market is burgeoning, with functional foods to
help manage specific diseases such as diabetes and arthritis
or problems such as stress or low energy. There is a growing
need to protect consumers from fraudulent claims and
harmful products, so that knowledgeable consumers “can
exercise choice in a highly unregulated health and wellness
market” (45).
Case studies: policy development in countries for tackling noncommunicable diseases