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

Chapter 4
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was medically and economically appropriate to amend PHC
legislation to extend breast cancer screening to women
aged 60–69 years. European Community projects also play
an important role affecting national actors and efforts.
3.2. Human resources
Despite its rather small population, Finland plays an influential
role in international organizations dealing with health
policy. Key officials in Finland have vast experience of health
policy development, particularly in Europe but, owing to
their generosity as international donors, also in other parts
of the world. At both the national and local levels, key
officials in the public sector give their time and efforts to
spreading know-how and knowledge through NGOs.
The once unparalleled force of GPs in PHC is now rather
more uncertain as their conditions of service have deteriorated
and new doctors gravitate towards the hospitals.
Furthermore, the once strong network of health promotion
coordinators at the local level has largely disappeared. Many
of these came from the nursing profession, which has been
underpaid for years and is now in crisis. “There is no national
human resources plan for health promotion. The total numbers
working in the field are not known, and whereas professional
education opportunities exist, systematically organized
in-service professional training appears to be lacking, and
career opportunities for qualified people are unclear” (12).
On the other hand, the universities, the Urho Kaleva
Kekkonen (ukk) Institute, STAKES and KTL all carry out
extensive training of professionals, and on-the-job additional
training is the norm. The National Advisory Board on
Health Care Ethics is also involved in planning and implementing
joint training for nurses, physicians, hospital ethics
commissions, university researchers and students, and
hospital theologians.
In addition, broad use is made of “consensus meetings” to
consider ways of dealing with various topics such as cholesterol
reduction and smoking among young people, for
example.
3.3. Financial resources
Although certain programmes and projects are funded
on a time-limited basis, there appears to be an attempt to
maintain long-term funding for health promotion. Finland
was quick, for example, to earmark a proportion of the tax
on tobacco products for financing health promotion.
Present and forecast shortages in the general labour force
have focused attention on the need for a healthy workforce,
which has probably encouraged the continued financing of
health promotion.
A number of the policy documents examined for this study
estimate the costs and benefits to the economy of investments
in health.
3.4. Information and research
Routine surveys of chronic diseases and their risk factors
have been carried out for the age group 25–74 years since
1972, and reports are available on the Internet (54). Surveys
of adolescent health and lifestyles have been carried
out since 1977 (55).
Despite this long history of systematically collecting statistics,
it was felt that a more clear and comprehensive set of
indicators was needed to define the health and well-being
of the nation. A group of experts chaired by MSAH was
therefore set up in 1993 to start designing and developing
such indicators (56). It became clear that, apart from certain
gaps that could be rectified, existing data were not being
effectively interpreted for policy-making purposes. This
prompted regular reviews of keys areas of welfare.
This proved beneficial when, in 1995, Parliament decided to
replace reports on the alcohol and drug situation by regular
Case studies: policy development in countries for tackling noncommunicable diseases