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

eports on the state and development of health. The decision
to produce a report on social affairs and health (40)
every four years and to submit this to Parliament as an appendix
to the Government’s annual report has meant that a
regular review is made of the state of health and welfare in
Finland and the possible policy implications.
In 1996, the first such public health report was prepared
and presented to Parliament for broad debate, and subsequently
among health professionals, local government and
the general population. It was also discussed by NGOs in
their “health court session” (a type of traditional round
table discussion).
What is particularly important and innovative is that, since
1996, these reports have included a systematic overview
of public health aspects of policies of all ministries (except
the Ministry of Foreign Affairs). The reports not only present
the data but analyse the reasons for observed trends,
emerging challenges, the intersectoral nature of health
policies necessary to tackle them, and suggested actions.
To some extent, therefore, they may be considered as
pre-policy documents. The latest report (57) also includes
international comparisons.
From the researcher’s point of view, the Finnish epidemiological
database has the advantage of linking information
sets, not always possible in other countries. The linking of
data to a personal identification number has allowed for
greatly improved mapping techniques, and every attempt
is made to ensure that data are accessible to and easily
processed by local authorities.
Regarding research, Finland was one of the few countries to
develop a research policy for Health for All (58), although
the necessary interdisciplinary, intersectoral and health
systems research did not win much ground at the time (11).
Considerable attempts were later made to develop interdisciplinary
research involving clinical, nursing, biomedical,
epidemiological, behavioural, social and economic sciences.
This approach is said to have “greatly contributed to the
basic credibility of the anti-smoking work in the country”
(38), for example.
Both the Academy of Finland and MSAH fund research
related to tackling NCD, and designate funds specifically for
research related to government health policy. A number
of centres of excellence are available to carry out such
research. On the initiative of the National Council for Research
and Technology, the Government decided that the
scientific quality and performance of all government-funded
research institutions should be evaluated periodically.
MSAH started such a process in 1995, and all research institutions
under the jurisdiction of MSAH have been evaluated
by mixed teams of Finnish and international experts.
The Academy of Finland, which operates under the auspices
of the Ministry of Education, has annual research funding
representing about 14% of the Government’s total spending
on research and development, part of which relates to
health. In 1997, a research programme on inequalities in
health and welfare was launched and a Health Promotion
Research Programme (TERVE), including four interrelated
projects, was implemented for 2001–2004. TERVE was
the first multidisciplinary programme in the field of health
promotion research in Finland. Additional funding was
given to this programme by the Finnish Work Environment
Programme, the Ministry of Transport and Communications
and the Finnish Cancer Foundation.
As is the general rule for the Academy, TERVE was assessed
by an external evaluation team, including experts
from other countries (59). Their view was that, although
there had been thorough preparatory work, health promotion
research had not been adequately defined, with the
result that the programme was more epidemiologically than
socially oriented. Funding for long-standing projects with
institutional support was considered sometimes more than
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Case studies: policy development in countries for tackling noncommunicable diseases