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

Chapter 4
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planning philosophy and culture conducive to intersectoral
action for health promotion based on principles of equality
and solidarity.
Finland has a highly educated and motivated population, not
only in the sense of formal education but in their continued
search for information. A high proportion of Finns read
newspapers and the nationwide network of libraries is
one of the densest in the world and is well used, with 12.5
visits per resident each year (64). The public is accepting of
reasoned argument and expert opinion.
Investment in research and development is a defining characteristic
of the Finnish economy, and is reflected in tackling
NCD. The strong culture of monitoring health status and
evaluating the impact of interventions for health promotion
has meant that the evidence for disease prevention and
health promotion has frequently been ahead of the actual
action. It has also meant, however, that public opinion has
been prepared. For example, public opinion supported antismoking
measures and allowed radical anti-smoking legislation
to be introduced as early as 1976. Consensus-based
action has also been important in the workplace.
Over the years, this practice of evidence-based decisionmaking
has meant that the knowledge base has been continuously
built up and improved. Information is accessible
and available in forms that are easy to use. Young experts
involved in this type of work are trained for working outside
the medical model.
The use of regular public health reports in raising awareness,
following progress in policy implementation and
preparing the path for policy revision, has been extremely
effective. Such reports have gradually evolved so that now
all sectors must account for their actions to promote health.
Work on HIA, in combination with other types of social and
human impact assessment, is still at an early stage but opens
the way for making actors across sectors more aware of the
importance of public health for overall development.
The very long history of occupational health in Finland, and
the legal responsibility of both public and private enterprises,
sensitizes the private sector to health promotion to
some extent. It remains for this to be further broadened to
focus more strongly on tackling NCD.
NGOs related to the main NCD and their risk factors have
been active in Finland for many years. Their membership
includes top experts in the field of NCD. Their knowledge
is valued and utilized by the public sector in formulating and
implementing health policies.
Notable successes have been achieved, particularly in relation
to smoking, nutrition and the reduction of CVD, showing
that it can be done and encouraging further attempts
at health promotion. Certain aspects of Finnish life and
attitudes facilitate making the healthy choice. For example,
mass catering remains a useful point of intervention, since
a large proportion of children and adults eat at their place
of education or work. Finland is a forerunner in producing
functional foods, with some of its products in global demand.
Physical activity is an important part of leisure time –
approximately 40% of 10–18-year-olds participate in sports
club activities, for example.
Finnish experts have for many years been closely involved in
WHO and more recently EU networks. Through these international
networks and national efforts such as the North
Karelia Project, an attempt has been made to balance medical
knowledge with social and behavioural theory. Opportunities
have been taken to share experience and know-how
with other countries at an early stage of innovation.
There is a clear recognition of the influence and possible
threats of European and global policy on national NCD
policy. An explicit attempt is made to influence European
Case studies: policy development in countries for tackling noncommunicable diseases