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

terests, on the whole these values are generally marshalled
to protect hard-won health gains.
In the wake of recent political and social changes, however,
these values may need some reaffirmation, and stronger
attempts to provide the evidence that their implementation
can be economically more effective and efficient.
5.3. From awareness building to policy action
The 1972 Public Health Act laid strong foundations, still
largely valid today. Finland has a long history of both broad,
Health-for-All-type policy development and strategies for
tackling specific diseases and health risks.
There is heavy investment in building up, maintaining and
developing a reliable knowledge base for health policy,
reflecting social inequalities and including some evaluation
of the effectiveness of actions.
• Regular surveys of health behaviour and health status
are standard practice. Information is easily accessible to
researchers and planners at the national level, although
perhaps more could be done to bring this to the local
level.
• Innovative public health reports, with reporting on
health impacts from all sectors, play an important role in
raising awareness and open the way for further intersectoral
action.
• Demonstration projects such as North Karelia, MONI-
CA and CINDI have made a significant contribution to
the evidence-based approach to policy development,
both in the pilot areas and throughout the country. This
experience was not restricted to epidemiological surveillance
but included testing hypotheses and evaluating
interventions. They have also provided a training ground
for young experts.
Dedicated opinion leaders, mainly sympathetic to the
political left or centre, remained in place in the bureaucracy
despite changing governments and were able to implement
long-term strategies that kept public health issues on the
agenda.
Finnish experts and bureaucrats are active players on the
international scene, aware of and contributing to innovations
in approach and practice. International policies such as
the WHO Health for All policy and issue-specific policies
such as those for smoking and alcohol control brought further
legitimization to ongoing domestic efforts.
The use of policy training seminars and consensus-building
conferences help keep professionals in touch with policy
development issues. NGOs, including the medical and nursing
associations, work regularly with those in the scientific
field to prepare recommendations and carry out training.
The trade unions have participated actively in considering
health policy options, particularly in the area of occupational
health. Although the media have played an influential role,
particularly in relation to lifestyle issues, more could probably
be done to reach the general public.
Published and widely distributed policy documents and
strategies provide the argumentation for action and indicate
the potential role of stakeholders, at least at the national
level. There is some concern that municipalities are not sufficiently
supported.
Intersectoral mechanisms with broad participation have
been established. These are advisory bodies and have
apparently been helpful as a forum wherein other sectors
could bring up issues of concern to them, and in providing
a consensus view when regulatory decisions or legislation
were being prepared. They have not yet been evaluated,
and there is some concern that their full potential has not
been realized.
Regionally, the health gaps are gradually being closed, with
differences in infant mortality rates practically disappearing.
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases