Timo Ståhl

Health in All Policies—The Finnish Initiative: Background, Principles, and Current Issues

Many historical developments, such as the Alma Ata Declaration or the Ottawa Charter, have drawn attention to the need for intersectoral work and for considering the health aspects of different policy proposals. In the 1970s, Finland started broad actions to change national diets to reduce the high mortality associated with cardiovascular diseases (CVDs). This and other work in Finland have involved many sectors and policies, resulted in significant public health improvements, and paved the way for the Health in All Policies (HiAP) initiative started during the Finnish European Union (EU) presidency in 2006. The initiative and the principles have encouraged further developments in Finland and have been linked with related developments within the EU and the World Health Organization (WHO).

Is health recognized in the EU's policy process? An analysis of the European Commission's impact assessments

BACKGROUND The European Commission has an Impact Assessment (IA) procedure that aims to inform decision-makers of the all important impacts that decisions may have. This article studies how health is considered in the IA procedure and how it is reflected in the reports: what aspects, whose and simply in what context health is mentioned in the IA reports. METHODS Half of the Commissions IAs from 2006 were studied. The analysis was text based and informed by content analysis. In total, 48 reports by 17 DGs were analysed. RESULTS Five DGs (29%) and 10 reports (21%) made no reference to human health, public health or health systems. Five DGs were clearly considering health impacts more often than others; DG EMPL, SANCO, AGRI, ELARG and ENV. Health systems/services were most often and human health next most common referred to (39% and 29% of all, respectively). Health impacts were usually referred to in the sections on the definition of problems and the analysis of impacts. Seldom were they reported on in the sections on policy options, comparing options, or in the monitoring and evaluation sections. CONCLUSION The results partly support concerns about the potential neglect of health impacts. The results also suggest that health is not considered an important factor when discussing alternative policy choices, and neither does it seem to be an important objective. There is a clear need for further exploration on ways in which health could be more appropriately considered when impacts of other policies are considered by the various DGs.

Quality of the contraceptive service structure: a pilot study in Finnish health centre organisations.

Objectives To evaluate the quality of the contraceptive service structure in health centre organisations (HCOs) in western Finland and to establish whether the characteristics of the HCOs are associated with the quality measured. Methods Survey data were collected from all HCOs in a university hospital area in western Finland (N = 63). Quality was evaluated using a score of ten indicators. Associations between the score and the characteristics of the HCOs were studied using rank correlation analysis and a multivariate ordered logit model. Results Among 51 HCOs yielding complete data for the evaluation, the quality score ranged from 3 to 10, the mean being 5.8. From 25 variables studied, ‘a chief nursing officer or leading nurse engaged in the HCO’ (p = 0.001) and ‘an appointed person responsible for management of health promotion’ (p = 0.006) were found to be associated with a good score in the rank correlation analysis, and they also remained significant in multivariate analysis (Odds Ratio [OR] = 11.5, 95% confidence interval [CI] 2.3–56.5 and OR = 5.9, 95% CI 1.6–21.5, respectively). Conclusions In the majority of the HCOs involved, the quality of service structure was rated average, but there was much variation between the HCOs. The results of the multivariate analysis emphasise the importance of good management of services.

Tobacco Use Documenting Policy and Its Association With Pupils’ Smoking and Their Perception of the Enforcement of School Smoking Bans in Finland

Finnish national data sets on schools (N = 496) and pupils (N = 74,143; 14–16 years) were used to study whether a systematic documenting policy for the violations of school smoking bans was associated with pupils’ smoking and their perceptions on the enforcement of smoking bans. Attending a school with a systematic documenting policy was associated with perceptions that smoking is prohibited and restrictions monitored, with lower levels of smoking in the vicinity of the school during the school day, but not with smoking prevalence. Findings suggest that a consistent documenting policy could be an effective tool for reducing pupils’ smoking in schools.

Health in All Policies: From rhetoric to implementation and evaluation – the Finnish experience

The principles of the Health in All Policies (HiAP) approach are not new. Their international roots can be traced back to 1978 and the Alma-Ata Declaration and the 1986 Ottawa Charter. In Finland, the roots of HiAP go back to 1972 when the Economic Council of Finland, chaired by the Prime Minister, launched the ‘Report of the working group exploring the goals of health’. The paper discusses the history, rationale, and implementation of the principles underlying the umbrella concept of HiAP. A rationale for implementing a new concept – HiAP in 2006 during the Finnish European Union presidency – is given. The focus here will be on implementation of HiAP. International material supporting the implementation is introduced and practical examples from Finland presented. The Benchmarking System for Health Promotion Capacity Building is introduced, since it has been used as a primary source of information for monitoring and evaluating HiAP in Finland at the local level. The experience from Finland clearly indicates that HiAP as an approach and as a way of working requires long-term commitment and vision. For working across sectors it is crucial to have data on health and health determinants and analyses of the links between health outcomes, health determinants, and policies across sectors and levels of governance. Intersectoral structures, processes, and tools for the identification of problems and solutions, decisions, and implementation across sectors are prerequisites of HiAP. Legislative backing has proven to be useful, especially in providing continuation and sustainability.

Access to a school health nurse and adolescent health needs in the universal school health service in Finland

Universal school health services are expected to offer similar, needs‐based services to all students across schools, service providers and students’ socio‐economic statuses and health needs. This study investigates access to school health nurses in Finland. The objectives were to study the differences in access to school health nurse between service providers, schools, students’ characteristics and school health nurse resources. Access was examined through a nationwide School Health Promotion study, which is a self‐reporting, voluntary and anonymous survey for 8th and 9th graders (15 to 16‐year old, N = 71865). The ethical committee of the National Institute for Health and Welfare has approved procedure for the School Health Promotion study. Data on school health nurse resources and service providers were obtained from the national database (534 schools; 144 service providers). Multilevel logistic regression was used. Of the pupils, 15% of girls and 11% of boys reported difficult access to a school health nurse. The number of adolescents who reported difficult access ranged between service providers (0%–41%) and schools (0%–75%). Students with lower socio‐economic background, poorer well‐being at school, lack of support for studying and greater health needs reported difficult access more often. School health nurse resources were associated with difficult access only among boys, when resources were under the national recommendations. These findings raise concern about equality and unmet health needs in school health services.

Psychosocial Problems, Indoor Air-Related Symptoms, and Perceived Indoor Air Quality among Students in Schools without Indoor Air Problems: A Longitudinal Study

The effect of students’ psychosocial problems on their reporting of indoor air quality (subjective IAQ) and indoor air-related (IA-related) symptoms has not been studied in schools in a longitudinal setting. Therefore, we analyzed whether changes in students’ psychosocial problems (socioemotional difficulties and perceived teacher–student relations) between the beginning of seventh grade (age 12–13 years) and the end of ninth grade (15–16 years) predicted subjective IAQ and IA-related symptoms at the end of ninth grade. In order to explore the independent effect of psychosocial factors, we focused only on students in schools without observed indoor air problems. The analysis was of longitudinal data (N = 986 students) using latent change modelling. Increased socioemotional difficulties were related to more IA-related symptoms (standardized beta = 0.20) and deteriorated subjective IAQ (standardized beta = 0.20). Increased problems in teacher–student relations were related to deteriorated subjective IAQ (standardized beta = 0.21). Although students’ psychosocial problems explained only 9–13% of the total variances, our findings support the notion that psychosocial factors also need to be taken into account in the evaluation of IAQ and the prevalence of IA-related symptoms in schools.

The comparative and objective measurement of health promotion capacity-building: from conceptual framework to operationalization:

The aim of this study was to analyse and test a theoretical generic health promotion capacity-building framework with empirical data on primary health care. The framework consists of seven dimensions: commitment, management, monitoring and needs assessment, resources, common practices, participation and other core functions. The data were collected in 2014 from all the health centres in Finland, of which 156 (99%) submitted their data. The data were scored by the quality of activities on a scale from 0 to 100, where 100 stands for desirable quality. Individual indicators were nested into subdimensions, which in turn were nested into the dimensions of the theoretical framework. Variables were clustered using the dimensions and subdimensions as initial partitions. The internal consistency of dimensions and subdimensions was tested with standardized Cronbach’s alpha both before and after the clustering analysis. The results showed that although the internal consistency of the dimensions was high in the initial classification, it is possible to get even more consistent dimensions. The internal consistency of the initial classification varied from 0.62 in participation to 0.93 in common practices. In the clustering analysis, 45 out of 203 indicators were assigned to a dimension different from the initial partition. The biggest gain in internal consistency was achieved in the subdimension of systematic mass communications by relocating two indicators. This study suggests that it is possible to assess the health promotion capacity-building of organizations in a coherent way with comparable and objective indicators. These analyses also show that the number of indicators can be reduced. It would be interesting to see how the framework works in other governmental structures or political contexts.

TEAVIISARI - A TOOL FOR BENCHMARKING SAFETY PROMOTION AND INJURY PREVENTION ON LOCAL LEVEL

Background In Finland, municipalities are responsible for promoting the health and welfare of their residents. Safety promotion and injury prevention are an integral part of health promotion on various fields of municipal action. Description of the problem Until the launch of TEAviisari, a nationwide benchmarking tool for the management, planning and evaluation of health promotion capacity building (HPCB), there has been very little accurate and comparable nationwide information on health promoting activities in different sectors in Finnish municipalities. Results Aiming to make measures taken by local authorities visible and to provide information on actions that promote better public health on local level, TEAviisari is based on a generic HPCB framework. The framework consists of seven dimensions: commitment, management, monitoring and needs assessment, resources, common practices, participation and core functions. Safety and injury related topics covered in TEAviisari include but are not limited to prevention of home and leisure accident injuries, inspection of health and safety at schools, home-school collaboration to promote safety, prevention and monitoring of accidents and injuries at school, compiling a local safety plan, evaluating older person’s housing safety and having expertise on health and safety technology and assistive devices. The results show that differences between municipalities and schools exist in all topics. The data can be viewed on municipal level or on various geographical or administrative levels. Data for single schools are shown with the permission of the school. Conclusions TEAviisari shows that it is possible to assess the HPCB of municipalities, serving as a tool for the local government while making it transparent to the residents. Web-based user interface provides a quick access to relevant, interpreted information for decision-makers. TEAviisari is free of charge and available at http://teaviisari.fi in Finnish, Swedish and English.