Finland curbs childhood obesity by integrating health in all policies
Six years ago, almost 1 in 5 five-year-olds in the Finnish city of Seinäjoki was overweight or obese. Not all schools and day care centres were providing nutritious food and sufficient physical activity.
Since then, the municipality’s health department has worked with the childcare, education, nutrition, recreation and urban planning departments to ensure all day care centres and schools provide the same quality of services. As a result, the proportion of five-year-olds who are overweight or obese has been halved.
But, results did not happen overnight. It took time for all the different departments to understand how each influences health and the role each must play to promote it.
The urban planning department improved school playgrounds. Recreation implemented more physical activity in schools. Nutrition worked with day care centres to eliminate sugary snacks and with schools to serve healthier lunches. And the health department instituted comprehensive yearly health examinations in schools, which included parent education on healthy eating.
"It’s not just the programme that’s achieving good results. It’s the families who have worked hard to change their lifestyles.”
Oili Ylihärsila, Director of Health Promotion, Seinäjoki Health Centre
“I am very proud of this programme, but it’s not just the programme that’s achieving good results. It’s the families who have worked hard to change their lifestyles,” says Oili Ylihärsila, Director of Health Promotion, Seinäjoki Health Centre. “Parents are now wiser when it comes to good nutrition and exercise because of our efforts.”
Finnish policies improve child health
Recognizing that most of the factors that influence child and adolescent health lie outside the health sector, Finland is taking a Health in All Policies approach in its Health Care Act by directing cities, like Seinäjoki, to incorporate health into all of their decision-making areas.
“The Government has reformed the Health Care Act to mandate health promotion services and require municipalities to involve all sectors in their plans,” explains Marjaana Pelkonen, Ministerial Advisor, Finnish Ministry of Social Affairs and Health.
Seinäjoki and other municipalities are providing free health care counselling and health examinations of equal quality to all children and their families because of Government Decree 338 enacted under the Health Care Act in 2011. Without the decree, many municipalities would have lacked the resources to hire additional public health nurses and physicians to support their programmes to improve child health.
The National Institute of Health and Welfare, under the Finnish Ministry of Social Affairs and Health, is helping municipalities implement national policies, like the Health Care Act. Municipalities can regularly track their progress on national monitoring websites, share best practices and attend trainings on implementing legislation through a Health In All Policies approach.
Schools teach good health
Because unhealthy eating habits, limited access to healthy food, and lack of physical activity are driving Finland’s childhood obesity epidemic, the country is using schools to improve the health of their pupils.
Following the Finnish National Nutrition Council dietary guidelines, schools must provide free, healthy lunches to every student. Though the free lunches have been provided since 1948, nutrition has come second.
Finland has also made recommendations to reduce access to sugary, high-fat snacks and drinks in school vending machines and on how foods can be marketed to children. Sweets, chocolate, soft drinks and ice cream are taxed at higher rates throughout the country.
Municipalities are required to ensure health nurses in every school provide free, yearly health examinations for all students and give personalized advice on mental health, healthy eating and physical fitness. Through these services, school nurses are able to monitor the health of the child and the well-being of the entire family.
National policies also require that schools provide obligatory health education classes, physical education and nutrition and cooking lessons.
As a result of these efforts, childhood obesity is starting to stabilize across the country.
“We are doing an excellent job in incorporating health in all policies at the national level, but we still have a long way to go,” says Pelkonen. “We need to ensure all of our more than 300 municipalities are integrating health into all of their plans. All children should receive equal quality health examinations and all parents should be involved in part of these exams no matter in which municipality they live.”
Training countries to implement Health in All Policies
Incorporating a Health In All Policies approach across sectors is often challenging. While countries like Finland are leaders in the field, many governments still lack the capacity and skills necessary to integrate health into all sector plans.
For many years WHO has been helping countries apply a Health in All Policies approach, but gaps still exist.
A new Health in All Policies Training Manual is being used to train health professionals and policy makers in public health institutes, universities, non-governmental organizations, and government and intergovernmental organizations to apply and teach the approach.
It takes time to get the approach up and running, but Finland’s experience is proof that when all sectors think about their impact on health and health equity, it can deliver big results.
“While it was difficult to connect everyone in the beginning, we achieved what we planned because we worked together,” says Ylihärsila. “Our programme is now a city-wide priority and an example for other municipalities in Finland.”