Health promotion

Book Webinar: Health in All Policies

Study maps successes and challenges of HiAP in Finland

The course of Finland’s public health interventions over the last four decades towards the comprehensive approach defined by the Health in All Policies (HiAP) concept reveals many exemplary developments in approaches to health promotion. It also highlights what still needs to be done to overcome obstacles so that HiAP can be more fully realized.

Writing in this year’s March issue of the Scandinavian Journal of Public Health Tapani Melkas, a former Director at the Ministry of Social Affairs and Health (MSAH), provides an all-inclusive study, sponsored by the ministry, of Finland’s development of and towards HiAP.

Towards systemic change

The process has been one of tackling single health problems, then broadening out into large-scale health programmes, and subsequently giving health promotion a firm systemic dimension by rooting it in legislation and permanent structures in particular embracing non-health sectors.

Four decades on from the groundbreaking North Karelia project – started in 1972 to tackle coronary heart disease by engaging a range of sectors – we now see HiAP ingrained in many areas of governance.

Melkas says that one of the highpoints of the last decade has been establishing a detailed legislative basis for HiAP at local level.

“Municipalities are now obliged to recognize health in all local policies. They must monitor health and health determinants, and prepare regular health reports, and do all of this while paying attention to inequalities in health.”

Targeting health inequalities

Melkas’ study highlights that addressing health inequalities remains one of the key obstacles to better realizing HiAP. “Increasing inequalities are very detrimental to whole of society and really diminish the advantage of our better average health situation,” he observes. But more needs to be done. “For instance, health impact assessments almost never cover health inequalities.”

Finland’s use of HiAP as the health theme of its 2006 EU Presidency did much to inculcate the concept in EU health promotion work. Now, as the 8th Global Conference talks place in Finland, Melkas believes that an important example Finland can now stress to other countries is that HiAP needs to be a strategy integral to government as a whole.

But the learning process is a two-way one. “Finland can best learn from other countries in terms of multilateral work in the WHO and EU, such as what kind of structures have been built, how different instruments are used, and what kind of successes and failures there have been.”