Title: Improving inter-sectoral co-operation on Health 2015 to improve health equity
Member Involved: National Institute for Health Welfare (THL, Finland)
Website: http://www.thl.fi/en_US/web/en
Contact Name: Tuulia Rotko, Development Manager
Context: The Finnish National Public Health Programme Health 2015 laid great emphasis on reducing health inequalities between population groups, stating that inequalities had become critical and were becoming worse. In 2008 the National Action Plan to Reduce Health Inequalities outlined proposals for strategic policy definitions and highlighted the most important measures to reduce socio-economic health inequalities in Finland. However, the implementation of the National Action Plan was not very successful, with deficiencies in resourcing, co-ordination and commitment.
The current Finnish government has listed the reduction of poverty, inequality and social exclusion as one of its three core objectives. In 2006, during the Finnish term of Presidency of the Council of the European Union, the ‘Health In All Policies’ (HIAP) approach was promoted at the EU level. One of the main aims of HIAP is to ensure adequate consideration of the potential health and health equity implications of policies from all sectors in policy making. HIAP is a priority in Finnish health policy, and intersectoral boards and committees have been created to ensure structures of intersectoral co-operation exist.
The Advisory Board for Public Health is an important body covering every aspect of health policy, representing almost all the administrative sectors. The role of the Board Representative is to support intersectoral co-operation for promoting welfare and health, and reducing inequity and inequalities in health. In some respects, they represent advocates of health equity within their own sector. However, action has so far appeared ineffective on this issue.
THL conducted interviews in eight Finnish ministries in 2011. The aim of these interviews was to find out the role and practical possibilities of different ministries to take equity into account in all policies. The representative of the Advisory Board for Public Health from each ministry invited 2-8 civil servants from different departments and units of each ministry to participate. Each interview lasted about two hours and was held in the host ministry.
Findings showed that although the Board Representatives were ‘committed’ to HIAP, health inequalities and the social determinants of health were a new and unfamiliar viewpoint. Collaboration in planning as well as resourcing were seen as essential to implement measures to reduce health inequalities.
Aims:
1) To promote advocacy of HIAP for health equity at ministerial level in Finland. This will be achieved by supporting advocates in each sector to understand needs, expectations, best arguments and formats to promote advocacy of health equity in different sectors. Discussion will also take place on the possibilities and interests of each sector to follow and use welfare and equity development as well as policies to impact on health equity.
2) Improve intersectoral co-operation to tackle health inequalities at ministerial level in Finland.
Research Method:
First stage: Work meetings with the representative of the Advisory Board for Public Health from each ministry to discuss needs/expectations/best arguments and formats of promoting equity. Semi-structured interview during these meetings including questions such as:
- How do you define your role as an advocate of heath equity in your sector? (If not, why?)
- What is required in order for more effective advocacy?
- What kind of help (background information, data, arguments, tools, concrete suggestions) do (or would) you need to promote health equity?
- How can you convince policy makers in your sector to take account health equity in decisions?
- Through which processes can equity issues be advocated for in your sector?
- The applicability of different data indicators for equity in each sector.
Process evaluation and diary of advocacy work will be produced. We will arrange meetings in each ministry and collect the feedback.
Second stage: Materials based on this interview will then be prepared for follow-up meetings, which will also be used to derive feedback and conclusions. These follow-up meetings can be considered a form of validation/calibration of the theme interviews conducted earlier.
Expected Outcome:
1) To find out (in the context of different sectors in Finland):
- The kinds of evidence needed to advocate for health equity and how to transfer this knowledge to policy-making processes.
- Who advocates for health equity and to whom?
- Advocacy messages and their respective merits and disadvantages.
- Catering of arguments to different political standpoints.
- Barriers (and enablers) of effective successful advocacy.
- Practices and activities that may increase the effectiveness of advocacy efforts.
- How can we realistically evaluate the success or failure of advocacy efforts? (benchmarking?)
2) To disseminate findings within Finnish ministries to improve the overall uptake of HIAP for health equity.
