Health Care Act to upgrade municipalities’ health and welfare promotion

The Finnish government is drawing up a new Health Care Act, which in part will aim to make welfare and health promotion more closely linked to decision-making and financial and programme planning. The role of municipalities in Finland as promoters of health was the focus of the reform of the Primary Health Care Act in 2006. The same year quality recommendations on health promotion were prepared, and local authorities have already applied the models for action that it contained.

The aim of the new Health Care Act is to make health and welfare promotion a central point of emphasis by municipalities. The point is to prevent the onset of health problems and the resultant increase in the need for services.

The government bill stipulates that municipalities must monitor the health and welfare situation of their residents and that they must compile a broad, statistics-based account on this during each council's term of office. In addition, municipal councils will report annually on the health and welfare of their residents.

"The compilation of data on each population group will allow municipalities the opportunity to intervene in time in the growth of health inequalities", says Koivisto.

The data needed for the reports on welfare will be compiled in collaboration with various administrative sectors and specialists. The National Institute for Health and Welfare has prepared welfare indicators to support this data collection, and municipality-specific data is available on the SOTKA-net website, which is maintained by the Institute and which contains comprehensive statistical data on welfare and health in Finland.

"The National Institute for Health and Welfare's website also has instructions and guides that support the assessment of health impacts. In addition to monitoring, it will be the job of municipalities to provide prior assessment of the impacts of proposed decisions concerning the health and welfare of their residents."

Koivisto says that the input for the goals of health and welfare promotion require a clear division of work and responsibility within the municipal administration. It has to be agreed who has the main responsibility and how collaboration will be done among different administrative sectors. Some municipalities have established a permanent network or working group to steer the incorporation of health and welfare promotion factors as a part of municipal decision-making and activity.

"The social and health services system naturally occupies a key position in welfare promotion. It has sufficient expertise to make use of and interpret data that is the basis of decision-making and to put it to decision-makers. In addition to social and health care, there is a need, for example, for an input for teaching, youth and sports services to support welfare", says Koivisto.

The cooperation is also required between the nascent areas of joint municipal organization and the activities of basic municipalities. The former are taking shape within the reform of the municipal and service structure throughout Finland. Most of the social and health care services that are cared for by the areas of joint municipal organization have to be carried out in cooperation with basic municipalities to both compile and provide data as the basis for decision-making. The municipalities will decide on the practicalities of this cooperation.

"One possibility is to create working groups in which there are representatives from municipalities and areas of joint municipal organization. But we have to bear in mind that the main responsibility for the welfare and health of residents lies always with the municipality, even though social and health services would be implemented as a joint activity."

Koivisto points out that hospital districts could act as specialists, for example in regional programmes on preventing illnesses. They would have better opportunities than individual municipalities also to gather regional health data in support of municipal decision-making.

Koivisto recalls that in terms of health promotion municipalities are at present in widely different stages. Many large and medium-sized municipalities have adopted the measures contained in quality recommendations, while small municipalities still lack much know-how, resources and interest in terms of health promotion.

"It is a big challenge to get municipal decision-makers to understand how great an importance health and welfare promotion has for a municipality's vitality and economy. Changing attitudes and ways of thinking requires that municipalities have sufficient information and guidance available on the new procedures and their background."

A variety of projects and guides on the different aspects of health and welfare promotion are being prepared to help support municipalities. The National Institute for Health and Welfare is also developing a peer data system with which municipalities can compare their health promotion work.

"There has been a strong basis for health promotion created during the current government term of office. The aim of the projects now underway is to develop operational models that can be applied in the future nationwide", says Koivisto.

Anni Syrjäläinen