Reaching for sustainability and efficiency

Päivi Sillanaukee, Permanent Secretary at the MSAH since the beginning of October, has a hefty portfolio. With the country's economy is in tight straits social and health services have to be organized more stringently, and efficiency sought at every turn.

Prior to working at the MSAH Sillanaukee was Deputy Mayor of Tampere and responsible for social and health care. She believes that one of the reasons for persistent health inequalities is that service arrangements are on different levels in different municipalities.

Sillanaukee is also concerned about the problems raised by population ageing, and specifically how to prolong life-long working careers, and how people who for one reason or another are not employed can be brought on-board so as not to fall foul of social exclusion.

She stresses that there are also plenty of opportunities that go unused due to existing practices failing to promote cooperation and people's participation. She believes that the MSAH has the necessary tools to tackle the problems, and that people should pull together more to bolster welfare.

"People should bear more responsibility for one another's welfare. Think of youth social exclusion: society can't act as a parent, and yet you should be able to get support when it's needed."

Sillanaukee believes that government ministries need to collaborate together more closely and not decide on things simply on their own terms. She says that everything should aim for a society that is sustainable socially, not just ecologically and economically.

"The know-how is there, but it isn't used as well as it could be. We need more cooperation between the administrative sectors, for instance on broad national programmes and better networking."

She would like to see more long-term planning in areas such as the budget. She says that finances tend to be too often considered in periods of just a few years, when more emphasis should be given to the long-term impacts of each decision.

 "The reform of the service structure currently underway has far reaching consequences. The productivity angle should be taken into account in the decision making as one of the guiding principles. We can't afford a multiplex and convoluted service system."

This depends to a great extent on staff being well prepared for the tasks at hand and having the right tools for the job. "The quality of services must also be good and they must be arranged by listening to clients. We must also ensure that Finland can continue to conduct high-quality research."

Sillanaukee believes that better updating and harmonizing of legislation to remove contradictions and ensure swifter and easier implementation can accomplish much. She hopes there will soon be an assessment of the effectiveness of legislative work to improve productivity.

Sillanaukee places developments within the Finnish health and social sector squarely in the context of international developments.

"We have seen significant changes in the global health and social policy debate within international organizations and in the general international debate," she observes.

"Changes in lifestyles have meant that non-communicable diseases have become a significant burden on public health, including in developing countries. Finland has been actively involved in shaping the global agenda on this issue and we are seen as model country in this respect."

This and the course of population ageing in industrialized countries compound uncertainty about the financial future of social policy.

"The ageing population in most developed countries combined with the financial challenges puts the sustainability of both health and social systems in jeopardy. Here too the experience of Finland is instructive."

She stresses that the heightened confluence of global problems is making it harder to tackle them. "The many global crises are affecting international collaboration, most significantly the financial crisis that has reduced the ability of countries to contribute to global solidarity and has deepened poverty and distress in many parts of the world, including in Europe."

Sillanaukee also points out that the question of sustainable development and the limits of environment include the social dimension as one of the three pillars.

She says that the MSAH needs to define its role in the process of evaluating the Millennium Development Goals, which are set for 2015, and the terms of the post-2015 debate. The MSAH will coordinate on this with the foreign ministry, which leads the evaluation process in Finland.

By investing in expertise Finland is able to actively take part in decision making internationally. "The Ministry has invested in posting its experts in key strategic missions - Brussels, Geneva, Paris, Stockholm, St. Petersburg - in order to be part of the political coordination processes and to get first hand information."

Sillanaukee says that in terms of cooperation with neighbouring areas in the Russian Federation from 2013 onwards the main source of financing the projects will be the EU´s financing programmes.

"The Northern Dimension Partnership in Public Health and Social Wellbeing and its current chair country Finland will strive to raise the profile of social wellbeing and health in the EU`s financing programmes in the coming financing period 2014-2020."

She describes the Nordic countries as one of Finland's most important reference groups.

Nordic collaboration involves work on reducing social exclusion, poverty and health problems. The MSAH also participates in Nordic initiatives on gender equality, occupational safety, nutrition, narcotic control and preparedness for crisis situations.

"The Nordic countries and their welfare models are not identical with each other, but our social structures and the challenges we meet are very similar," says Sillanaukee. "Our similarities include, among other things, an emphasis on equality, universal services, extensive public funding and the importance of preventive work."

Tiina Tuominen and Mark Waller