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Taking health into account in all policies
Correspondence
Taking health into account in all policies Francisco Becerra-Posada (July, 2015)1 writes about the efforts of the Pan American Health Organization to take up the challenge of addressing the social determinants of health through action across sectors and on becoming the first in the world to adopt a Regional Plan of Action on Health in All Policies. I fully agree with his comment that “the public health community now has a unique opportunity to use a Health in All Policies approach in informing policies and practices”.1 However, I would like to stress that adopting a Health in All Policies plan does not automatically lead to taking health into account in all policies. For an example, Finland’s role in promoting Health in All Policies in the European Union has been substantial,2 whereas the realpolitik in Finland has not always been very health-supportive. The first Finnish national programme “Health for all by the year 2000” was implemented in 1986, and at the very same year the abrupt liberalisation of Finnish financial markets led to massive unemployment and widening health inequalities.3 A revised programme was implemented in 1993, which was soon followed by severe austerity policies that were not allocated evenly across all public spending but were more heavily concentrated on the services for social classes with least power to resist them. 4 The latest programme “Health 2015” was implemented in 2001, and, 3 years later, the Finnish alcohol policy was changed dramatically despite warnings given by health impact assessments, resulting in a 20% rise in alcohol-related mortality within a year.5 As Becerra-Posada writes,1 attention must be given to the development of capacities and structures for taking health into account in all policies. But should the public health community also give attention to raising the www.thelancet.com/lancetgh Vol 3 October 2015
standing of health on the political agenda and to helping induce political solutions through often contentious and divisive political policy processes? I declare no competing interests. Copyright © Kokkinen et al. Open Access article distributed under the terms of CC BY 4.0.
Lauri Kokkinen lauri.kokkinen@ttl.fi Finnish Institute of Occupational Health, 33540 Tampere, Finland 1
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Becerra-Posada F. Health in all policies: a strategy to support the Sustainable Development Goals. Lancet Glob Health 2015; 3: e360. Ståhl T, Wismar M, Ollila E, Lahtinen E, Leppo K. Health in all policies: prospects and potentials. Helsinki: Ministry of Social Affairs and Health, 2006. Kokkinen L, Muntaner C, Kouvonen A, Koskinen A, Varje P, Väänänen A. Welfare state retrenchment and increasing mental health inequality by educational credentials in Finland: a multicohort study. BMJ Open 2015; 5: e007297. Lehto J, Blomster P. Recession in the 1990s and its policy influence on social and health care services. Yhteiskuntapolitiikka 1999; 64: 207–21 (in Finnish). Herttua K. The effects of the 2004 reduction in the price of alcohol on alcohol-related harm in Finland: a natural experiment based on register data. Helsinki: University of Helsinki, 2010.
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Taking health into account in all policies Francisco Becerra-Posada (July, 2015)1 writes about the efforts of the Pan American Health Organization to take up the challenge of addressing the social determinants of health through action across sectors and on becoming the first in the world to adopt a Regional Plan of Action on Health in All Policies. I fully agree with his comment that “the public health community now has a unique opportunity to use a Health in All Policies approach in informing policies and practices”.1 However, I would like to stress that adopting a Health in All Policies plan does not automatically lead to taking health into account in all policies. For an example, Finland’s role in promoting Health in All Policies in the European Union has been substantial,2 whereas the realpolitik in Finland has not always been very health-supportive. The first Finnish national programme “Health for all by the year 2000” was implemented in 1986, and at the very same year the abrupt liberalisation of Finnish financial markets led to massive unemployment and widening health inequalities.3 A revised programme was implemented in 1993, which was soon followed by severe austerity policies that were not allocated evenly across all public spending but were more heavily concentrated on the services for social classes with least power to resist them. 4 The latest programme “Health 2015” was implemented in 2001, and, 3 years later, the Finnish alcohol policy was changed dramatically despite warnings given by health impact assessments, resulting in a 20% rise in alcohol-related mortality within a year.5 As Becerra-Posada writes,1 attention must be given to the development of capacities and structures for taking health into account in all policies. But should the public health community also give attention to raising the www.thelancet.com/lancetgh Vol 3 October 2015
standing of health on the political agenda and to helping induce political solutions through often contentious and divisive political policy processes? I declare no competing interests. Copyright © Kokkinen et al. Open Access article distributed under the terms of CC BY 4.0.
Lauri Kokkinen lauri.kokkinen@ttl.fi Finnish Institute of Occupational Health, 33540 Tampere, Finland 1
2
3
4
5
Becerra-Posada F. Health in all policies: a strategy to support the Sustainable Development Goals. Lancet Glob Health 2015; 3: e360. Ståhl T, Wismar M, Ollila E, Lahtinen E, Leppo K. Health in all policies: prospects and potentials. Helsinki: Ministry of Social Affairs and Health, 2006. Kokkinen L, Muntaner C, Kouvonen A, Koskinen A, Varje P, Väänänen A. Welfare state retrenchment and increasing mental health inequality by educational credentials in Finland: a multicohort study. BMJ Open 2015; 5: e007297. Lehto J, Blomster P. Recession in the 1990s and its policy influence on social and health care services. Yhteiskuntapolitiikka 1999; 64: 207–21 (in Finnish). Herttua K. The effects of the 2004 reduction in the price of alcohol on alcohol-related harm in Finland: a natural experiment based on register data. Helsinki: University of Helsinki, 2010.
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