Fran Baum on Finland’s primary healthcare system

Fran BaumFran Baum is blogging from the 8th World Health Organization Global Health meeting. Read her other blogs here.

Yesterday was “Europe Day” and the impact of the financial crisis in Europe was at the forefront of people’s minds. Many talked of its health impact and especially the devastating impact of high unemployment. Zsuzsanna Jakab, World Health Organization regional director for Europe, spoke about her region’s Health 2020 strategic objectives which aim to improve health and reduce the health divide through leadership and participatory governance for health. She spoke of the economic burden of chronic disease and the need to use fiscal measures to control risk factors. I was very impressed that she didn’t mention behaviour change strategies—there has been progress in health promotion!

Finland presented its journey from a poor rural country in early 20th century to being one of the wealthiest and healthiest today. This was done through the progressive development of its welfare state including the implementation of a primary healthcare system. I went on a site visit to one of their centres—it was in a lower socio-economic area, had been opened a year ago and provides free, accessible multidisciplinary primary healthcare services to all its population. The investment in health is so impressive! Yet even in Finland there are persistent health inequities and targeted efforts are addressing these—for example working with long term unemployed young men. Finland suffered a deep recession in 1990s and as they recovered established Health in All Policies (HiAP) as a central part of its government programme.

Minister Frances Fitzgerald, Ireland, spoke of the impact of the economic crisis which affected most families. She posed the question of “how do you keep the focus on health promotion when services are being cut back.” She noted children are increasingly rare, as the population is ageing and so it is even more important to support them. She said failed childhoods are very costly to society.  She also noted the tendency to move away from more universal services under austerity towards more targeting and spoke of how the “Healthy Ireland” initiative included investing more in universal primary healthcare services. She was very strong on the influence of industry over policy saying “Industry is very clever about clogging up parliamentary systems with questions,” and called for much greater transparency about lobbyists, and said that health promoters need to have as much influence as industry has.

Ilona Kickbusch’s closing keynote talked of the need for solidarity among global citizenship and noted the growing importance of the commercial determinants in shaping health. She highlighted that ideological debates about health increasingly focus on the nature of freedom of choice with opponents of public health maintaining the right of consumer choice. She argued the need to finance global public goods for citizens.

Our day ended with Kimmo Leppo (Finland) being recognised for his long contribution to health promotion with a lifetime achievement award from WHO Europe. His acceptance speech stressed the importance of a power relationship to understanding health policy. The day ended on a high note as he received a warm standing ovation.

Fran Baum is a professor of public health. She is the director of the Southgate Institute of Health Society and Equity, Flinders University, Adelaide, Australia, and is a member of the Global Steering Committee, People’s Health Movement. She is an Australian Research Council Federation fellow.