7.2 Administration and governance
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Governance
The legal framework for health policy is set by the Constitution of Finland, the Act on the Promotion of Sports and Physical Activity, the Local Government Act, the Youth Act, the Health Care Act, the Student and Pupil Welfare Act (in Finnish) and relevant decrees issued by the Ministry of Social Affairs and Health. The Health Care Act promotes and maintains the population’s health and welfare, work ability and functional capacity and social security. It also:
- reduces health inequalities between different population groups
- ensures universal access to the services required by the population and improves quality and patient safety
- promotes client-orientation in the provision of health care services
- improves the operating conditions of primary health care and strengthens cooperation between health care providers, between local authority departments, and with other parties that promote health and welfare and provide social services and health care.
According to the Act, health promotion means actions aimed at individuals, the population in general, communities, and living environments with a view to maintain and improve health, work ability and functional capacity, influence determinants of health, prevent illnesses, accident injuries, and other health problems, strengthen mental health, and reduce health inequalities between different population groups, as well as systematically to target resources in a manner that promotes better public health. At the national level, the Ministry of Social Affairs and Health is primarily responsible for guiding and overseeing health promotion in Finland.
In addition to the Health Care Act, health promotion is regulated by legislation concerning infectious diseases, tobacco control and alcohol. Reducing health inequalities is one of the prime objectives of the Ministry of Social Affairs and Health. Other ministries participate in health promotion in these subjects, which are central to their areas of expertise. The Ministry of Education and Culture is responsible for creating favourable conditions for sport and physical activity as well as the reconciliation and development of sport policy. For example, the Ministry of Education and Culture promotes physical activities by allocating state subsidies to national sport organisations and institutes and financing sport and health sciences.
At regional level, the new Health Care Act (2021) obligates Health and social services counties (see Glossary), instead of municipalities, to monitor the health of its inhabitants by population subgroup. According to the Act, health and welfare promotion are central responsibilities of the Health and social services counties. A change from municipal administration to a county-based model has been one of the most crucial governmental reforms in Finnish history and by January 2023 the reform will be fully adopted.
In 2023 there will be 22 health, social and rescue services counties, and additionally a separate Hospital district of Helsinki and Uusimaa, instead of the previous 195 health and social services, and 22 rescue departments. The state is responsible for funding the health, social and rescue services counties and giving needed guidance for the implementation of planned actions. Private and third sector health care institutions will continue complementing public health and social care services.
According to the presentation of Finnish Government, “Counties are responsible for integrating clients’ healthcare and social welfare services into packages and must ensure, that client groups and clients who need integrated services are identified, healthcare and social welfare are coordinated, service chains and service packages are defined, healthcare and social welfare services are coordinated with other services provided by the counties and information about clients is utilized between different providers. Counties must also ensure the coordination of healthcare and social welfare services in cooperation with other wellbeing services counties and coordinate their healthcare and social welfare services with municipal and central government services. Each county is responsible for the provision of information and advice on the use of services, assessment of individual service needs, drawing up client-specific plans for healthcare and social welfare.”
Having a county as a single organiser allows operational integration and reforms. This new model gives a possibility to allocate resources evenly and according to the inhabitants’ needs. The purpose is to prevent the onset of health problems and the resultant increase in the need for services. Counties must still coordinate their healthcare and social welfare services with municipal and central government services. For more information, visit: What is the health and social services reform?
County councils are in charge of exerting influence in wellbeing services counties. In each county there will be a separate youth council or a similar group to ensure opportunities for young people to participate and exert influence. According to the reform plan, the county executive will need to ensure the operating conditions for a youth council and a possibility to influence the planning, preparation, implementation and monitoring of the activities of the wellbeing services county, which are or which the council deems to be relevant for the services. According to the plan youth councils must also be involved in developing participation and consultation in the wellbeing services county.
According to the Act on the Promotion of Sports and Physical Activity, municipalities are responsible for creating opportunities and facilities for engagement in physical activities at the local level. This means providing physical exercise services and organising physical activities that promote general health and well-being with due regard to the various target groups; secondly, supporting civic action including club activities; and thirdly, constructing and maintaining facilities for physical activity.
Additionally, municipalities are responsible for arranging and developing child welfare services. According to the Child Welfare Act (Section 12), each municipality, or two or more municipalities together, must draw up a plan, concerning the actions of the municipality or municipalities to promote the well-being of children and young people, and to arrange and develop child welfare services.
The National Institute for Health and Welfare (THL) is an independent expert agency working under the Ministry of Social Affairs and Health and it works to protect and promote the welfare and well-being of the Finnish population. In 2022, its priorities are to create a sustainable welfare society, to reduce inequality and social exclusion, to monitor the changing spectrum of diseases, to be prepared for health threats and to reform the service system. THL gathers and produces information based on research and register data and provides expertise and solutions to support decision-making. Their strategy was updated in the spring of 2019 in cooperation with personnel and stakeholders and its mission is to promote the welfare, health and safety of the entire population, prevent diseases and social problems, and develop the welfare society.
Since 2021, there has been youth work centre of expertise, which, with other objectives focuses also on improving the mental health of young people and substance abuse prevention. A consortium consists Into – Association for Outreach Youth Work and Workshop Activities, EHYT Finnish Association for Substance Abuse Prevention, MIELI Mental Health Finland and Juvenia Youth Research and Development Centre as a part of South-Eastern Finland University of Applied Sciences (XAMK). Centre of expertise aims to support the mental well-being of young people by developing the overall operational culture of the youth work field from the perspective of well-being. Additionally, centres try to prevent the causes of substance abuse in young people by educating youth workers and other professionals. (More about the youth work centres of expertise, see Ministry of Education and Culture and Youth Wiki/Finland 1.4 Youth Policy Governance: Youth policy decision-making).
Cross-sectorial cooperation
There is a consensus in Finland that health promotion must be based on cross-sectoral cooperation. Legislation reflects this approach. The Health Care Act specifies responsibilities for different sectors and levels. As mentioned above, the Child Welfare Act requires municipalities to draw up a plan to promote the well-being of children and young people. Cooperation between municipalities in planning and implementation is possible: two or more municipalities together can draw up a plan concerning the actions of the municipality or municipalities to promote well-being, and to arrange and develop child welfare services. This plan will be subject to approval by the council of each municipality involved and must be reviewed at least once every four years. The plan must cover the circumstances in which children and young people are being raised, and the state of their well-being. (For more information, see Youth Wiki/Finland: 4.2 Administration and Governance)
The National Youth Work and Policy Programme and the National Strategy for Children both emphasise that youth policy needs cross-sectoral cooperation.