Implementation of Health 2015 public health program in Finland: a welfare state in transition

Our study sought to examine the implementation of Health 2015 [a public health programme prepared following the principles of Health in All Policies (HiAP)] between 2001 and 2015 in the context of welfare state restructuring. We used data from the realist multiple explanatory case study by HARMONICS, which focused on political factors (processes) that lead to the (un)successful implementation of programmes following the principles of HiAP. We analyzed data-key informant interviews, grey and scholarly literature-from our Finnish case to examine how Health 2015 implementation has been affected by the changing role of the state. We find that the dismantling of formal funding allocation decreased the capacity of national authorities to exert control over municipalities' health promotion work, diluting the financial arrangements regarding municipal obligations. As a result, most municipalities failed to contribute to Health 2015, resulting in losses for health promotion activities. Our results also point to joining the EU. Whereas the procedures for preparing Finland's unanimous positions on EU matters were useful in harmonizing ideologies on various policy issues between different ministries, joining the EU also increased commercial interests and the strength of the lobby system, leading to the prioritization of economic objectives over public health objectives. Finally, our informants also highlighted the changing relationship between the state and the market, manifested in market deregulation and increasing influence of pro-growth arguments during the implementation of Health 2015.

Child Safety Reference Frameworks: a Policy Tool for Child Injury Prevention at the Sub-national Level

OBJECTIVES

The aim of this paper is to present the Child Safety Reference Frameworks (CSRF), a policy advice tool that places evidence-based child safety interventions, applicable at the sub-national level, into a framework resembling the Haddon Matrix.

METHOD

The CSRF is based on work done in previous EU funded projects, which we have adapted to the field of child safety. The CSRF were populated following a literature review.

RESULTS

Four CSRF were developed for four domains of child safety: road, water and home safety, and intentional injury prevention.

CONCLUSION

The CSRF can be used as a reference, assessment and comparative tool by child safety practitioners and policy makers working at the sub-national level.

Explaining the role of the social determinants of health on health inequality in South Africa

BACKGROUND

Action on the social determinants of health (SDH) is relevant for reducing health inequalities. This is particularly the case for South Africa (SA) with its very high level of income inequality and inequalities in health and health outcomes. This paper provides evidence on the key SDH for reducing health inequalities in the country using a framework initially developed by the World Health Organization.

OBJECTIVE

This paper assesses health inequalities in SA and explains the factors (i.e. SDH and other individual level factors) that account for large disparities in health. The relative contribution of different SDH to health inequality is also assessed.

DESIGN

A cross-sectional design is used. Data come from the third wave of the nationally representative National Income Dynamics Study. A subsample of adults (18 years and older) is used. The main variable of interest is dichotomised good versus bad self-assessed health (SAH). Income-related health inequality is assessed using the standard concentration index (CI). A positive CI means that the rich report better health than the poor. A negative value signifies the opposite. The paper also decomposes the CI to assess its contributing factors.

RESULTS

Good SAH is significantly concentrated among the rich rather than the poor (CI=0.008; p<0.01). Decomposition of this result shows that social protection and employment (contribution=0.012; p<0.01), knowledge and education (0.005; p<0.01), and housing and infrastructure (-0.003; p<0.01) contribute significantly to the disparities in good SAH in SA. After accounting for these other variables, the contribution of income and poverty is negligible.

CONCLUSIONS

Addressing health inequalities inter alia requires an increased government commitment in terms of budgetary allocations to key sectors (i.e. employment, social protection, education, housing, and other appropriate infrastructure). Attention should also be paid to equity in benefits from government expenditure. In addition, the health sector needs to play its role in providing a broad range of health services to reduce the burden of disease.