Kokkinen Lauri, Muntaner Carles, O'Campo Patricia, Freiler Alix, Oneka Golda, Shankardass Ketan
Faculty of Social Sciences, University of Tampere, Tampere, Finland.
Finnish Institute of Occupational Health, Tampere, Finland.
Health Promot Int. 2019 Apr 1;34(2):258-268. doi: 10.1093/heapro/dax081.
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.
我们的研究旨在探讨2001年至2015年期间，在福利国家结构调整的背景下，《2015年健康计划》（一项遵循“健康融入所有政策”（HiAP）原则制定的公共卫生计划）的实施情况。我们使用了HARMONICS进行的现实主义多重解释性案例研究的数据，该研究聚焦于导致遵循HiAP原则的计划（未）成功实施的政治因素（过程）。我们分析了来自芬兰案例的数据——关键 informant 访谈、灰色文献和学术文献——以研究《2015年健康计划》的实施如何受到国家角色变化的影响。我们发现，正式资金分配的取消降低了国家当局对市政当局健康促进工作的控制能力，削弱了有关市政义务的财政安排。结果，大多数市政当局未能为《2015年健康计划》做出贡献，导致健康促进活动受损。我们的研究结果还指出了加入欧盟的影响。虽然芬兰就欧盟事务达成一致立场的程序有助于协调不同部委在各种政策问题上的意识形态，但加入欧盟也增加了商业利益和游说系统的力量，导致经济目标优先于公共卫生目标。最后，我们的 informant 还强调了国家与市场之间不断变化的关系，这体现在《2015年健康计划》实施期间的市场放松管制和支持增长论点的影响力增加上。
