Reducing socioeconomic inequalities in health

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

Three Finnish governmental research agencies have started the TEROKA project (In English: Reducing Socioeconomic Health Inequalities in Finland) to develop a knowledge base about heath inequalities between socio-economic groups and to find means to promote health equality in practice. Reducing health inequalities between population groups has been a central goal in Finnish health policy and one of the key targets of the national public health programme "Health 2015".

Purpose of health policy or idea

The objective of the TEROKA  project (Finnish abbreviation of "Reducing Socioeconomic health inequalities in Finland") is to diminish socio-economic inequalities in health. To achieve this goal the project compiles and publishes information on trends in health inequalities; maintains and develops internet pages and educational material and provides lectures on health inequalities; collects material for the basis of a national action plan for reducing health inequalities; develops and assesses national, regional and local measures to reduce health inequalities in co-operation with partners; and builds practical models for evaluating future trends in health inequalities on the regional and municipal level.

The project has been mainly financed by the Ministry and Social Affairs and Health (MSAH). Researchers have a key role in the project. At the start of the project the researcher were from STAKES (National Research and Development Centre for Welfare and Health) and National Public Health Institute, but during the last two years researchers from the Finnish Institute of Occupational Health has been involved in this project also. These governmental agencies are working under the supervision of MSAH.

The project has produced various publications, seminars and workshops on health inequalities. The TEROKA group formulated a position paper on health inequalities for the socio-political ministerial group and for the Minister of Health in 2005. The purpose of the position paper was to convince both civil servants and the political establishment of the need to prepare an action plan as one way to move forward in tackling socio-economic health inequalities.

The last endeavour has been to contribute to the preparation of an action plan on health inequalities in Finland both for national and municipal level. This process is led by the intersectoral Public Health Committee, a statutory body for the development for public health appointed by the Ministry of Social Affairs and Health.

The practical work is carried out by the TEROKA project group consisting members from STAKES, the National Public Health Institute and the Finnish Institute of Occupational Health. Although the project is directed especially towards practical solutions for reducing health inequalities, the scientific community plays a major role in the project.

Main points

Main objectives

The TEROKA  project's main aims are:

• to strengthen the knowledge base on and monitoring of health inequalities and to disseminate this information;
• to develop and promote co-operation between different sectors of society on the national and municipal level on activities to reduce health inequalities;
• to encourage policies and practical measures on tackling health inequalities;
• to advance the use of health impact assessment as a tool to reduce health inequalities.

Type of incentives

Increasing inequality between socio-economic groups

Groups affected

population, national and local level policy-makers

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral

Health inequalities have generally thought to be an important public health problem in Finland. There has existed some information on health inequalities before, but knowledge on how to reduce these inequalities has lacked. The TEROKA project aims to combine theory and praxis by developing both a knowledge base and measures on how to tackle health inequalities.

Political and economic background

The reduction of health inequalities between population groups has been a central goal in Finnish health policy and one of the key targets of the national public health programme "Health 2015" started in 2001. Despite the long-standing attention paid to health inequalities by the health sector in Finland, efforts to reduce health inequalities have not been very successful.

The overall health status has improved in Finland over the past decades, and Finns live longer than before. However, population groups have not benefited from the development equally and socioeconomic differences in life expectancy have increased. White-collar workers are healthier than blue-collar workers, and employed people are healthier than unemployed people. High-income people with the highest educational level are healthier than low-income people with only a basic education.

The foundations of the TEROKA project were established in 1997 as a response to the concerns over increasing health inequalities. It was also considered that too few measures had been put forward to reduce health inequalities. The TEROKA project aims to develop a knowledge base and tools to promote the attainment of the objective of the public health programme "Health 2015" for reducing health inequalities. According to the programme "the objective will be to reduce mortality differences between the genders, groups with different educational backgrounds, and different vocational groups by a fifth by 2015".

Change based on an overall national health policy statement

Government Resolution on the public health programme "Health 2015" (2001)

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Origins of health policy idea

STAKES has been the initiator of the project. The idea of the project was launched in mid 1990s as part of networking between researchers from different European countries. It was considered that too few measures had been put forward to reduce health inequalities on national and local levels, although rather clear data on health inequalities in Finland existed already. The TEROKA  project started systematic work to raise awareness on health inequalities in Finland. Initially the main actors were researchers from STAKES, the National Public Health Institute and the University of Helsinki (Department of Public Health).

Initiators of idea/main actors

• Government

• Scientific Community

• Media

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

Researchers from different governmental agencies have had the leadership role in the project from the beginning. Feedback on the TEROKA  project has been very positive and it has not been opposed by any relevant stakeholder. The main stakeholders are engaged in the project by a steering group consisting of representatives from the Ministry of Social Affairs and Health (MSAH) and the Director Generals of STAKES, the National Public Health Institute and the Finnish Institute of Occupational Health.

Actors and positions

Government
Ministry of Social Affairs and Health	very supportive		strongly opposed
Scientific Community
Researchers in government research agencies	very supportive		strongly opposed
Media
Media	very supportive		strongly opposed

Influences in policy making and legislation

The purpose of the project is to influence policy making and not explicitly legislation.

Legislative outcome

n/a

Actors and influence

Government
Ministry of Social Affairs and Health	very strong		none
Scientific Community
Researchers in government research agencies	very strong		none
Media
Media	very strong		none

Positions and Influences at a glance

Adoption and implementation

Researchers have had the main role in the implementation of the TEROKA  project. The TEROKA project group (with representatives of the three institutions mentioned above) consists of experts on health inequalities with a variety of academic backgrounds including epidemiology, health services research, social policy, medical sociology and nutritional science.

A major achievement in the implementation of the project has been the preparation of the national level action plan on health inequalities in Finland. Important actors in the implementation of the action plan will be MSAH (as well as other political sectors than health on the national level), municipalities and NGOs. The implementation of the action plan will start after the action plan has been finalised.

Monitoring and evaluation

It is too early to evaluate the outcome of the TEROKA project, as the real policy formulation process has just started. There is no explicit evaluation mechanism specified. However, this project closely monitors how trends on health inequalities will develop in the future.

Results of evaluation

The project has not been evaluated.

Expected outcome

The TEROKA  project has been rather successful in raising awareness on socio-economic inequalities in health among politicians and other policy makers. It is possible that the project will lead to practical measures which will reduce these inequalities or at least prevent them from increasing.

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high

The project will affect factors influencing health inequalities. The project will probably have a rather small influence on health care services.

References

Sources of Information

• TEROKA  project. http://www.teroka.fi (information in English also)
• Brochure on the TEROKA  project http://www.teroka.fi/teroka/uploadfiles/teroka_lopullinen_en.pdf
• Government Resolution on the public health programme "Health 2015". http://www.terveys2015.fi/english.htm
• Preparation of a National Action Plan to Reduce Health Inequalities - a Roadmap http://www.teroka.fi/teroka/uploadfiles/health_inequalities_action_plan_2007.pdf

Author/s and/or contributors to this survey

Sihto, Marita

Suggested citation for this online article

Sihto, Marita. "Reducing socioeconomic inequalities in health". Health Policy Monitor, April 2007. Available at http://www.hpm.org/survey/fi/a9/2