-
18 September 2025 | Country Update
Preparedness for emergencies is reinforced in health and social services -
01 December 2022 | Country Update
From highly decentralised system towards more centralisation
2.3. Intersectorality
Intersectoral action (engagement with other sectors) and Health in All Policies (HiAP) have a long tradition in Finland. This is reflected in both explicit legal obligations and long-term institutional practices. The 1999 Primary Health Care Act enables the MSAH to establish an Intersectoral Committee for Public Health for three years at a time, although this is not a legal requirement (Amendment to the Primary Health Care Act in 1999). The last committee was functional until 2015, but intersectoral work continues as part of institutional cooperation on specific programmes and joint ministerial initiatives. The 1999 Primary Health Care Act obliges the local government to take health into account as part of other policies and to be responsible for disease prevention and health promotion. In addition, Finland played a major role in health promotion and support of HiAP during its Presidency of the EU Council in 2006 and in WHO’s Global Conference on Health Promotion in 2013 (Ståhl et al., 2006; Ollila et al., 2013; Melkas, 2013). However, the role of HiAP as part of Finland’s national policies has changed, with the current focus being on the local level and an emphasis on both health and well-being.
Intersectoral action in Finland has been particularly strong in the field of nutrition. The National Nutrition Council was established in 1954 with an initial focus on ensuring nutritious school meals. Later, the scope of the council, based in the Ministry of Agriculture and Forestry, widened and to date it remains responsible for official guidance on nutrition. Food safety and regulation is the responsibility of the Ministry of Agriculture and Forestry, with examples of effective actions in cooperation with MSAH, including in addressing antibiotic resistance and the prohibition of the use of antimicrobials in animal production. The North Karelia project is Finland’s best known example of intersectoral action (Puska et al., 2009). It combined mass dietary interventions (in schools and workplaces) with initiatives on tobacco and alcohol control.
The Ministry of Transport and Communications has been a traditional partner in intersectoral policies, playing a key role in expanding walkways and cycling routes. The Ministry of the Environment has played a key role in air quality control with regard to wood-burning and transport pollution, joined intersectoral cooperation on housing, as well as, more recently, in promoting national parks as areas to relieve stress and improve well-being. However, the role of the MSAH has been limited in intersectoral cooperation on environmental health and sustainability issues.
There is also a tradition of formal consultation across Government on policies of relevance to other sectors. Intersectoral action and relevant parliamentary decision-making also engages with different NGOs, trade unions, local government and relevant commercial and corporate representatives, with the exception of the tobacco industry. However, involvement is dominated by a few actors, including the Finnish Business and Policy Forum, EVA, the Association of Finnish Local and Regional Authorities and the Finnish Central Union of Agricultural Producers and Forest Owners, with relatively strong influence of commercial and corporate representatives in legislative work. Research and development institutions and NGOs have served as institutional structures in support of policy-making at the national and local level. In addition to the THL, FIOH has been an important actor with regard to occupational health.
In terms of alcohol and tobacco control, the state has the monopoly on alcohol distribution for wine, strong beer and spirits. The alcohol tax was lowered by 33% in 2004 and since then raised five times. Current taxation in relation to ethyl alcohol is more lenient for wine than beer and more stringent towards cider and strong alcohol. In 2018 the current Government relaxed, to some extent, alcohol control policies by increasing the maximum strength of alcoholic beverages allowed to be sold in ordinary retail shops from 4.7% to 5.5% by volume, as well as by liberalizing opening hours for restaurants and bars. As a countermeasure, the Government increased excise taxes on alcohol by 10%.
In 2016, the tobacco tax was raised and new legislation was enacted, with prohibition of added flavours, the inclusion of e-cigarettes and snus under the tobacco law, the introduction of a 25-hour import restriction from countries outside the EEA, and making it easier for municipalities to prohibit smoking on balconies as well as inside apartments and flats (Tobacco Act 549/2016). Earmarking part of the income from tobacco taxation to support health promotion activities by NGOs has provided a useful, although limited, addition to available resources for health promotion.
Health impact assessment has not played a major role in the implementation of intersectoral action in Finland, although it has been legally required as part of environmental impact assessments. Integrated impact assessments with a focus on regulatory measures are often required, but have been applied to health only to a limited extent (Kauppinen, 2011). In 2015, the MSAH has produced guidance for improved human impact assessments as part of integrated impact assessment work with a broader focus on assessing impact on humans, including gender, child, social, environmental health and equality.
In June 2025, the legal framework for preparedness in social and health services was strengthened. The amendments aim to ensure that WBSCs and the national actors can respond effectively to disruptions, both in normal times and in exceptional circumstances. The reform aims at improving cooperation between the five collaborative areas formed around university hospitals, establishes a national preparedness group under the Ministry of Social Affairs and Health, and clarifies division of work between regional and national actors. The changes are intended to improve readiness for risks ranging from pandemics and cyber-attacks to military threats, reflecting the central role of wellbeing services counties in safeguarding both civilian and defense needs.
In addition to the amendments passed in the summer of 2025 the government is proposing an amendment that would oblige the WBSCs to prepare for the use and threat of military force. The amendments aim to ensure close cooperation between the WBSCs and the Finnish Defense Forces in both normal and emergency conditions. The level of preparedness and related responsibilities would not be the same in all counties, but instead the responsibilities could vary and depend for instance on geography.
Authors
References
Ministry of Social Affairs and Health. 2025a. Sosiaali- ja terveydenhuollon valmiutta ja varautumista vahvistettiin lakimuutoksella – Sosiaali- ja terveysministeriö https://stm.fi/-/sosiaali-ja-terveydenhuollon-valmiutta-ja-varautumista-vahvistettiin-lakimuutoksella
Ministry of Social Affairs and Health. 2025b. Preparedness for emergencies to be reinforced in healthcare and social welfare – Ministry of Social Affairs and Health https://stm.fi/en/-/preparedness-for-emergencies-to-be-reinforced-in-healthcare-and-social-welfare
Historically highly decentralized and fragmented administrative structure encumbered the governance of the Finnish health system. Until the end of 2022, over 300 municipalities were responsible for funding primary and specialist care for their residents while some 200 organisations (municipalities, joint municipal organisations, hospital districts) were responsible for organizing the services. In the new structure health care is organized by 21 Well-being Service Counties (WBSC); the city of Helsinki; and the Hospital District of Helsinki and Uusimaa.
The central Government had limited means for steering. In practice, the municipalities often had a limited capacity in planning, evaluation of the system performance and decision-making regarding service delivery models. This led to inequalities and lack of coordination, as well as high degree of administrative inefficiency. The reform process to centralise healthcare to counties began in the early 2000’s, and, after years of debate, refinement and various failed reform proposals, resulted in the establishment of Wellbeing Services Counties which are responsible for provision of all publicly financed health and social services, and creation of central tax-based funding mechanism for these services at the national level from 2023.