Noora Ala-Hakuni Anna Inberg Hanna-Maija Kari Laura-Maria Klemetti

CULTURAL PERSPECTIVES ON PUBLIC HEALTH

Faculty of Social Services and Health Care 2012

TABLE OF CONTENTS 1 INTRODUCTION........................................................................................................3 2 IMPORTANT DEFINITIONS....................................................................................4 2.1 Health ..............................................................................................................4 2.2 Well-being............................................................................................................5 2.3 Rehabilitation........................................................................................................6 2.4 How environment affects in our health................................................................8 2.5 Health promotion..................................................................................................9 3 HEALTH OF ADULT POPULATION GROUP......................................................11 4 PUBLIC HEALTH.....................................................................................................14 4.1 Health policy in Finland.....................................................................................14 4.2 Legislation..........................................................................................................14 4.3 Health care system..............................................................................................15 4.4 Health political programs...................................................................................16 4.5 The third sector...................................................................................................17 5 CONCLUSIONS........................................................................................................18 LIST OF REFERENCES................................................................................................19

INTRODUCTION

This essay tells about the public health in Finland, especially the health of adult population group. The health can be defined in many ways. One of the defines is the World Health Organizations (WHO) definition: Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. In Finland some diseases occur in adult population group more than other diseases. These are so called national diseases. Preventing the diseases and nursing people who are ill form the foundation to health care of adults. In Finland the population is geographically spread in different sized cities and sparsely populated areas. How does this and big differences in incomes affect to the public health? As we know, at least environment has a big influence on humans health. In Finnish health care the main emphasis is on prevention, promotion and primary services. Health policy has two main objectives: securing best possible health for the population and minimalizing differences in health between population groups. (Aromaa, Huttunen, Koskinen & Teperi 2007, 8, 13.)

IMPORTANT DEFINITIONS

2.1

Health

What creates health? There are many ways to understand what health is. In the Middle Ages if you get sick it was sign that you had commit sin and now this was how you paid back. In 1900-century came an idea that we can define health by categorizing it into three groups: biomedical, functional and positive. Biomedical way thinks that a person can be sick or healthy but nothing between those two. If you are healthy its a lack of diseases. This way of thinking has been criticized a lot, for example because of mental health problems and how its not as black and white. In functional way of thinking the diagnose is not as important as if you are losing your ability to function. The main thing is to be able to work and act in normal way. But even this model is not so understandable, because with some people you can easily see the sickness than with others. Positive insight of health thinks that you have get a perfect state of health. It covers physical, mental and social well-being and this is something we should try to get all the time. This something we still have in our world, because WHO (World Human Organization) lives with this idea. (Kauhanen J., Myllykangas M., Salonen J.T, Nissinen A. 1998, Terveyskirjasto 2012.) You can say that health is completeness of physical, mental and social well-being, something where you are not just healthy for not being sick right now. Something like an illusion, something you could have. This idea of health is been criticized a lot because its not possible to get this kind of perfect level of health. Health is more like a stage that changes all the time and that is affected by illnesses and the places where you live. (Kauhanen etc. 1998.) In 1979 Aaron Antonovsky had an idea of why some people got sick under a stress while other people didnt. This idea is called as Sense of Coherence (SOC) and it is de-

fined as: The extent to which one has a pervasive, enduring though dynamic, feeling of confidence that ones environment is predictable and that things will work out as well as can reasonably be expected. (Psych Central 2006). There are three important parts that make SOC so good, and they are comprehensibility, manageability, and meaningfulness. Professor Antonovsky thinks that a person with good SOC can cope better in stressful situations and make better success. SOC is a method that is been used worldwide. When reading about Antonovskys work you also come across with salutogenesis. Salutogenesis is a fact that takes person that is under a lot of stress towards health. It helps people to stand stress better and gives a better quality of life and mental wellbeing. (Folkhlsan Research Centre 2012, Psych Central 2006.) The most important way is to think that health can either be objective or subjective. When its objective, its the way that society thinks that is their definition of health. But then subjective is what a single person thinks is healthy. For different people it has a different meaning, for example a blind man may not he is sick, but other people might treat him like he is. Its also important in what kind of environment you live and if it has any impacts of your life, for example sitting in a wheelchair. Its also important how people around you act and help you in your daily basics. (Kauhanen etc. 1998, Terveyskirjasto 2012.)

2.2

Well-being

Finnish future researchers Aleksi Neuvonen and Roope Mokka have found that wellbeing is human beings confident that he is his own lives lord. Well-being is a phenomenon which is difficult to define, because it means different things to different people. In standard language well-being means wealth and good health but the same word in society has different definitions and indicators. Well-being consists of various components, measurable things as well as individualized valuations and feelings. Individualized well-being components are social relationships, self-realization and happiness. In the broadest sense, well-being refers to what we have when we live life that is good for us. (Finnish Federation of the Visually Impaired 2012, Terveyskirjasto 2012.) Well-being can be sectioned into three components; health, living conditions and sub-

sistence. It can mean different things to different people. Some can think that well-being includes only good health when some not so healthy can feel oneself happy and well-being. Erik Allardt has crystallized the components of well-being into three words; having, loving and being. The key is that well-being requires satisfaction in all three components. (Lykky 2012, Stakes 2012.) The quality of life describes the satisfaction which is related to health, psyche, social needs and environment in respect to ones needs. The WHO (World Health Organization) has developed the indicator where the quality of life has been divided into six different extents of the quality of life; physical health (pain and the quality of sleep), psychological health (thinking, learning, concentration), working order (ambulatory, daily functions), social relationships (relationships, sexuality), environment (earnings, conditions at home, recreational opportunity) and values (religiosity, attitudes, world view). (Introducing the WHOQOL instruments 2012.) The Finnish Ministry of Social Affairs and Health supports Finnish well-being, health and working order. Their ambition is that well-being and health would be taken into account in all decisions and actions. Finnish Ministry of Social Affairs and Health seeks to promote the health and well-being by increasing the security and preventing exclusion and poverty, by using health promotion, reducing substance use and by preventing diseases and health inequalities. (Ministry of social affairs and health 2012.) Well-being means different things for us in different stages of our life cycle. When we are children, the well-being comes from our parents and family. The love, play and safety which they give to us, makes us happy and feeling well. At teenage, we feel that self-realization, and new things are more important than caring. (Kohtaamo 2012.)

2.3

Rehabilitation

There are three main jobs in health care, which are preventing illness, nursing and rehabilitation. The goal in rehabilitation is improve sick or disabled persons function, independence, well-being and possibility to work. Goal is that they can survive in their situation of life and in their own environment. Rehabilitation contains different kinds

of services, like therapy, guidance, training, different kinds of instruments, technical solutions and financial support. There are many different laws controlling rehabilitation and taking care that people can survive in normal life. It is also systematic and diversified, that is separated into professional rehabilitation, educational rehabilitation, medical rehabilitation and social rehabilitation. (Kauhanen etc. 1998, Kuntoutusportti 2012) Professional rehabilitation is offered to people, that have some kind of sickness and it looks like that sickness can be a threat for disability to work now or inside a few years. In that case the Social Insurance Institution is going to help persons earning capacity. Rehabilitation is teamwork with many different people and their expertise. (Ministry of social affairs and health 2012) Educational rehabilitation in needed when we want to change persons ability to function. It is most usually been needed with disabled people, so that it covers all new learning with people in different ages and different situations. For many people it is remedial education so that students individual needs are noticed. (Suomen cp-liitto ry 2012.) Medical rehabilitation includes measures that improve individuals physical and mental performance and have been initiated on the basis of medical tests. It can also be called functional rehabilitation or performance sustaining rehabilitation (Kuntoutusportti 2012.) Social rehabilitation means persons social functioning healing process which aims are help living and general participation. In particular it is for difficult marginalized people for helping them to make the return on social inclusion. (Ministry of social affairs and health 2012.) The rehabilitation system in Finland consists of many different separate and independent subsystems. These individual subsystems are the municipal social and health service system, labor administration, the national pension and social insurance system, the occupational pension scheme, a mandatory accident and motor insurance voluntary accident insurance, veterans rehabilitation and organization in rehabilitation

activities. It has been integrated into a part of public service system and it is multiprofessional and long-term. (Kuntoutusportti 2012, Kujala P. 2012.)

2.4

How environment affects in our health

In persons health has also other factors than just heredity and lifestyle. That is our environment and the air we breathe. The health and safety of our economic environment has changed a lot and it has consequences in our lives. Contaminated environment threats our health and the blame is energy production, industry, traffic and lifestyle etc. Protecting our environment has not been as good as how fast our industrial development has been. Every country should have its own program made so that we can stop our environment getting any worst. We should take care of our environment and that how also take care of ourselves, by preventing contamination of water, pesticide detriment, noise, pollution of air in cities etc. (Terveyskirjasto 2012, The Public Health Portal of European Union 2012.) It is really important to take care of the wellbeing of our ecosystem. Because of all these loggings all around the world we have lost most of our forests and even the quality of trees has failed. Because of these loggings its been estimated that in less than 90-years most of our tropical forests will die out. One of the reasons is smoking. Its not good to smoke just because its not healthy but also because it has an influence for our forests. Because of smoking there are loggings for more than millions of hectares every year. But smoking is not only thing that is destroying our health. In commercial using there are tens of thousands industrial chemicals. There are new chemicals coming out on market every day and most of those havent been tested for toxicity. (Terveyskirjasto 2012.) Global warming has been an important issue for many years now. It means that we are destroying our planet with carbon dioxide. Our planet becomes warmer and we dont exactly know how its going to affect in our planet. But if planet does get warmer it means for some species that they cant survive anymore and that can have affect in other species including humans. In recent years there has been more all kind of natural phenomenons including floods, earthquakes, tsunamis etc. Those are like warnings for

us, that we should really do something and not just keep doing bad for our planet. Because of all this people are dying for these huge natural phenomena or then just because climate is now so warm in some part of the globe that it is not just possible to live there anymore. That same affect has some islands, which no longer exist because sea level has risen so much and that how leaving these islands under water. (Ilmasto 2012.) It is really clear how much environment affects in humans and how much we affect in our environment. By taking better care of our environment, we are taking better care of ourselves.

2.5

Health promotion

WHO defines health promotion as a process that gives more opportunities for individuals and communities to manage health and its determinants. The most significant document which coordinates health promotion concepts and work is the Ottawa Charter. Its strategic guidelines are; building healthy public policy, creating health supportive environments, strengthening community action, developing personal skills and re-orientating health care services. (Markkanen, M. 2012, WHO 2012.) Health promotion is affecting on the determinants of health which are; individual-, structural-, social- and cultural factors. Individual factors includes age, sex, genotype, information, knowledge, experiences and manners of living. Structural factors are educational opportunities, living conditions, environment, working conditions and equitable access to health service and their functionality. Social factors include socio-economic status, livelihood, social and community networks and interaction between human. Cultural factors are the safety of physical-, psychological and economic environment, comfort and interactivity and attitudes of health. (Markkanen, M. 2012.) There is internal and external health protective factors. Internal health protective factors are physical health and genetics, early positive relationships, self-esteem, feeling of being accepted, skills of solving problems, skills of handling conflicts, interpersonal skills, the ability to self-fulfillment, as well as the ability to create and maintain rela-

tionships with others. The external health protective factors are social support, access to education, employment or other income, secure environment, being heard and opportunity to influence. (Markkanen, M. 2012.) There is also internal and external health risk factors that may reduce the health and well-being. Internal health risk factors are vulnerability in self-esteem, feeling of helpless, poor interpersonal relationships, sexual problems, isolation, alienation and institutionalization. (Markkanen, M. 2012) Health promotion means building and supporting health and its conditions and health prevention means prevention of diseases. In Finland the Ministry of Social Affairs and Health has the general guidance and supervisory responsibility for health promotion. The Ministry aims to influence to health-promoting lifestyle and living environment, cleanliness, security and accessibility. Particularly the fight against accidents is a key target. (Ministry of social affairs and health 2012.) In Finland, we have good experiences on prevention of communicable diseases. With good hygiene and vaccination program we have averted especially most of the childrens infectious diseases. (Ministry of social affairs and health 2012.)

HEALTH OF ADULT POPULATION GROUP

Adulthood is a concept which is explored by age of human. Adulthood is a process which contains progressing and maturation socially, physically and mentally. Finding oneself is also connected to adulthood. Young adult searches own place and capabilities by studying, working or doing things which are remarkable. The first decade of adulthood is full of choices and important decisions. With these choices and decisions it is easier to plan own life. Middle-aged adult has often found central contents of life. The meaning of life is also thought in middle-age by decisions. Between middle-age and beginning of old age central problems are ageing and accepting that. Speculations about death are also very topical. (Sirola, K., Hrml, M., Puodinketo-Wahlsten A., Salminen E-M & Sundstrm, L 1998.) Environment and society impact to health habits and attitude to health. Also smaller parts like genotype are impacting to health habits (Sirola, etc. 1998.) National institute for Health and Welfare has surveyed national diseases. National diseases in Finland are cardiovascular diseases, diabetes, musculoskeletal conditions, cancers, rheumatoid arthritis, asthmas and allergies and mental health- and intoxicant problems. Despite the fact, health of Finnish people has improved during the last 30 years. Occurrence of cardiovascular diseases, some cancers and dental diseases has gone down. Number of suicides has also decreased. Life expectancy of adults has grown 3-4 years. More and more people in Finland feel that their health has improved. Rise of education level, better ways of life, better social security and developed health services are the main reasons to improved health. (Peltonen, M., Harald, K., Mnnist, S., Saarikoski, L., Peltomki, P., Lund, L., Sundvall, J., Juolevi, A., Laatikainen, T., Aldn-Nieminen, H., Luoto, R., Jousilahti, P., Salomaa, V., Taimi, M. & Vartiainen E.

2008.) Health of Finnish people isnt good in all sectors. Average mens life expectancy is still shorter compared to western Europe. More than half Finns suffer from some chronic disease which is the most common reasons to disability to work. Those chronic diseases cause also many of untimely death. Mental health diseases and musculoskeletal conditions are diagnosed more than previously. Asthma, allergies and diabetes are also on the increase. Disability pensions are also given more and more. (Peltonen etc. 2008, Helakorpi S., Laitalainen, E. & Uutela, A. 2009, Terveyden ja Hyvinvoinnin laitos 2012.) Health differences between population groups, ageing and usage of drugs and intoxicant are very big challenges to health. For example differences between educational groups have grown. Ageing of population brings big challenges to health care and influence to occurrence of some diseases. Also growth usage of intoxicants creates new problems for health care. Loneliness and lack of social contacts assists usage of intoxicants and depression. (Peltonen etc. 2008, Helakorpi S., Laitalainen, E. & Uutela, A. 2009, Terveyden ja Hyvinvoinnin laitos 2012.) Chronic national diseases are tried to prevent by two ways. At first it is important to point preventive measures to people who are in big danger to get some national disease. This preventive measure is called strategy of high risk. At second it is important to try to govern the ways of life among whole population. This is called strategy of population. Strategy of population aims to healthy changes of lifestyle which reduce risk factors. Even small improvements in diet, use of intoxicants and physical training may reduce ill health of population more than only remedying high risk situations. There is some expert help to people who are suffering from mental health- and intoxicant problems. A big problem is that man has to be able to search help oneself. (Peltonen etc. 2008, Helakorpi S., Laitalainen, E. & Uutela, A. 2009, Terveyden ja Hyvinvoinnin laitos 2012.) Too many Finnish people are sedentary. Two thirds of working people are having insufficient physical training. Activity in training is dividing distantly between different population groups. People from lower social standings are exercising less than people

from higher social standings. Fitness-training is common mainly in higher population groups but for example walking and cycling is common in all population groups. Diminution of everyday exercising and growth of unhealthy food has resulted in all socio-economic groups gaining weight. These all reasons mean that Finns get easier some national diseases. Encouraging to physical training and guiding how to eat healthy is an important part of promoting the health of adults. (Peltonen etc. 2008, Helakorpi S., Laitalainen, E. & Uutela, A. 2009, Terveyden ja Hyvinvoinnin laitos 2012.)

PUBLIC HEALTH

4.1

Health policy in Finland

The policy of health care in Finland is guided by the World Health Organization (WHO) and the alignments of the European Union (EU). The aim is to extend the time human is able to function, to ensure everyone a best possible quality of life and also to decrease the differences in health between population groups and to reduce premature deaths. The foundation of the health care is preventive health care and health services obtainable for the whole population. (Haarala, Honkanen, Mellin & TervaskantoMentausta 2008, 44.) The present Finnish government platform stresses the importance of emphasizing health and social welfare concerns in public policy-making and actions. In practice health promotion is often neglected although local governments have adopted governmental strategies and produced reports highlighting the importance of taking health promotion into account in all municipal decision-making. (Aromaa etc. 2007, 16.)

4.2

Legislation

The Constitution of Finland guarantees everyone gets basic incomes and adequate social and health services. The law also requires that government officials promote the health of Finnish population. (Haarala etc. 2008, 42.) There are many ways of health promotion that can be directed by health policy. Laws that dont directly come under the public healths administrative branch, are yet significant for the public health (so called health protection). In Finland there are about twenty laws that involve public health. These laws form a frame for promoting public health and the state and corporations fulfill the laws. (Kauhanen etc., 272-274.) Public

health is largely determined in arenas of everyday life that are outside the realm of health care: at home, at schools, in the workplace, in transport, consumption and leisure environments and in immediate communities (Aromaa etc. 2007, 14). The Public Health Act rules the health centers to organize the public health service. Nowadays the public health work (primary health care) can be organized by the municipality or as outsourcing service. The law includes child health and prenatal clinics, school and study health care, preventive mental health work, occupational health care, challenges of ageing and environmental health care. According to the law the tasks of public health work are the follow-up of the populations health and the factors affecting to it, taking health perspectives into account in every activity of the corporation and the cooperation to promote the health. (Haarala etc. 2008, 43.) The education and competence of health care professionals is strictly supervised by laws and statutes (Kauhanen, Myllykangas, Salonen & Nissinen 1998, 278-279).

4.3

Health care system

Affecting to the populations awareness of health issues by education and health communications is an important part of the Finnish health policy. Health care system is vital to the promotion and maintenance of populations health. The three main tasks of health care system are prevention of diseases, nursing and rehabilitation. (Kauhanen etc. 1998, 278-279.) The health care system in Finland is based on the fact that the municipalities and the federations of municipalities are in responsible for realizing the health services. The services are mainly financed by tax revenue and tax-like payments. The municipalities are obligated to arrange services for their own inhabitants only (not in acute cases). There is a certain gradation in health care: first the patient is examined in primary health care by GP and he/she makes the decision of sending the patient on to special health care. (Kauhanen etc. 1998, 281-282.)

4.4 Kaste

Health political programs

Kaste Program 2012-2015 (The National Development Plan for Social Welfare and Health Care) is a strategic steering tool that is used to manage and reform social and health policy (Kaste 2012). The Kaste Program is a part of the Government Program and the Strategy of the Ministry of Social Affairs and Health and it is the main program of social welfare and health care. The program has two main targets: to reduce inequalities in wellbeing and health and to re-organize social welfare structures and health care structures and services to more client-oriented form. (Kaste 2012.) The aim is to improve the quality, availability, and influence of the services. For example the services for children, the young and families with children are intended to pull together and bring to homes, day care, school and leisure activities. Also the alliance of the public, the private and the third sector and the academies, universities, research institutes, social institutes and the ministry is an important target on the program. Wide local projects are expected and the municipal development should strengthen. The state is pledged to support the Kaste Program by renewing the legislation and giving guidelines and government subsidy. (Haarala etc. 2008, 49-50.) Health 2015 The Health 2015 Program was drawn up in 2001 and it is based on the WHOs global program and the program for the European Region. The Ministry of Social Affairs and Health is coordinating and monitoring program implementation and attainment of its targets. It is a long-term program and it is aiming on promoting health and welfare in health care but also in every other fields of society. In the Program there are common targets and targets for different age groups. The targets are concrete: for example by the year 2015 maximum 15 percent of the age group 16-18 are smoking. (Health 2015.) Common targets are: increasing healthy lifespan, reducing health differences and maintaining the satisfaction for health services, ones own experience of health

and experiences of environmental effects. (Haarala etc. 2008, 48.)

4.5

The third sector

The third sector, voluntary organizations, have stable traditions in Finland. Some of the public health services have originally started as voluntary work. Nowadays the voluntary work is an important part of the official health care and a supporting action for public health work. Organizations, foundations, cooperatives, and private persons form the third sector. Patient organizations are often reformers in developing health care services. Sports organizations have a direct effect on health promotion because their aim is to increase physical training. Also the social work of the Finnish Evangelical-Lutheran church has some improving effects on the public health: pastoral counseling in hospitals, family counseling and the helpline. (Kauhanen etc. 1998, 300301.)

CONCLUSIONS

Knowing different definitions of health and welfare is important when studying nursing or public health nursing. Being a good nurse it means that you also know what kind of influence the environment has on humans health. Especially public health nurses need to know the ways to promote health and prevent health problems. In Finland we have long traditions in childrens health care and it is still well-organized. The problem is that adults are responsible for their own health and they dont always know how or when to get help. Also the poor mental health care of the Young leads to serious mental health problems in adulthood. Although common health in Finland has improved there is still a lot of work on preventing the national diseases. We have many different health promoting programs and well-progressed health policy. The change to better health care needs long-term work and commitment on affecting peoples attitudes and opinions. Everyone is primarily in responsible for their own health and actions affecting their surroundings.

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