By the second half of the 1980s, Finns enjoyed a standard of health fully comparable to that of other highly developed countries. If health standards did not match those of Finland's Nordic neighbors in all areas, it was because Sweden, Denmark, and Norway were the world's leaders in health care. Finland had made remarkable progress, however, and was rapidly catching up. In one major area, the prevention of infant mortality, Finland led the world in the mid-1980s: it had the world's lowest infant mortality rate.
Development of the Health System
Since becoming an independent state in 1917, Finland has managed to deal with the "traditional" health problems. The most important cause of death in the nineteenth century, pulmonary tuberculosis, was brought under control by means of a network of tuberculosis hospitals built between the world wars. Smallpox and pneumonia have also ceased to be serious problems. With the aid of the vaccination law passed in 1952, the fight against communicable diseases was largely won. In 1980, for example, there were no deaths from common diseases of this type. By the mid-1980s, no cases of diphtheria had been registered in Finland for several decades, and, with the exception of a mini-epidemic of seven cases in 1983-84, poliomyelitis also had disappeared. An emphasis on hospital construction in the 1950s and 1960s brought the ratio of hospital beds per capita up to international norms, and new medical training centers more than doubled the number of physicians between 1970 and the mid-1980s. The passage of the Sickness Insurance Act in 1963 and frequent expansion of its coverage meant that good medical care was available to everyone. Later legislative measures, such as the Primary Health Care Act of 1972, or the Mental Health Act of 1978, aimed at moving health care from large centers, increasing the amount of preventive treatment at smaller local facilities, and favoring out-patient care when possible. Finnish health authorities believed, even in the late 1980s, that care of this kind could be more flexible, humane, and effective and could also check cost increases. Despite this policy innovation, however, social expenditures on health had increased ten-fold in real terms since the early 1950s.
Organization of the Health System
Health care was directed by the Ministry of Social Affairs and Health and was administered by the National Board of Health. In accordance with government practices, the ministry decided policy, and the national board determined how it would be administered. Actual delivery of care was the responsibility of local government, especially after the Primary Health Care Act of 1972, which stipulated that the basis of medical treatment should be the care offered in local health clinics. Previously, the emphasis had been on care from large regional hospitals.
The 1972 law resulted in the creation of about 200 local health centers each of which served a minimum of 10,000 persons. As municipalities varied greatly in size, small ones had to unite with others to form health centers, while about half the centers were operated by a single municipality. Centers did not necessarily consist of a single building, but encompassed all the health facilities in the health center district. With the exception of some sparsely settled regions, people were usually within twenty-five kilometers of the center charged with their care.
A basic aim of the 1972 law was to give all Finns equal access to health care, regardless of their income or where they lived. Because most services of health centers were free, subsidies from the national government were required to augment the financial resources of municipalities. The subsidies varied according to the wealth of the municipality and ranged roughly from 30 to 65 percent of costs. By the mid-1980s, about 40 percent of the money spent on health went for primary care, compared with 10 percent in 1972.
Health care centers were responsible for routine care such as health counseling, examinations, and screening for communicable diseases; they also provided school health services, home care, dental work, and child and maternal care. Most health centers had at least three physicians and additional staff at a ratio of about eleven per physician. Because of the high level of their training, nurses performed many services done by physicians in other countries. Most centers had midwives, whose high competence, combined with an extensive program of prenatal care, made possible Finland's extremely low infant mortality rate, the world's best at 6.5 deaths per 1,000 births.
Once it was established that a health problem could not be treated adequately at a center, patients were directed to hospitals, either to one of about thirty local hospitals with some degree of specialization, or to one of about twenty hospitals, five of which were university teaching hospitals, that could offer highly specialized care. In addition, there were institutions with a single concern, such as the sixty psychiatric hospitals, and others that dealt with orthopedics, epilepsy, rheumatism, or plastic surgery. Given the great drop in the incidence of tuberculosis in Finland, the country's dozen sanatoria were gradually being taken over for other purposes. Hospitals were usually operated by federations of municipalities, as their maintenance was beyond the power of most single municipalities. By the mid-1980s, the country's public hospitals had about 50,000 beds, and its 40-odd private hospitals had roughly 3,000. There were another 20,000 beds for patients at health centers, homes for the elderly, and other welfare institutions.
By the late 1980s, Finland's health problems were similar to those affecting other advanced countries. The most common causes of death in Finland were, first, cardiovascular diseases, followed by neoplasms (malignant and benign), accidents, poisonings, trauma from external causes (including suicides), and, lastly, diseases of the respiratory system. The mortality rate from cardiovascular diseases was among the world's highest for both sexes, but it was especially high for middle-aged males. A national diet rich in fats was seen by medical specialists as a cause of the prevalence of coronary illnesses.
Despite its location on the periphery of Europe, Finland was also affected by the spread of acquired immune deficiency syndrome (AIDS), but not to a serious degree. As of late 1988, only 32 cases of AIDS had been reported, and 222 persons had been found to be infected with the human immunodeficiency virus (HIV), although health officials believed there might be as many as 500 HIV-positive cases in all of Finland. Reasons for the slight presence of this health problem were the low frequency of drug use and prostitution, an aggressive and frank public education campaign, and the trust Finns felt for the national health system, which led them to adopt practices it recommended.
The most striking of all Finnish health problems was the high average mortality rate for males once they reached adulthood, which contributed to an average longevity in the mid-1980s of only 70.1 years compared with 73.6 years for Swedish males. In the second half of the 1970s, Finnish males over the age of twenty were one-third more likely to die by their sixty-fifth birthday than their Swedish neighbors. Cardiovascular diseases struck Finnish men twice as often as Swedish men. The three other chief causes of death were respiratory illnesses at twice the Swedish rate, lung cancer at three times the Swedish rate, and accidental or violent death at a frequency 50 percent higher than the Swedish figure. Health authorities have attributed the high mortality rates of the Finnish male to diet, excessive use of tobacco and alcohol, disruption of communities through migration, and a tradition of high-risk behavior that is particularly marked in working-class men in eastern Finland.
Mortality rates for Finnish women, with the exception of women over sixty-five, compared well with those of the other Nordic countries. A reason for this discrepancy between Finnish and other Nordic older women was the higher Finnish incidence of coronary problems, which occur later in women than in men. In the mid-1980s, Finnish women lived an average of 78.1 years, compared with 79.6 years for Swedish women. Except for coronary illnesses, of which Finnish women died 50 percent more often than their Swedish counterparts, the other causes of Finnish female mortality matched those of Sweden. In some cases, cancer and respiratory diseases for example, Finnish women had an even lower rate of incidence.
National efforts to improve living habits have included campaigns against smoking, restraints on the consumption of alcohol, and better health education in schools. One program that has been widely studied by international health officials was one implemented in the province of Pohjois-Karjala that aimed at reforming dietary habits in a region particularly hard hit by coronary illnesses. Finland was also a participant in the World Health Organization's program Health for All by the Year 2000 and was its European reporting nation.
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