The Finnish and British Health Inequalities Strategies: Theory, Practice, and Effectiveness

Health inequities are differences in health outcomes caused by social injustice in society, and are present within every country in the European Union. This research analyzed the Finnish Health 2015 and British national Tackling Health Inequality strategy to tackle health inequalities and inequities. We created logic models that reflected our expectations about the target groups and social determinants that were expected to be tackled by the programmes. These expectations were based on the model of the social determinants of health, WHO framework of the social determinants of health and health inequalities, and the strategies. The programmes that were created to implement the strategies were compared with the logic models, in order to analyze whether or not the promises that were set out in these strategies were actually implemented in practice. Moreover, we compared whether or not these strategies already showed results at this point in time. We found that the Finnish Health 2015 tackled a wider range of target groups and social determinants. and focused very much on equal treatment and social conclusion, children, people of working age, and vulnerable groups. However, efforts to reduce smoking, alcohol consumption, homelessness, and poverty were missing, and some programmes did not specify actions. The Finnish strategy seemed to have improved self-assessed health and smoking prevalence, but these effects could not be attributed to a specific policy category. For the British Tackling Health Inequalities we found that a smaller range of target groups and determinants were tackled. Efforts focused mainly on ensuring a good start in life for children and families, and these determinants were tackled in a very comprehensive manner. Unfortunately where was only limited attention for improvements in well-being in specific vulnerable groups, and efforts to decrease poverty, homelessness, discrimination, participation, and improve social inclusion were missing. The Tackling Health Inequalities strategy seems to have improved self-assessed health, and decreased alcohol-related mortalities. However, these effects could not be attributed to a specific policy category. Unfortunately, the Demetriq database provide only limited data to fully evaluate the effects of the national strategies. Data for many relevant health indicators were missing, data was only stratified according to educational achievements, and no data in social determinants was available. Moreover, the Finish and British health strategies are very recent. Unfortunately, many of the effects of the strategies are not yet visible at this point in time.