Health in All Policies: From rhetoric to implementation and evaluation - the Finnish experience.

The principles of the Health in All Policies (HiAP) approach are not new. Their international roots can be traced back to 1978 and the Alma-Ata Declaration and the 1986 Ottawa Charter. In Finland, the roots of HiAP go back to 1972 when the Economic Council of Finland, chaired by the Prime Minister, launched the 'Report of the working group exploring the goals of health'. The paper discusses the history, rationale, and implementation of the principles underlying the umbrella concept of HiAP. A rationale for implementing a new concept - HiAP in 2006 during the Finnish European Union presidency - is given. The focus here will be on implementation of HiAP. International material supporting the implementation is introduced and practical examples from Finland presented. The Benchmarking System for Health Promotion Capacity Building is introduced, since it has been used as a primary source of information for monitoring and evaluating HiAP in Finland at the local level. The experience from Finland clearly indicates that HiAP as an approach and as a way of working requires long-term commitment and vision. For working across sectors it is crucial to have data on health and health determinants and analyses of the links between health outcomes, health determinants, and policies across sectors and levels of governance. Intersectoral structures, processes, and tools for the identification of problems and solutions, decisions, and implementation across sectors are prerequisites of HiAP. Legislative backing has proven to be useful, especially in providing continuation and sustainability.