This study explores, how the idea of health promotion, appearing on the global public health policy agendas in the end of 1970s, has been interpreted and adapted in Finland and in Portugal. In this research, which in geographical terms is limited to Western Europe and which focuses particularly on soft governance, European health promotion policy has been traced by analysing declarations, recommendations and programmes produced by the WHO and the EU as well as the related comparative practices, which have been used to guide and evaluate the desired policies. In temporal terms the study covers the period from the 1970s until the end of the 2010s.
The dissertation comprises a theoretically and methodologically oriented summary, that frames the study, and four articles based on empirical analysis. The research data obtained from the case countries consists of various texts, such as government programmes, public health strategies, programmatic documents of the majority churches of the case countries and newspaper articles. The theme pervading the entire dissertation is the movement, travel or transfer of ideas and policies from one place to another. Place refers here not only to geographical location, but also to more abstract localizations, such as epistemic communities, international organizations or different societal institutions (church, welfare state, media). The movement of ideas and programmes for its part is understood to occur between these places across borders and in all directions. Methodologically I have approached the movement of particular policy ideas and programmes in different ways in each original article.
The first article addressed the movement of key recommendations of the Health for All programme to the government policies of Finland and Portugal in the historical context of broader welfare state development. The study indicated that the application of the programme to the local context caused only minor changes in national policies. In the second article the state-centred perspective was broadened towards community actors by analysing the majority churches of England, Finland and Portugal as actors in health promotion policy. The analysis of programmatic documents of the churches of England and Portugal revealed the transition from the treatment of sickness towards the promotion of health and wellbeing. The churches have interpreted and recontextualized the health promotion discourse mediated by the WHO as well as the core results of public health science into their own programmatic documents. The analysis showed how the main ideas of health promotion have spread over institutional, professional and disciplinary borders. Such a transnational diffusion can be taken as an indication of the rise of health and its promotion to be one of the metadiscourses that characterizes our era.
By analysing the use of comparisons produced by international organizations in national policy-making, the third and fourth articles demonstrate concretely and in detail how national policies are defined in relation to what is described to happen by means of comparisons in other countries. International comparisons and the related categorizations are actively and continuously manner used when defining what are perceived to be nationally significant problems and the (related) future objectives. The analysis of the use of comparisons as a one method of governance produced a novel perspective to comprehend the roles of the WHO and the EU in public health policy. The results of this study indicate that by authoring and producing comparisons the EU influenced the public health policies of its Member States long before gaining any formal competence in this area.
Studying texts can be perceived as studying policy agendas. However, in those models which describe policy-making as a rational and linear process, agendas are often perceived as a mere starting point for the actual implementation. From the point of view of constructivist policy analysis, policy programmes and texts are understood as a focal form of policy-making. One of the key results of this research is a conceptualization of health promotion policy as programmatic and declarative (as opposed to system based). Of the essence is also the international and transnational nature of this programmatic dimension. From this reason it is not very useful to approach health promotion solely from the perspective of national health care system research. This study provides a novel perspective on the Finnish and international debate in order to understand health promotion policy.
