Political Leadership, Institutional Memory and the Implementation of Health in All Policies: An Explanatory Case Study of the Health 2015 Public Health Programme in Finland

Abstract

Our study sought to examine how and why political leadership and institutional memory affected the implementation of Health 2015, a public health programme prepared following the principles of the Health in All Policies (HiAP) strategy, between 2001 and 2015 in Finland. We analysed the data using a realist explanatory case study method. We found that the HiAP strategy did not have a strong leader who was able to generate interest in HiAP among other policymakers. This contrasted with the Finnish success story in previous decades when several interested elected politicians and high-ranking civil servants promoted the implementation of healthy public policies. Our results also pointed to institutional amnesia. During the implementation of Health 2015, a transition to project-based implementation, the retirement of many long-term policymakers and a change from the financial steering of local authorities to steering by information took place. The subsequent institutional amnesia was followed by discontinuity of previous institutionalised HiAP implementation structures and practices, such as intersectoral working groups.