Having just completed my third trip to Finland since August 2023, I continue to admire this country’s approach to ensuring the wellbeing of its people and communities.
Most people who follow news from Nordic countries may already know from extensive media coverage that Finland, for the seventh year in row in March 2024, was named the “happiest country in the world” by a United Nations ranking that started in 2013. This ranking, that gets a lot of mostly airy news coverage, is based on mostly solid criteria looking at individual and society wellbeing, supported by national data and survey sentiments. (See my commentary about the “World Happiness Report” ranking in my story I posted in March 2024 on the meaning of this global survey.)
Naturally, Finland takes pride in these rankings, though many residents, including my relatives there, find this distinction puzzling, especially considering issues facing the country such as mental health challenges and the country’s long winters and often-unpredictable northern weather.
The Finland Promotion Board’s web platform that I follow online, called “This is Finland,” was quick to celebrate Finland’s happiness ranking for the seventh year standing.
“Finland has fostered an infrastructure of happiness, constructing and maintaining the culture and the social institutions that form the basis and framework for individuals and communities to build their happiness,” the board boasted. “Happiness doesn’t just – happen. Countries can take steps to encourage it. Research shows life satisfaction correlates with a well-functioning society that provides healthcare, social security, and labour [sic] market access.”
Finland observations from September 2024
On my most recent trip, I continued to observe why the Nordic country does well by its people, regardless of what this one much-tracked survey claims is societal reality. One of the most obvious ways is how Finland has ensured community needs are met, regardless of the size and location of the cities.
I have now passed through dozens of small cities and town across the south half of the country, as well as most of its largest cities: Helsinki, Espoo, Tampere, Pori, Turku, Jyväskylä. All are developed to ensure basic needs are meet, with well-organized local public transit and multi-used trails. In fact, such trails are found in every Finnish community, regardless of size.
On my last trip in September 2024, I can recall only seeing one depressed smaller city in the interior of the Lakeland area, Sysmä, whose downtown area showed signs of commercial abandonment. A few other cities showed some similar issues, but not as bad, including Laitila, north of Turku. Most all communities I saw, however, seemed very livable, even the small towns.
Most Finnish people, regardless of where they live, can also access healthy food at most stores, even at the ubiquitous fast-service stores like K-Supermarket. This chain’s ads were relentless on the radio as I drove over 2,000 kilometers in eight days in the southeast and Lakeland areas of central Finland. Every single branch of this supermarket I visited, regardless of the city, had fresh fruit, fresh vegetables, usually healthy choices of meat and dairy, and many varietals of Finland’s famous and healthy rye bread, like Reissumies. Healthy food is surprisingly a catchy branding theme in Finland for social media platforms.
Celebrating Finnish policy successes at Työväenmuseo Werstas
At the societal level, where one can’t easily observe the big picture of how health is provided, I can turn to exhibits like some of the wonderful displays I found at the Työväenmuseo Werstas, or Finnish Labour Museum Werstas, in Tampere. My Finnish relatives strongly recommended it, and I’m so glad I paid a visit.
The museum is free. Along with physical artifacts about the history of working and social conditions, it provides powerful visual imagery, including historic photographs, documenting Finnish working life and social history. The Finnish Ministry of Education and Culture is the force behind its operations, and the day I was there, many newly arrived immigrants and university and high school students were getting tours.
According to the museum’s website, “The museum seeks to understand history from various perspectives by exploring the life of ordinary workers and various minorities, as well as marginal phenomena.” It attracts more than 50,000 visitors every year, and it’s found in the historic quarter near the city center, in the old factory district.
I was especially impressed by the exhibits documenting Finland’s social welfare decisions to expand universal and basic health care. The images and narratives show these changes did not happen overnight. Instead, according to the museum exhibits, they arose out of real challenges facing the country like lack of health care in rural areas, chronic health problems like heart disease and smoking, and maternal health concerns.
Some of the displays focused on Finland’s landmark Primary Health Care Act of 1972.
Finland’s major policy shift to socialized medicine came after its Nordic neighbor, Sweden, which adopted its National Health Insurance Act in 1946.
Finland first adopted its health insurance system in 1964. Its maternal and child health care services, including its famous baby boxes that were started in the 1939, were well established by the 1960s. Municipalities already had received state subsidies for organizing midwife and community health nurse services since the 1920s.
The 1972 Primary Health Care Act made municipalities responsible for organizing all health services—like the facilities I saw in Kurikka during my three visits I’ve made to visit my relatives who live there.
They law brought all preventive and curative services, including the local hospitals that were run separately, under local and integrated municipal primary health care authorities. All local health care staff, including physicians, became salaried employees. At the national level, a national planning system was implemented for both primary and specialized care. The municipalities were required to make five-year plans for primary care. State subsidies ranged from 39 to 70 percent, according to the financial health of the municipality, with more support given to less affluent areas. The changes helped direct new resources to underserved areas in particular in the northern and eastern parts of the country. (For more information on these reforms, see this 2022 white paper published by the Lancet Global Health Commission, “Development of Primary Health Care in Finland,” by Ilmo Keskimäki.)
How Finland compares to other nations—the data
While recent studies have put Finland below its Nordic and continental neighbors in overall health standings, it far outperforms the United States.
Today life expectancy in Finland is 81.2 years in 2022, with a drop of nearly one year as a result of the pandemic. By comparison, life expectancy in the USA In 2022 was just 77.5 years for the total U.S. population. However, by European standards, Finland currently spends less on health than both the EU average and less than other Nordic countries per capita, devoting 10.3 percent of its gross domestic product in 2021.
It likely surprises no one who studies public health among developed countries that the United States, despite spending more money per capita on health care than other developed countries, vastly underperforms its peer nations, like Finland, in life expectancy and other health outcomes.
In fact a poll in 2023 reported seven in 10 Americans felt they were failed by the U.S. health care system.
As an American, in a country where two-thirds of the nation is obese and overweight, I would be envious of what Finns share about own health. Overall, 65 percent of Finns felt that they were in good health, compared to 68 percent in the European Union. The data overall confirmed what I could observe—societal investments produce results and do not happen by accident.
Well done, Finland.
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(First published, October 2, 2024)