Finns offer inspiration for EU health, sports policy

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Finnish policymakers were yesterday (22 February) in Brussels to outline how innovative projects in the south of the country can inspire similar action at EU level, revealing how prescribing exercise rather than drugs can improve public health. 

"We need to market physical activity much more effectively. Our competitors are the sofa, the TV and the car," said Harri Helajärvi, a top doctor of sports and exercise medicine at the Paavo Nurmi Centre in Turku, Finland, told a Committee of the Regions conference.

"We need to position ourselves in those same markets to compete for attention. We need to make healthy lifestyles seem more tempting and we need PR people to enlighten hearts and minds. Research is not enough," he told policymakers from across Europe.

In a drive to make Europeans move more in their everyday lives, the EU adopted physical activity guidelines in November 2008 in an effort to set in motion changes to national policies on health, transport, urban planning and services for senior citizens.

The guidelines were backed by sports ministers from all 27 EU member states.

Finland, meanwhile, was the first EU country to introduce physical activity guidelines at national level, and in 2008 developed a national sports programme to increase the number of physically active citizens and facilitate coordination between different government sectors and other organisations that provide sports services.

Moving beyond the pill

One of the innovative approaches to promoting active lifestyles employed by the Finnish authorities is the so-called HEPA (Health-enhancing Physical Activity) scheme, which sees doctors prescribe exercise vouchers, redeemable throughout Finland, rather than drugs to patients in need of developing more active lifestyles.

Studies have estimated that one million euros spent on implementing HEPA generates 4-5 million euros of savings in healthcare costs further down the line.  

"We need to change our way of communicating. You can put a price on a pill and yes, you'll get better, but what would it have cost to prevent the need for the pill in the first place? It's difficult to start thinking like this, because it's not what we're used to," said Helajärvi.

EU officials confirmed that they were closely following the Finnish experience to see if it offered solutions for improving citizens' health across the EU as a whole.

"We're looking at moving beyond the pill to considering the way we live. Health is the top thematic priority in [EU research programme] FP7, but we need to do much better at integrating it across other policies," said Kevin McCarthy of the European Commission's directorate-general for research and innovation.

He cited improving the built environment by making sure that deprived as well as affluent neighbourhoods are safe and pleasant to walk and cycle through, introducing traffic-calming measures and making healthy food options more readily accessible in supermarkets among measures that can be taken to improve the health of Europeans.

'Jury still out' on EU action

As for the success of EU action in this area so far, McCarthy admitted that "the jury is still out". "Most of our projects aren't delivering yet, but we're only 18 months into them," he said.

Experts, meanwhile, urged caution before embracing HEPA schemes as a cure for all society's ills. "Exercise on prescription can work if the patient doesn't revert to what they did before afterwards. It only works if it succeeds in changing behaviour," warned Helajärvi.

Others insisted that more work had to be done to break down barriers and create new channels of communications between doctors, the authorities and the sports sector before HEPA could be declared a success.

"If you get a prescription it's easy to find a pharmacy and get the medicine. But if you are prescribed health-enhancing physical activity, then where do you go to get it?" asked Vesa Harmaakorpi, professor of innovation at the Lappeenranta University of Technology and the Lahti School of Innovation.

Clearly, schemes like the Finnish one cannot be successful without the enthusiastic participation of the citizens themselves. "HEPA prescription is a culture change for patients as well as doctors. Patients come to doctors to be given pills and easy answers, not to be quizzed about their lifestyles and told they need to exercise," said Helajärvi.

Commission officials warned that Brussels would have to make sure that the actors responsible for implementing EU policies on the ground embrace the challenge if the bloc's health policy is to be successful.

"We need projects that make a European approach to public health real, and we need to build the bridges to transfer that knowledge to universities and other actors across Europe," said McCarthy.

"We won't actually focus on sport per se, because by keeping it at physical activity you can involve more DGs and policies," the Commission official added.

It remains to be seen, however, whether action by Brussels policymakers can genuinely succeed in encouraging Europeans to lead more active lifestyles.

"We have a lot of good practice for involving actors in the public, private, sports and NGO sectors in promoting health and well-being," said Jaana Simola, project director and senior advisor at the Regional Council of Päijät-Häme.

"There's no easy way to get all the partners together speaking the same language. Politicians are the most difficult to get on board. But we like trying to be the pacesetters of Europe on this," Simola added.

Harri Helajärvi, a doctor of sports and exercise medicine at the Paavo Nurmi Centre in Turku, Finland, had the following advice for policymakers: "Think globally, act locally, have an open mind, create a full and devoted team, and just do it! You need tax benefits and you need to get employers on board. Speak with one voice and without mixed messages."

"The key to effective public health policy is to recognise the importance of the transport sector. The cost-benefit ration is king here. We've developed a model for using economic levers to influence transport appraisals. It's about getting authorities to build cycle networks, not roads," said Charlie Foster, a lecturer at the University of Oxford and vice-chairman of HEPA Europe.

The Lisbon Treaty, which entered into force on 1 December 2009, gave the European Union a competence on sports policy (Article 165) for the first time.

The Treaty gave the European Commission a mandate to develop a specific EU sports programme, supported by a budget. EU sports ministers now also meet in official Sports Council meetings. 

The Commission set out how it plans to achieve these goals in a communication entitled 'Developing the European Dimension in Sport', published on 18 January 2011. 

The communication proposes action at EU level in areas where it believes the challenges cannot be sufficiently dealt with by governments alone. These include the societal role of sport, its economic dimension and the organisation of sport in Europe.

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LIFE TACKLE is co-funded by the LIFE Environmental Governance and Information Programme of the European Union - Project Number LIFE17 GIE/IT/000611



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