Aims: The fact that health is largely constructed outside the remits of the health sector has been known for a long time. However, implementing intersectoral health policies is difficult. The aim of this article is to study possibilities for strengthening the implementation of Health in All Policies (HiAP) approach. Methods: The article analyses earlier efforts in intersectoral health policy-making and adapts Kingdon's theory on policy change for exploring opportunities and challenges for strengthening HiAP approach. Results: Opportunities for HiAP can be identified by analysing possibilities for amending health determinants on the one hand, and by analysing policy trends, proposals, and actors, especially in fields other than health, on the other. Four basic strategies for HiAP are identified, namely: health strategy, win-win strategy, cooperation strategy, and damage limitation strategy. Their strengths in various situations are explored. Using an adaptation of Kingdon's framework, possibilities for creating opportunities for HiAP by raising health issues on the agenda, developing appropriate tools and by creating conducive momentums are discussed. Conclusions: It is concluded that systematic efforts of experts in public health, health policy, and international health are important in identifying and prioritising the needs for HiAP, in analysing health implications of policies and policy proposals and making these understood by the policy-makers, as well as in suggesting feasible solutions. Improving health literacy of the public, the policymakers, and the media is key for improved understanding on health implications of policies. Participatory and transparent approaches to policy-making are prerequisites for strengthening HiAP.

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Health has gained importance on the global agenda. It has become recognized in forums where it was once not addressed. In this article three issues are considered: global health policy actors, global health priorities and the means of addressing the identified health priorities. I argue that the arenas for global health policy-making have shifted from the public spheres towards arenas that include the transnational for-profit sector. Global health policy has become increasingly fragmented and verticalized. Infectious diseases have gained ground as global health priorities, while noncommunicable diseases and the broader issues of health systems development have been neglected. Approaches to tackling the health problems are increasingly influenced by trade and industrial interests with the emphasis on technological solutions.

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The aim of Finnish tobacco policy is to end the use of tobacco and other nicotine-containing products by 2030. Towards that end, the regulation of electronic cigarettes (e-cigarettes) in Finland is stricter than that in other European Union (EU) countries, including a ban on characterising flavours in e-cigarette liquids as well as on marketing e-cigarettes. This article describes the e-cigarette market, its regulation and the challenges faced in enforcing regulations in Finland. The materials used for this study include data from tobacco control authorities on retail licences, product notifications, and guidance and decisions concerning enforcing regulations, as well as public documents from the courts concerning e-cigarette-linked appeals on selling flavours and marketing e-cigarettes. Legislation and documents produced during legislative processes are also used. Access to e-cigarettes is limited, as only 5% of retailers for tobacco or nicotine products have a licence for retailing nicotine liquids. Liquids containing flavours but without nicotine are commonly sold by specialised e-cigarette shops and websites as foodstuffs. Effective regulation is hampered by the enormous number and variety of e-cigarette products notified for potential market access, limited resources for tobacco control to expand in scope and reluctance of the e-cigarette business to comply with the stricter regulations in Finland, resulting in court cases filed by e-cigarette businesses. Mounting evidence suggests that regulating flavours in e-cigarettes to protect youth is wise although not easy. Many counties are currently considering further regulations on e-cigarettes and so should the EU.

Two problems originating from the advanced use of medical technology in screening for malformations and in the care of preterm and low birthweight infants are presented: the impact of the increasing number of induced medical abortions and the differences in statistical definitions on perinatal mortality (PNM) figures. Data on 186,562 births registered in the Finnish Medical Birth Registry between 1987 and 1989 were studied, and 65,554 medical abortions (of which 1647 were performed after the sixteenth week of gestation) registered in the Abortion Registry between 1985 and 1990. A 115% increase in abortions for medical reasons in the period 1985-1990 was found. It was estimated that the trend accounted for up to one-third of the decline in PNM rate during that time. The perinatal mortality rate was strongly influenced by very small infants. The application of the Finnish version of the International Classification of Diseases, Ninth Revision (ICD-9) (including all livebirths and using both birthweight of 500 g and gestational age of 22 weeks as the criteria) resulted in PNM rates which were about 5% higher than according to ICD-9. We suggest that the impact of medical abortions on perinatal statistics has reduced the value of the perinatal mortality rate as an indicator of the standard of care.

Background: Use of snus and snus-like nicotine products is increasing, in particular among young people, in several Nordic countries and Estonia, while snus is legally on the market only in Sweden and Norway. Snus is available in a great variety of tastes and packaging particularly catering for young users. Recently, strong snus-resembling nicotine pouches have emerged on the market. This research investigates the regulatory means to counteract this development. Methods: European Union (EU) and national tobacco control legislation, case law of the European Court of Justice (CJEU) and relevant public health studies are analysed. Results: The research finds that the judgement of the CJEU relating to the sale of snus on Finnish ferries has not been enforced. Permitted large traveller imports for personal use have contributed to wide availability of snus in Finland. Even if the legislation in Sweden is in conformity with the exemption it obtained in the Accession Treaty, the public health impact of snus use for young people in its neighbouring countries has become considerable. Nicotine pouches, -which are not regarded as medical products in terms of medicine legislation, lack harmonised EU-wide regulation. Controlling smuggling across open borders is challenging. Conclusions: The legislation at the EU and national levels should be able to protect young people from new tobacco and nicotine products. It is urgent to harmonise regulation relating to new tobacco and nicotine products taking as a base a high level of protection of health as required in the Treaty on the Functioning of the EU.

The World Health Report 2000 on health systems has raised concerns about its political biases, its methods and indicators, and its lack of reliable data. Tracing the origins of the Report, this article argues that it counteracts many of the concerns that gave rise to preparation of the Report in the first place. The mutually agreed-upon value-base, expressed in the Health for All strategy, has been largely abandoned. The Report includes contradictory messages, and many of its recommendations are not evidence-based. Furthermore, the ranking of countries according to their health systems' performance is not useful for health-policy-making, even if the methods and data could be improved. Because the member states and governing bodies of the WHO were not consulted during the production of the Report, the WHO secretariat has not received a mandate to change the value-base of the WHO's health policy or the aims of the Report. The WHO should return to its mandate as a normative intergovernmental U.N. agency on health.