Table 2

Perceived barriers to Finland’s tobacco endgame

Theme: insufficient funding
Too few resources for the 2030 Initiative “So there’s basically no one who is really doing full-time work on 2030 Tobacco–Free Finland.… ASH Finland is more or less doing it as kind of a side job.”
NGOs indispensable to tobacco control “… the public agencies don’t do the campaigning. It’s the NGOs that run the campaigns and I have noticed that’s a little different compared with many countries, for example, Denmark.”
Activities of NGOs are not well coordinated “…because (quitline) is run by one (NGO), the NGO is not really recognised as part of smoking cessation - at least not officially. But we have been around for 15 years.”
Theme: political and legal barriers
Compromise among political parties “… unlike other Nordic countries, we don’t have one big body which could have a hegemonic position to introduce policies; so we have a coalition government.”
Compromise among government ministries “… the Ministry of Social Affairs and Health is not totally free to create their own policies. They have to negotiate with the Ministry of Finance and Ministry of Trade.”
Supply-side strategies won’t work in the EU “Reducing supply if there is demand is a very problematic situation since we are in the middle of Europe with free trade.”
Theme: institutional practices
Low quality of health ed. in vocational school “(Vocational students) are more likely to be disadvantaged…school health facilities, health education, etc is actually dealt worse than if you go into academic track school.”
Compliance w/ school smoking policy varies “(Vocational schools) have this one leader in a very high level, then they have several unit leaders or unit chiefs that are responsible for what happens in the specific unit.”
Employee smoking and school leadership “So if you have a lot of personnel smoking in (vocational schools), you don't really have a committed school head master - it’s not school board in Finland, it’s school leaders.”
Theme: ambivalence about mass media
Mass media campaigns are viewed ineffective “I'm a firm believer of campaigns. But when it comes to general non-targeted mass media campaigns, I have very little confidence in their efficacy or power to change thinking.”
Mass media campaigns are not the priority “So why is the Ministry of Health not asking THL* to implement a huge Tobacco-free 2030 campaign and give the resources to do it? That's a good question.”
Mass campaigns are incompatible w/ culture “… (Finns) are not that easy to jump on those movements.”
Theme: lack of prioritising smoking cessation
Low priority for standardising services “The Ministry is not earmarking resources at the national level to develop a system where in every health centre, in every hospital, at all levels of healthcare there would be standardised system on smoking cessation. That is a big issue.”
Cessation services not well-known/marketed “…in order to get physicians to (advise patients to quit smoking), they need to know where to refer patients. This is the link that is missing.”
Healthcare not viewed as a cessation resource “(Patients) don't see healthcare as a place to stop smoking…. And then all the expertise at the moment in Finland is in healthcare.”
  • *National Institute for Health and Welfare (THL).

  • EU, European Union; NGOs, non-governmental organisations; ed., education; w/, with.