Gaining health : analysis of policy development in European ...

period of the programme, while others are budgeted on
an annual basis. The HCSP stresses the need for long-term
budgeting. In its latest report (3), it argues that the changing
pattern of disease from infectious to noncommunicable and
chronic diseases makes new financial mechanisms necessary.
While short-lived infectious diseases require short-term
measures, nowadays long-term strategies are needed for
NCD policy based on long-term budgeting.
3.3. Information and research
Information on health status and programme evaluation is
traditionally provided by public institutes. INPES, INSERM,
INCa, InVS and regional bodies collect information regularly,
linked either to specific projects (such as the WHO MON-
ICA Project or to general surveys on the health behaviour
and status of the population (such as the Health Barometer
of INPES published every five year). The regularly published
reports of HCSP are an excellent source of information,
containing collated key data not only on the overall public
health situation in France but on health status and behaviour
as well.
The Public Health Act of 2004 took a step towards systematic
data collection by setting comprehensive and clear
indicators that are measured regularly. Two years after the
Act entered into force, a thorough report was published,
with contributions from a number of institutes, government
bodies and insurance funds, to explore the possibilities of
achieving the 100 objectives by 2008 (28).
Scientific research in the field is partly the realm of public
health institutes such as INSERM and partly that of the
universities. It is felt that epidemiological research is excessively
dominant in France and that the social sciences are
not well represented in public health research. Nevertheless,
excellent report was published in 2007 by the Institute
for Research and Documentation in Health Economics on
the results of a general population survey on psychosocial
resources and health inequalities in France (29).
To step up research and make it more multidisciplinary, the
Government has suggested the creation of a new institute
aimed at coordinating scientific public health research in
France. However, experts doubted the real need for such
an institute and feared that it would lead to greater fragmentation
of capacities and resources. It was pointed out
that INSERM, for example, with its strong team of experts
in the social sciences, would be in the position to cover a
broad perspective of public health research. On the other
hand, some argued that a new institute would be justified if
it focused specifically on health promotion research, which
is chronically underrepresented in France.
3.4. Training
Public health and health promotion training in France
reflects the typical characteristics of the French higher education
system and public health structures. Training focuses
on the education of professional public health administrators
in the field of public health and fosters the medicalized
focus of public health.
In principle, there are three types of educational centre
for studies in public health. First, faculties of medicine at all
universities offer public health courses within the framework
of the basic, obligatory training at graduate level to all
students. In addition, some departments of law and of social
and economic sciences integrate public health courses into
their curricula as well.
Second, specialized studies in public health are organized at
some faculties of medicine for students who have accomplished
their basic courses. Students who completed the
specialized studies obtain a final diploma of “Medical Expert
in public Health”. Some 15 universities in France offer specialized
public health studies at faculties of medical sciences.
Third, the National School of Public Health (ENSP) was
founded in 1945 in Rennes in northwest France to provide a
masters degree in public health. ENSP is not research-based
but rather a public administration school where courses
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases