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

Chapter 4
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the wake of political changes the Socialist party eventually
established the ESY in 1983. Since then, there have been
numerous proposals for reorganizing the health services
and unifying the health insurance funds. Few of these have
been fully implemented, since “Governments continue to
postpone costly political decisions either by replacing the
real problems with formalistic conflicts or by offering shortterm
remedies” (9).
The issue of a broad policy for health has been largely
absent from the political agenda for the past 20 years and,
apart from the work of individual researchers, there has
been little official recognition of the problem of inequality
in health status, observed in all countries across Europe. As
in other countries, the National Statistical Service publishes
regular statistical yearbooks containing data related
to health (mainly mortality and hospital discharge data),
though these do not usually reflect socioeconomic inequalities.
At the beginning of the 1990s, the Ministry of Health and
Welfare (with the support of WHO) established an ad hoc
committee, with experts from the University of Athens,
the School of Public Health and others, to prepare a public
health report. The report was prepared in Greek and, with
WHO funding, translated into English. Neither version appears
to have been published or distributed after submission
to the Ministry. Experts from the University of Athens
voluntarily prepared analyses of the health status of the
population for the period 1986–1996 and again for 1997–
2006 (10), which they presented to the Ministry. We were
unable, however, to locate any official national report on
the health status of the population. 7 It is difficult to understand
therefore the evidence basis on which NCD policy is
discussed and developed.
7
Since this case study was completed in October 2007, a National Action
Plan for Public Health 2008–2012 (in Greek only) has been formulated by
the Ministry of Health and Social Solidarity. The first chapter of the Action
Plan includes a detailed analysis of the health of the population.
Similarly, apart from mental health, there do not yet appear
to be published policies relating to NCD, or their risks,
although there are related health education campaigns. On
the whole, Greece seems to have missed much of the vast
mobilization for health promotion that has taken place in
Europe since the Ottawa Charter and the WHO Health
for All policy. There are signs that this may be about to
change however, as the Law on Public Health (11), passed in
June 2005, calls inter alia for reports on health status to be
prepared at national and regional levels and for the national
report to be presented annually to Parliament.
2.2. How things started
The WHO Health for All policy seems to have had little
impact at the national level in Greece, despite a number of
attempts by WHO Regional Office for Europe in the early
1990s to initiate such a policy development process. At the
start of the 21st century, Costas Stefanis, a professor of psychiatry
who enjoyed intensive international collaboration,
was Minister for Health and Welfare. Since Greece held the
EU presidency in 2003, Stefanis, together with Commissioner
Byrne, signed the WHO Framework Convention for
Tobacco Control on behalf of the EU. Under his leadership,
public health, including the need to bring care for mental
health from institutions into the community, gained some
prominence.
The Supreme Council for Health (KESY) was reorganized
to advise on public health issues. KESY is, however, composed
of physicians and professors from the medical schools
and takes a medicalized view of health. It is responsible,
inter alia, for recognizing medical specialities and awarding
educational leave and research grants. There does not,
however, appear to have been a clear strategic plan for the
disbursement of research grants. KESY did play an important
role in putting in place the means to secure the 2004
Olympic Games against threats to health. It had hardly
started in its enhanced public health role, however, when
general elections brought in a change of government.
Case studies: policy development in countries for tackling noncommunicable diseases