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

Chapter 4
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2.3.3. Setting the agenda
Unlike in many European countries, there is no tradition in
Greece of preparing public health reports. The universities
and large NGOs make fragmented attempts to analyse aspects
of the situation, focusing on issues of interest to them,
but there is no official published report giving a comprehensive
picture of the health challenges and their determinants
and the ways in which these might be tackled. By default,
the focus remains on the organization and reorganization
of health care, with passing interest in other issues when
these are raised by interested researchers or NGOs, or
when a “world day” on a particular theme is celebrated.
The “Health Map” (18) (see below) is to bring together a
considerable amount of data in an organized way and could
perhaps shift the future agenda.
Given the lack of focus on relevant data concerning inequalities
in health in the policy proposals available to us, the link
between socioeconomic inequalities in health and the need
to address the determinants of health is almost nonexistent
2.3.4. Finding solutions
Since the health challenges have yet to be openly discussed
outside academic circles, solutions remain focused mainly
on the provision of health care or are linked to the potential
for EU funding. As observed in certain other countries,
attention is paid to high-visibility action such as providing
intensive care units and reducing waiting lists rather than
the long-term and less visible action needed to tackle NCD.
Disease prevention relies on health education rather than
health promotion. Issues related to the use of new communications
technology seem to be high on the agenda, again
partly due to the availability of EU funding.
Implementation of the 2005 Law on Public Health should
offer hope for change in the future, as should the plan of
action for public health currently being formulated. The
growing attention given by the EU to tackling health risks
could, in the long run, open up the discussion in Greece.
2.3.5. Structures and processes for implementation
Article 8 of the 2005 Law on Public Health provides that
the MHSS, together with the National Council for Public
Health, will decide on the priorities for public health and
formulate four-year action plans, which are to be compulsory
for the regional level of government.
2.3.6. Monitoring and evaluation
Provisions are made in the 2005 Law on Public Health
for annual reports to Parliament on the health status of
the population. Similar reports are to be prepared at the
regional level. This provision has not yet been implemented
but, if well founded with structures and processes in place
for the collection and processing of essential data, the
evidence base for monitoring and evaluating health policy in
the future could gradually be built up.
Apart from regular administrative monitoring, for example
of budgets, it appears that the monitoring of EU structural
funding (for which regular reports are prepared by the Planning
and Evaluation Unit of the MHSS and can be found on
the Internet) dominates the process.
2.4. Public health and health promotion
Recently, the Minister for Health and Social Solidarity announced,
during a public presentation, a strategy for health
up to 2020. The text of the speech focused in its introduction
on the need to deal with a situation in which the old
welfare state had reached its financial limits and there had
been rapid developments in information and communication
technologies, administration and the management of
human resources. It referred to the heavily bureaucratic
ESY and the need for greater flexibility, control and evaluation
to ensure equal access to health and welfare services.
The Minister presented the following ten strategic points:
• financial improvement of the ESY and ensuring its sustainability;
Case studies: policy development in countries for tackling noncommunicable diseases