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

tion from sister medical specialities. There are no other
career pathways or training opportunities, and one Masters
Degree in Public Health is available at this medical faculty”
(40). The health system in Greece is extremely medicalized,
with physicians dominating decision-making bodies related
to public health. As one respondent for this case study put
it, “the Greek population still see physicians as gods”.
In accordance with the 2005 Law on Public Health, a General
Secretariat and General Directorate for Public Health
was established in the MHSS. One of the main responsibilities
of the new Directorate is to propose policies and
strategies for public health in close collaboration with the
National Council for Public Health. The National Council
has been reorganized over the years with changing governments,
seemingly suffering from the general party politicization
that dominates the public sector in Greece. Intended as
an independent organization, when fully operational it is to
be guided by a 15-member scientific committee, appointed
by the Minister and including staff of the MHSS.
One of the problems faced for many years by the National
School of Public Health, which provides postgraduate
training in public health, is that its graduates have not found
positions in the public sector demanding their level of training.
There is a small financial incentive for those who undergo
this postgraduate training, in the form of a scientific
supplement to their salary in the public sector. Public health
does not have a high status, and as yet a critical core of
public health experts has not been created in the country.
According to Article 5 of the 2005 Law on Public Health,
“public health services are provided by specialized scientists
who belong to the Body of Public Health Specialists and the
necessary training and experience”. This includes “scientists
from the wider field of health sciences, the environment,
communication, education, and social and economic sciences”.
This body has not yet been established, so it is not
possible to assess where they might be employed and what
might be their impact.
3.2. Financial resources
Without clearly defined policies for tackling NCD, it is not
possible to assess resources designated for that purpose.
On the whole, funding for NCD prevention seems to be on
a project basis.
3.3. Research
There is a great deal of scattered research related to NCD,
but this is not collected to give a comprehensive picture.
Regular surveys of lifestyles and behaviour have not yet
been instituted on a national basis in Greece. This appears
to form part of a vicious circle, whereby the limited and
discretionary Greek welfare state has not required extensive
assessments of its citizens and the lack of such information
keeps potential health challenges out of the public eye.
Where limited surveys are carried out, they depend on
the interests of individual researchers and the institutions
in which they work, as seen in relation to nutrition, or they
are carried out in relation to EU-funded programmes.
The need for such surveys to uncover the health challenges
in Greece is evident. In 2006, under the leadership
of Jiannis Tountas, Associate Professor of Social Medicine
at Athens University, the first national survey of inequalities
in health was carried out (41). The ESOMAR social grades
were used, based on the age at which formal education
terminates and the occupation of the main income earner.
Initial results indicate patterns similar to those found in
other European countries, with chronic diseases being
more frequent among the lowest compared to the highest
socioeconomic class. Use of health services, according
to the organization under which people are insured, also
indicates the severe inequalities of access inherent in the
Greek system.
The reorganized National Council for Public Health is to be
an independent organization with its own budget, under the
aegis of the MHSS but without its administrative control. It
is to be responsible for overseeing the scientific work of the
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases