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

for example, information, advice and support) that international
research has shown to be more effective.
We do not have information on how effective health education
campaigns, such as the MHSS communication campaign
for public health described above, have been in terms of
monitoring people’s retention rates and their knowledge
concerning NCD risk factors, etc.
Generally in the health sector (and perhaps more broadly in
the public sector), there does not yet seem to be a tradition
of actively involving stakeholders in policy formulation
and evaluation, although a broad range of stakeholders
were said to be involved in the ongoing preparation of the
National Action Plan for Public Health.
3.6. Local community and social support system
The family and social support system in Greece is still comparatively
strong, partly owing to and partly reinforcing the
fact that the state steps in only when the family fails (43).
A complex network of family and kin, including koumbaroi
(godparents, marriage witnesses, etc.) offer and receive
economic and practical support, information and personal
contacts. There is as yet little development of community
services, although some local authorities are slowly moving
into this area and the community centres for older people
(KAPI) are popular where they have been established.
4. Forces facilitating or obstructing disease
prevention and health promotion
Greece’s rapid economic development over the last half
century may have outstripped the corresponding social
development and change in attitudes. No tradition of a
strong “welfare state” has developed, although solidarity
was expressed quite practically for many years through,
for example, third-party taxes levied on the urban working
population to support health care and insurance for the
agricultural population.
The WHO Health for All movement, with its focus on tackling
inequities in health through intersectoral action, has had
little impact in Greece, even on a rhetorical level. Although
individual Greek researchers are involved in multicountry
studies, engagement from the public sector with the international
level and therefore the influence of that level do
not appear to have been significant.
In this respect, there is a clear differentiation in relation
to the EU, where the development of certain strategies is
essential for political or funding reasons. The recent shift in
thinking in the EU in relation to the determinants of health
has not yet penetrated Greece to any significant degree,
however, although there are indications of the health determinants
terminology entering the policy vocabulary. Only
in areas where individual national experts have managed
to maintain and utilize international links, supporting their
research findings over a long period of time, and where
they were in a position to influence policy (as in the case
of nutrition) or where politicians had a particular focus of
interest (as in the case of mental health) has the health
promotion message come through more strongly.
Although there are indications of change, the reasons for
this slow start are not easy to define. One of the main
obstacles to action must certainly be the lack of regular
and reliable information on health and its determinants.
One respondent to the case study interviews suggested
that Greece’s specific history, with a civil war and a military
dictatorship within living memory, has created considerable
suspicion and reluctance to collect information related to
the population.
The failure to prepare a formal public health report outlining
the main causes of death and morbidity, and their related
health risks and determinants, has meant that there has
been no focus for informed public debate. Consequently,
the mass media contribute to keeping health services in the
limelight. Similarly, although individual experts are involved
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases