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

surance organizations or other designated services. On the
whole, health professionals are not considered to be well
prepared for health promotion, and in the public sector it
is doubtful whether they have the time or facilities. Following
years of rhetoric regarding the need to develop PHC, a
draft law has now been formulated.
The situation may change dramatically in the next few
months, partly as a result of a proposal (44) presented to
the WHO Regional Committee for Europe in September
2007 for the establishment in Greece of a WHO centre
dealing with NCD. The practical implications of this are currently
being discussed.
5. Lessons from the Greek experience
The situation in Greece is characterized by a severe lack
of regularly collected data on NCD and their risks and
determinants. This has clearly hindered the development of
a comprehensive approach to tackling NCD. Persistent efforts
by key players have kept certain issue-specific policies,
such as those on mental health and nutrition, more firmly
on the agenda. The development of the necessary legislative
framework in 2005, and the process already under way for
a focus on public health, should facilitate attempts to tackle
NCD in the future.
5.1. The policy environment
Greece has been a member of the EU for many years and
enjoys a reasonably high standard of living, although income
inequalities are considerable and large numbers of the
population live close to the poverty line. The total amount
spent on health care is slightly above the EU15 average, so
the issue is probably one of effective rather than increased
spending.
Family support is still extremely strong, cushioning the
effects of unemployment and the lack of community and
other support services.
Greek society is characterized by a high degree of party
politicization, hindering any attempt at cross-party consensus
building. This also affects public administration, generally
considered to be in need of modernization. In the public
health field, even internationally recognized national experts
may not be fully utilized when they are not of the right
“political colour”.
There is as yet no well-developed culture of negotiation
and consensus building. The use of private consulting firms
in the policy development process (particularly when this is
EU funded), rather than attempting what admittedly might
be a more time-consuming process of involving a broad
spectrum of players from public administration, academia
and civil society, exacerbates the lack of broad ownership in
the policy-making process.
Involvement of the public services in international networks
has been rather limited, restricting their awareness of
developing public health issues and ways of tackling them.
Greater involvement in EU-funded projects could open
new windows and develop a culture for improved policy
development, including regular monitoring and evaluation.
5.2. The value system underlying policy development
As a member of the EU, Greece shares the EU values.
Partly owing to the lack of an adequate knowledge base to
focus discussion, equality in health is not clearly evident as
an underlying value of health policy, except in the sense of
access to health care and other services.
Given that, according to WHO and EU research networks,
“all European countries are faced with substantial socioeconomic
inequalities in health” (45), it would be surprising
if Greece were the exception. Initial results from a recent
first national survey referred to above have already brought
certain inequalities to light.
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases