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

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35. Ministerial decision concerning products provided in school canteens. Protocol No. Y1/GP/oik 109167. Athens, Ministry of Health and Social Solidarity, 2006 [in Greek]. 36. Labiris G, Voutsinas A, Niakas D. Preliminary evaluation of the school-smoking-prevention policy in Greece. Letter to the Editor. European Journal of Public Health, 2005, 15:329–330. 37. Minakouli T, Tsiakatoura C. Annual report on health, health care and care for the elderly. Athens, Ministry of Health and Social Solidarity, 2005. 38. National Action Plan for Social Inclusion 2003–2005. Athens, Ministry of Labour and Social Security, 2003 (http://ec.europa.eu/employment_social/social_inclusion/docs/napincl_2003_greece_en.pdf, accessed 22 May 2009). 39. National strategy report on social protection and social inclusion 2006–2008. Athens, Ministry of Employment and Social Protection, 2006. 40. Lionis C, Carelli F, Soler JK. Developing academic careers in family medicine within the Mediterranean setting. Family Practice, 2004, 21:477–478. 41. Hellas health. Athens, Institute of Social and Preventive Medicine, 2006. 42. Research and development in Greece. Athens, Ministry of Development, undated. 43. Mestheneos E, Triantafillou J, Kontouka S. National background report for Greece. EUROFAMCARE (services for supporting family carers of elderly people in Europe: characteristics, coverage and usage – an EU supported project) Athens, National School for Public Health, 2004 (www.50plus.gr, accessed 18 June 2007). 44. Proposal for the establishment of the European Centre for the Prevention and Control of Noncommunicable Diseases in Athens, Greece. Copenhagen, WHO Regional Office for Europe, 2007 (document EUR/RC57/11). 45. Mackenbach J, Bakker M, eds. Reducing inequalities in health. A European perspective. London, New York, Routlege, 2002. 46. Stahl T et al., eds. Health in all policies. Prospects and potentials. Helsinki, Ministry of Social Affairs and Health, 2006. 47. Diwan V et al., eds. Health impact assessment: from theory to practice. Report on the Leo Kaprio workshop, Gothenburg, 28–30 October 1999. Gothenburg, Nordic School of Public Health, 2000. 48. Kemm J, Parry J, Palmer S, eds. Health impact assessment. Concepts, theory, techniques, and applications. Oxford, Oxford University Press, 2004. Chapter 4 127 Case studies: policy development in countries for tackling noncommunicable diseases
Chapter 4 128 Hungary Péter Makara & Zsófia Németh 1. Country profile The Hungarian Republic is located in central Europe. It has a territory of 93 000 km 2 and a population of approximately 10 million. One fifth of the population lives in the capital, Budapest, and almost 65% lives in urban areas. The birth rate is lower than the death rate and the population has fallen steadily since the 1980s. The proportion of the population aged 0–14 years old fell from about 20% of the total in 1990 to 16% in 2003. The percentage of the population over the age of 65 years has increased since 1980; it is currently 15% and by 2030 is estimated to have risen to 22% (1). Hungary has 23 large cities and 19 counties. Since 1996, the counties have been grouped in 7 regions. 1.1. Socioeconomic development As a result of the shift to a market economy, Hungary had to face the collapse of the former economic system in the 1980s and a transformation crisis at the beginning of the 1990s after changing the political system. The GDP fell by more than 15% over the first three years. This period had a fundamental impact on the social structure, redistributing social positions, strengthening some old and creating some new inequities, and deeply influencing the health perspectives of the population. The Hungarian economy has seen constant growth since 1993, with an average of 3.5% per year. The high level of national debt was a legacy of the former regime and its repayment placed a heavy burden on the national economy. Nevertheless, the debt reached a manageable level by 2000, although in the last five years it had tended to increase. Balancing the national budget is one of the most significant risks for the national economy; one of the criteria for the introduction of the Euro in 2010 is that the budget deficit be stabilized below 3% by 2008. The unemployment rate decreased between 1993 and 2001 but has risen somewhat since. The difference between the unemployment rates of men and women has decreased. At the same time, the percentage of people actively employed in the working-age population in Hungary is one of the lowest in Europe. Eurostat reports that in 2002, 10% of the Hungarian population lived in relative poverty. The GINI index has fallen since the beginning of the early 1990s and is now comparable to that of western European countries. 1.2. The people and their health In the mid-1960s, life expectancy in Hungary was comparable with that of the more developed western European countries. Public health programmes, coupled with improvements in the socioeconomic situation, successfully brought communicable diseases under control. On the other hand, NCD prevalence increased, leading to rising adult mortality while life expectancy continuously improved in western European countries. An increasing gap opened up between the heath status of the Hungarian population and that of people in western Europe. In the late 1980s, mortality rates among 45–64-yearold men in Hungary rose to levels higher than those of the 1930s. Cardiovascular mortality accounted for the majority of this excess, and led to a dramatically high level of premature mortality in middle-aged men. The reasons for this are complex and not fully understood. The phenomenon, known as the central–eastern European health paradox, describes this remarkable gender difference, despite the fact that men and women share the same socioeconomic and political circumstances (2). Risk factors such as tobacco use, alcohol consumption, low fruit and vegetable intake and low level of physical activ- Case studies: policy development in countries for tackling noncommunicable diseases
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Gaining Health Analysis of policy d
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Abstract There is no greater threat
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Abbreviations The abbreviations sho
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vi Preface The WHO European Strateg
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Contributors Jill L. Farrington was
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Chapter 1 2 the European Region, sh
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Chapter 2 History and context of po
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tions and strategies to achieve the
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• Of the countries responding in
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Washington, D.C., US Government Pri
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Chapter 3 14 co-funded by the Publi
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Chapter 3 16 determine policy outco
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Chapter 3 18 • policies for older
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Chapter 3 20 developing methodologi
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Chapter 3 22 References 1. Gaining
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Appendix 1 Key informants interview
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Chapter 4 26 Albania Péter Makara
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Chapter 4 28 The strategy was final
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Chapter 4 30 for these organization
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Chapter 4 32 The directorates are a
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Chapter 4 34 etc. will continue to
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Chapter 4 36 thinking is still domi
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Chapter 4 38 Finland Anna Ritsataki
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Chapter 4 40 Both the state and the
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Chapter 4 42 2.1. Broad policy for
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Chapter 4 44 • the principle of u
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Chapter 4 46 Broad use is made of
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Chapter 4 48 MSAH prepares for appr
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Chapter 4 50 private donation. Ther
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Chapter 4 52 2.4.4. National demons
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Chapter 4 54 been the case at the E
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Chapter 4 56 materials or to check
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Chapter 4 58 The employer, in both
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Chapter 4 60 2.8. Broad intersector
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Chapter 4 62 was medically and econ
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Chapter 4 64 adequate, whereas that
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Chapter 4 66 planning philosophy an
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Chapter 4 68 any meaningful attack
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Chapter 4 70 In the overall improve
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Chapter 4 72 15. Strategies for soc
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62. International evaluation of the
Page 85 and 86: Chapter 4 76 The low cardiovascular
Page 87 and 88: Chapter 4 78 A characteristic featu
Page 89 and 90: Chapter 4 80 • cancer • CVD •
Page 91 and 92: Chapter 4 82 INPES carry out data c
Page 93 and 94: Chapter 4 84 the fight against canc
Page 95 and 96: Chapter 4 86 published in early 200
Page 97 and 98: Chapter 4 88 information was not su
Page 99 and 100: Chapter 4 90 intoxication, improves
Page 101 and 102: Chapter 4 92 research (see section
Page 103 and 104: Chapter 4 94 on public health repre
Page 105 and 106: Chapter 4 96 groups and the health
Page 107 and 108: Chapter 4 98 19. Chauliac M. Progra
Page 109 and 110: Chapter 4 100 recent years, Greece
Page 111 and 112: Chapter 4 102 the wake of political
Page 113 and 114: Chapter 4 104 telecommunications, h
Page 115 and 116: Chapter 4 106 2.3.3. Setting the ag
Page 117 and 118: Chapter 4 108 They were asked to se
Page 119 and 120: Chapter 4 110 been responsible for
Page 121 and 122: Chapter 4 112 companies. Neverthele
Page 123 and 124: Chapter 4 114 comparative analysis
Page 125 and 126: Chapter 4 116 an important effect o
Page 127 and 128: Chapter 4 118 2.8. Policies for spe
Page 129 and 130: Chapter 4 120 public health service
Page 131 and 132: Chapter 4 122 in defining inequalit
Page 133 and 134: Chapter 4 124 5.3. From awareness b
Page 135: Chapter 4 126 15. Draft Development
Page 139 and 140: Chapter 4 130 The main functions of
Page 141 and 142: Chapter 4 132 management at an appr
Page 143 and 144: Chapter 4 134 The Public Health Pro
Page 145 and 146: Chapter 4 136 • tobacco control
Page 147 and 148: Chapter 4 138 • positive changes
Page 149 and 150: Chapter 4 140 Finally, a Platform f
Page 151 and 152: Chapter 4 142 • health care and g
Page 153 and 154: Chapter 4 144 to be sharp. The prop
Page 155 and 156: Chapter 4 146 able reasons, the Min
Page 157 and 158: Chapter 4 148 2. Kopp M, Réthelyi
Page 159 and 160: Chapter 4 150 1.3. The main feature
Page 161 and 162: Chapter 4 152 from outside the DoHC
Page 163 and 164: Chapter 4 154 to incorporate an exp
Page 165 and 166: Chapter 4 156 In 2004, there was an
Page 167 and 168: Chapter 4 158 ing socioeconomic var
Page 169 and 170: Chapter 4 160 The strategy is seen
Page 171 and 172: Chapter 4 162 2.5.2. Nutrition Some
Page 173 and 174: Chapter 4 164 The national lifestyl
Page 175 and 176: Chapter 4 166 A first policy for ol
Page 177 and 178: Chapter 4 168 In addition, many of
Page 179 and 180: Chapter 4 170 The strategy calls fo
Page 181 and 182: Chapter 4 172 tional policies. At t
Page 183 and 184: Chapter 4 174 the office of the Pri
Page 185 and 186: Chapter 4 176 28. Towards a tobacco
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Chapter 4 178 Kyrgyzstan Péter Mak
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Chapter 4 180 In the case of Kyrgyz
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Chapter 4 182 The active involvemen
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Chapter 4 184 disease prevention at
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Chapter 4 186 The existing, often f
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Chapter 4 188 ment. One part of the
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Chapter 4 190 fell rapidly from 199
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Chapter 4 192 the health field were
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Chapter 4 194 An attempt was made t
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Chapter 4 196 iour of schoolchildre
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Chapter 4 198 Lithuania reports reg
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Chapter 4 200 risk factors have bee
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Chapter 4 202 closer state control
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Chapter 4 204 of industrial disease
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Chapter 4 206 ensure that in the lo
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Chapter 4 208 in order to deal with
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Chapter 4 210 added weight of being
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Chapter 4 212 2. World development
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Chapter 5 Reflections on experience
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whether lifestyles can be affected
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over the years. In these countries,
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In countries where the process has
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Policy formulation This section dis
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Capacity mapping The policy formula
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during policy formulation. Naturall
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civil servants have a degree of per
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It can be quite a challenge for the
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• the extent of the health proble
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example, improving health literacy
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The policy content The content of s
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With the possible exception of Finl
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tation, and an important investment
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We would add that more use needs to
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On the whole, “revised” policy
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arguments for applying an integrate
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the most appropriate prerequisites
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(http://www.euro.who.int/document/e
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Chapter 6 254 As premature deaths f
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Chapter 6 256 goods”, including f
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Chapter 6 258 be conflicting, and t
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Chapter 6 260 effectiveness of inte
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Chapter 6 262 • Examining the cos
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Chapter 6 264 ments/ev_060302_rd06_
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