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

Chapter 4
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management at an appropriate level to determine targets,
methods, organizational requirements, financing, evaluation
and adjustment mechanisms in a coherent system.
In the absence of appropriate annual and medium-term
programme formulation, priority-setting could not proceed
well. Since financial, personnel and organizational resources
were scarce, plans were over-ambitious and subjective. In
the lack of appropriate programme planning, the National
Council for Health Promotion was not accountable for
its work, stating that needs were so great that any action
taken would have some benefits somewhere. The lack of
conditions for fair evaluation made feedback and professionally
sound adjustment impossible. Further, there was
no sufficient research infrastructure to assist the policy in a
comprehensive way.
The continuance into this period of some major strategies
and guidelines for policy development to tackle NCD
permitted substantial elements of continuity in health policy.
2.3.2. Umbrella policies in the period of transition
After the basic political changes in 1990, a more conservative,
medicalized approach to public health emerged. The
long-term strategy from 1987 rebounded and there was a
nostalgia for the public health system of the 1930s. This, together
with a more centralizing and bureaucratic approach,
led to the formation of NPHMOS in April 1991. It was to
guide and supervise epidemiology and health protection activities
and supervise health care under the direct guidance
of the Minister for Public Welfare.
In the second half of 1992, the Government became interested
in quickly producing a strategic document for disease
prevention and improving the health of the population. At
first, the Secretary of State in the Ministry of Public Welfare
wanted to set a two-month deadline, but after internal
discussions, the Chief Public Health Officer secured the
right to formulate a health policy document and made it his
personal creation.
The Government accepted the document one month before
the election and its subsequent Resolution 1030/1994
(IV.29) on the principles of a long-term public health policy
set the following five national targets.
1. Health should be seen as one of the major values by
an increasing proportion of the population. At the
same time, efforts will have to be made to ensure that
decision-makers attach primary importance to improving
the population’s health in both legislation and
budgeting.
2. The years of life lived free from disease shall be extended
to at least 55.
3. Life expectancy at birth shall be increased to at least
67 years for males and 75 years for females.
4. The difference in life expectancy at birth of population
groups in extremely good and extremely poor social
situations shall not exceed three years.
5. The difference between the number of deaths and live
births shall be reduced considerably, to the advantage
of live births.
These rather simple targets formed the basis for a structured
system of prevention programmes. The way of thinking
of the document can be illustrated by the following basic
considerations (3).
a. Healthy lifestyles that influence the population’s health status
shall be shaped by means of education, mass media and health
education, in the frameworks of which people must be made
aware of the harmful effects of unhealthy dietary habits, tobacco
and alcohol abuse and sedentary lifestyles. Further, the methods
that enhance the adoption of healthy lifestyles shall be disseminated
widely. To implement the above, the national core curriculum
shall highlight activities related to health education, and
Case studies: policy development in countries for tackling noncommunicable diseases