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

the delivery of health care shall include, in addition to medical
treatment, counselling tailored to the needs of the individual.
. . . . . . . . . . .
d. Taking into account the most prevalent disease groups and
most frequent causes of death, efforts shall be made to develop
the methods of preventing, first of all, diseases of the circulatory
system and malignant neoplasms, as well as to establishing an appropriate
scheme of screening to ensure their early diagnosis.
This resolution offered a plan until the year 2000 with 20
prevention programmes, but was not discussed or approved
by the National Assembly and offered a strategy
mainly for NPHMOS. Intersectorality was not sufficiently
developed, while community action and, generally speaking,
partnerships were missing from the plan of implementation.
The prerequisites for health were not considered and there
was no clear concern for equality. In fact, the programme
was never really implemented and the change of government
in the summer of 1994 swept away the early plans (3).
In the autumn of 1994, the new centre-left Government
decided to restructure the health promotion and disease
prevention programme and to broaden its focus on the
determinants of health, with more emphasis on communitybased
elements. The financial crisis and the subsequent
economic restrictions in 1995/1996 led to the deferment of
that initiative.
During the next six years, various communiqués on public
health were issued by the governments of the day but little
was done. Nevertheless, some important legislative steps
were taken in 1997 (a law on health, including public health)
and in 1999 and 2000 (laws on protection of non-smokers
and amending regulations on tobacco and alcohol advertising)
but these did not become part of a larger framework.
Two important programmes were launched in 2000 and
2001.
• The National Strategy on Combating Drug Problems
had more resources and attention to implementation,
and in some aspects important results were achieved
(local forms of coordination were established, schoolbased
prevention programmes supported, and harm
reduction services established and maintained). From
the NCD prevention perspective the Strategy offered
a fairly good example of the feasibility of a sustainable
health strategy.
• The Public Health Programme for a Healthy Nation
started late in the parliamentary cycle (2001) and thus
faced the problem of limited resources. A national-level
breast-screening programme was launched, and several
administrative measures were taken to ensure effective
intersectoral cooperation within the government. The
Interministerial Public Health Committee was established
and its legal basis was established by the Government.
2.4. The NPHP
A few weeks after the elections in 2002, a new Parliament
with a socialist and liberal majority opened before
the establishment of the Government. In this period, its
agenda seemed relatively open and flexible. One of the
members, a former staff member of the National Institute
for Health Development, used the opportunity to propose
a resolution requesting the Government to elaborate a new
comprehensive public health strategy and to present it to
Parliament by the end of 2002.
This (partly improvised) initiative was rather successful,
Parliament adopting it without any difficulty. At the same
time, the short deadline for drafting the document of no
more than six months limited opportunities for consensusbuilding,
the development of realistic alternatives and the
appropriate integration of different interests as well as a
priority-setting procedure.
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Case studies: policy development in countries for tackling noncommunicable diseases