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

One of the key opportunities for tackling social determinants
of health would be a problem-centred approach
combining social and health policies. There has been no
harmonization at the level of government of actions in
social and health areas, not even when social and health
affairs belonged in the same ministry. The traditional medical
approach is socially insensitive while the social sector is
unprepared to tackle questions of health.
Taking into consideration the present characteristics of
policy development for tackling NCD, the key threats and
challenges in the medium term are as follows.
1. How can health and development be linked at national
level in the National Development Framework (EU
structural funds)?
2. How can social and economic determinants of health
be tackled from a health promotion and disease prevention
perspective to achieve better equality?
3. How can health be put higher on the political agenda in
a period of health care reform?
4. How can commitment be increased and strategic
sustainability of policies ensured to tackle NCD beyond
the government cycle?
5. How can economic models be found for NCD prevention?
6. How can one cooperate with the private sector in a
strategic and ethical way?
7. How can an integrated approach for the whole
communication system be developed from a health
prospective?
8. How can the fragmentation of strategy implementation
be avoided?
9. How can an increase in human and financial resources
for NCD prevention and health promotion be maintained
in the light of current developments?
5. Lessons from the Hungarian experience
The epidemiological situation related to NCD is quite
unfavourable by European standards, especially in the
middle-aged population. Considering the economic indicators
of national development, the health status of the
Hungarian population gives a much more negative picture
than expected.
In the last three decades, rich and increasing experience
and know-how have been created in Hungary in developing
policies to tackle NCD. Broad Health-for-All-type policies
were developed from the late 1980s, supported later by a
number of issue-specific sub-policies. This strategy, based
on umbrella policies while developing more and more vertical
programmes, does not offer an appropriate level of coordination.
In 2008, Parliament was to use the opportunity
of the fifth anniversary of the NPHP to look at the situation
and suggest ways for further development.
5.1. The policy environment
After beginning with some CVD prevention programmes
in the mid-1970s, Hungary developed a long-term Healthfor
All-type policy for health promotion in 1987. This
unique experience of the communist era was very largely
influenced by the WHO Regional Office for Europe. After
the fundamental political, economic and social changes in
1990, more conservative, medicalized approaches in public
health became dominant, leading to a government resolution
on the principles of a long-term public health policy in
1994. This programme has never been really implemented,
however.
At present, the key elements of the macro-policy environment
influencing the chances of developing policies to tackle
NCD can be summarized as follows.
• The present Government undertook important new
steps in health care reform. For politically understand-
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases