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

Chapter 4
146
able reasons, the Ministry of Health pays more attention
to the key elements of the reform (co-payments,
restructuring of the care system, new systems of
insurance, etc.) and less on long-term issues of policy
development to tackle NCD.
• The complicated economic situation of the country restricts
possibilities for public funding. This rather difficult
financial situation requires innovative ways of thinking in
using the assets of the country and creating a closer link
between health and development.
• In the medium term, the EU structural funds offer a
unique opportunity for investment in building new capacities
for NCD prevention and health promotion.
• Inequalities in health are much larger than the EU average
and are still increasing. The present situation challenges
policy development to use new techniques for an
efficient way of tackling social and economic determinants
of health in Hungary.
• Globalization greatly affects the Hungarian economy and
society, including the health sector. It is a huge challenge
for capacity building, learning processes and innovative
thinking to use the opportunities and to limit the
potential for harm of ongoing change. This stresses the
responsibility of policy development to tackle NCD.
5.2. Indications of the value system underlying policy
development
The NPHP and other key policy documents define the
values and visions for health policy according to the major
programmes of WHO and the EU. These values are based
on a broad national consensus and clearly linked to those
of the WHO Health for All policy. They are, however,
sometimes poorly translated into action. Thus, although
the Constitution guarantees health as a human right, the
prerequisites for health are largely missing in society and
inequalities are still increasing.
5.3. From awareness building to policy action
The Hungarian Parliament adopted a resolution on the
NPHP in 2003. Using existing experience and working
papers from the previous programme, the NPHP was
developed in only six months. A small number of international
experts in health promotion and disease prevention
played an influential role in guiding the policy development
process. The role of prime movers has been decisive in the
case of Hungary for any important policies to tackle NCD.
The NPHP includes 19 priority areas based more on a sophisticated
balance among the different interest groups than
on clear priority-setting mechanisms, combining different
approaches focusing on risk factors, settings and lifestyle.
The NPHP lacked a policy analysis of the experience of
former Hungarian strategies and information on existing
capacities was only partly available. Nevertheless, appropriate
basic information for shaping the policy document was
available, including data on morbidity, mortality, lifestyles,
risk factors, and geographical and social inequalities in
health. However, the text of the NPHP did not include any
proposals for its implementation and the central managerial
coordinating structure is still fluid and unclear.
The status of and relationship between different strategies
for the prevention of NCD are not clear or consistent. The
various sub-policies are not always and explicitly integrated
into the overall NPHP framework, and one can discern that
some sub-policies have been developed independently. The
most important, clearly identified sub-policies are those
on tobacco control, food and nutrition, alcohol control and
physical activity. Recently, a National Cardiovascular Diseases
Prevention Programme and a National Cancer Control
Programme have been drawn up by the Government.
Promoting health and preventing disease in settings are the
success areas of the last decade. Three major strands are
dominant in combating NCD: in cities and communities, at
the workplace and in schools.
Case studies: policy development in countries for tackling noncommunicable diseases