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

This includes: broad umbrella-type health system and health
promotion policies; specific policies dealing with diseases
such as cancer, with heart health and diabetes, and with risk
factors and behavioural issues such as food and nutrition,
obesity, alcohol consumption, physical activity and smoking;
health components in policies for population groups
such as children and older people; and health components
in the National Development Plan 2007–2013 (5), Towards
2016 (6) and the National Action Plan for Social Inclusion
2007–2016 (7).
This plethora of policies has been interlinked in various
ways, ranging from referencing, to the provisions of a particular
policy appearing in the text of other policies, to the
setting of common targets, to utilizing funding opportunities
in one policy area to implement related objectives under
another policy heading. Strands of continuity and a willingness
to build on previous efforts are reflected in references
to earlier policy documents. It was not possible, however, to
discern readily recognizable structures and channels for the
overall coordination of policies relevant to tackling NCD
and their risks. Partly owing to this, a Policy framework for
the management of chronic diseases (8) was approved early
in 2008.
2.1. Broad policy for health – “quality and fairness”
The current broad policy for health in Ireland is Quality and
fairness: a health system for you (9), covering a 7–10-year
period.
2.1.1. How things started
The pattern of health policy development in health in
Ireland has been that of formulating broad strategies and
complementing these by more detailed policies and strategies
for health promotion and for specific diseases and their
risk factors.
The 1994 strategy for effective health care, Shaping a
healthier future (10), provided the foundations for the current
policy. This document concentrated mainly on health
care, but was an integral part of the overall development
planning process for economic and social progress. It tried
to shift from the traditional focus of providing a particular
level of health service to achieving outcomes in terms of
health and social gains. CVD, cancer and accidents were
listed as the three main causes of premature death. The
four-year action plan accompanying the strategy set quantified
targets for their reduction and anticipated additional
strategies for health promotion and individual risk factors.
Quality and fairness (9) appears to have been triggered
partly by the fact that an unprecedented increase in the
funding of health services at the end of the 1990s (investment
in health care was doubled between 1997 and 2001),
although bringing improvements, was clearly not enough.
This conviction was strengthened by research results, including
the first survey of lifestyles and attitudes, completed
in 1998, and surveys in the health behaviour of schoolchildren.
This concrete evidence underlined past convictions
that, unless trends in smoking, alcohol consumption and diet
were reversed, this would lead to avoidable deaths in the
future.
As the 1994 policy did, Quality and fairness indicated concern
that Ireland was not keeping pace with health improvements
achieved in other EU countries. All of this led to the
understanding that it was time not only to improve the level
and quality of health and social services but “to ensure that
health is given priority across all the sectors with a role to
play in improving health status” (9).
2.1.2. Awareness building and the consultation process
Effective action was seen to require a stronger multisectoral
approach. To this end, in addition to a 17-member
Steering Group to oversee the process and a 15-member
Project Team comprising officials of the DoHC and of the
health boards, a high-level Inter-Departmental Group was
set up. Nine of the nineteen members of this group came
Chapter 4
151
Case studies: policy development in countries for tackling noncommunicable diseases