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

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to incorporate an explicit commitment to sustaining and
improving health status in their statements of strategy and
in their business plans. Judging from party political platforms,
HIA appears to have wide political support.
Since the publication of NAPS in 1997, government policy
is “poverty proofed” to test whether it reduces poverty or
has an adverse impact on poorer people.
2.1.6. Structures and processes for implementation
Recognizing the intersectoral nature of the strategy, a Cabinet
Sub-Committee was established for its implementation,
with ministers participating as relevant issues arose. The
Cabinet Sub-Committee was expected to review overall
progress and that of selected initiatives as it saw fit. In the
event, however, this committee does not appear to have
been active. An Inter-Departmental Group of senior officials
reviews, on a continuing basis, progress in implementing
the strategy.
The Sub-Committee and Inter-Departmental Group were
to be serviced by a National Implementation Team established
within the DoHC, which was to report annually, making
the report available to Parliament.
In addition, a National Steering Group, reporting to the
Minister for Health and Children and including people from
outside the health sector, was to oversee the process and
provide practical experience of managing change. The
DoHC was reviewed regarding its potential for supporting
this wide-reaching strategy, and a new Population Health
Division was to be established with responsibilities for
integrating DoHC policies in the areas of public health and
environmental health, health promotion, NAPinclusion, preventive/screening
programmes, food safety, medicines and
HIA. Following the huge upheaval of establishing the Health
Service Executive, the proposed Population Health Division
was not established. It remains to be seen, therefore, how
far the DoHC will be able to meet the challenges for policy
integration with its present capacity.
An Interim Health Information and Quality Authority was
also established. In addition to developing health information
systems, the Authority has a wide mandate in terms of
setting and monitoring standards and overseeing accreditation.
Finally, a broadly based National Consultative Forum of
stakeholders is convened annually to consider progress and
comment on priorities. The Forum may review any of the
various reports produced and has so far met three times.
Respondents from one of the NGOs, interviewed for this
study, questioned the real participatory character of the
Forum, however, since the agenda and the approximately
350 attendants at its one-day annual meeting are selected
by the DoHC.
2.1.7. Monitoring and evaluation
The strategy provides for the establishment of a monitoring
and evaluation function at both national and regional levels.
The large number of quantified targets set in this and related
strategies provide one of the means against which to
measure progress. In addition, a national set of key performance
indicators was established.
Since 2001, the 121-point Action Plan for implementing the
strategy has been reported on annually. From 2006, the
DoHC, the newly established Health Service Executive and
the then Interim Health Information and Quality Authority
were each responsible for reporting on the actions for
which they were accountable (4,12). These reports are
available in printed form and on the Internet.
The three key health status targets defined in Building an
inclusive society state that, by 2007, the gap in premature
mortality between the lowest and highest socioeconomic
groups for circulatory diseases, cancers and injuries should
Case studies: policy development in countries for tackling noncommunicable diseases