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

Chapter 4
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ing socioeconomic variables in the National Cardiovascular
Information System.
The Group’s report, Building healthier hearts (17), was
endorsed by the Government and launched by the Prime
Minister in 1999. The main aims of the strategy were:
• to reduce the risk factor profile in the general population;
• to detect those at high risk;
• to deal effectively with those with clinical disease, and
• to ensure the best survival and quality of life for those
who recover from CHD.
The targets set were to bring premature death from CHD
at least in line with the EU average, and over the longer
term to reach the best performers in the EU. The 211
recommendations, 58 of which relate to health promotion,
were presented to a national stakeholders’ conference
in November of the same year. The weight of the report
focused on health services and health personnel. In the case
of GPs, this also referred to an increased role in supporting
smoking cessation, improved nutrition and physical activity.
Considerable financial resources were designated for implementing
the strategy (€59 million in the first three years).
Infrastructure was put in place for its implementation over
the longer term, at national regional and local levels, including:
• a Ministerial Group, chaired by the Minister for Health
and Children;
• a joint parliamentary Committee on Health and Children;
• a Heart Health Task Force to ensure that intersectoral
recommendations were implemented, by reviewing the
objectives of government departments charged with
implementing detailed aspects of the strategy;
• an Advisory Forum, with subgroups relating to primary
care, hospital care, rehabilitation and health promotion
for heart health, to advise the Task Force and the
DoHC, including advice on priority-setting;
• a National Cardiovascular Information Systems Steering
Committee;
• a human resource group on consultant cardiology;
• a steering committee related to the secondary prevention
of CVD through the GP service;
• regional CVD committees (prior to 2005); and
• an interdivisional working group within the DoHC.
Together with the National Heart Health Alliance, which
represents about 40 NGOs, the CVD Advisory Forum held
a one-day workshop to identify the lead agency for each
recommendation of the strategy, and the tasks required for
its implementation. The report of the workshop indicated
priorities for action that were missing from the original
document. Later conferences organized by the Irish Heart
Foundation to consider the implications of the strategy for
hospitals and for PHC reiterated the need for prioritization
and for rolling out such a comprehensive strategy in a “logical
fashion” (21).
A national media campaign entitled “Ireland needs a change
of heart” was developed, with an accompanying information
pack and a handbook distributed to all households (22). The
Irish Heart Foundation, an NGO with 40 years’ experience,
played an active role throughout the process. Similar
campaigns were developed for other risk factors.
Legislation on tobacco control was tightened and Ireland
became the first country to ban smoking in the workplace
and all public buildings. In the second phase of implementation,
handbooks on specific risk factors such as physical
activity were designed for the general public, particular attention
being paid to walking as a form of exercise. A 2002
survey of people’s recall of the campaign and pamphlets
indicated that they had had a significant impact on people’s
knowledge (23).
Case studies: policy development in countries for tackling noncommunicable diseases