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

Chapter 4
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The strategy is seen as a further refinement of proposals
for cancer control set out in the Health Strategy and was
developed in accordance with recommendation 12 of that
Strategy. Although it is stated that more than 30% of all
cancers are preventable, and that prevention must remain a
central focus of cancer policy, the aims set out in the introduction
relate almost exclusively to health care. One of the
central proposals is for the reorganization of health services
around four cancer control networks, each serving about
one million people and with about eight cancer centres
each serving a minimum of 500 000 people.
This health care focus appears to be in tune with prevailing
public sentiment. An evaluation of the 1996 National Cancer
Strategy, including a broadly based consultation process,
found that the target to reduce mortality from cancer in
the under-65 age group by 15% in the ten-year period from
1994 had been reached by 2001. Those consulted commonly
stated the main achievement of the 1996 strategy as
being that of providing a framework for the development
and funding of cancer services. The relatively poor survival
rates for common cancers in Ireland, together with the
expected increase in the incidence of cancer due to population
ageing, led the 2006 strategy to conclude that there
“needs to be significant expansion in all aspects of cancer
service capacity”. As part of this effort, screening for breast
and cervical cancer has been expanded and funds made
available to offer this programme by 2007. Approval has
also been given for a national network for radiation oncology
services to be put in place between 2008 and 2011 (4).
The strategy refers to the national health promotion policy
and to policies relating to risk factors such as smoking,
alcohol abuse, nutrition and physical activity, endorsing their
full implementation. Specific recommendations are made to
deal with the danger from ultraviolet radiation and radon,
and for population-based screening where there is evidence
that this is effective.
Proposals are made for better monitoring of inequalities in
cancer risks, occurrence, uptake and access to services, and
of outcomes of care. The need for further human resources
planning and research is also covered.
2.5 Policies related to risk factors
2.5.1. Towards a tobacco-free society
Ireland is now one of the leading countries in tobacco
control. Broad consensus on the need for this has been
achieved through sustained effort and the fortuitous appearance
of a strongly anti-smoking Minister committed to
seeing the battle through.
The change in public attitudes to smoking built up slowly.
Towards the end of 1999, the Parliamentary Joint Committee
on Health and Children published a report on health
and smoking, recommending that a national anti-tobacco
strategy be adopted. A Tobacco Free Policy Review Group
was set up to carry out a review of health and tobacco
and make appropriate recommendations. The report of
the Review Group, Towards a tobacco free society (28), was
published in 2000 and adopted as government policy. The
strategic objectives are:
• to change attitudes
• to help people give up smoking
• to protect people from passive smoking
• to focus on children.
One recommendation was the setting up of an independent
statutory body, the Office of Tobacco Control (OTC),
formally established in 2002 through the Public Health
(Tobacco) Act. The OTC was responsible for national
implementation of the smoke-free law.
The means of implementing the strategy are far-reaching,
including gaining support from key figures and local communities,
providing adequate information and support
for research in collaboration with the main NGO (ASH
Case studies: policy development in countries for tackling noncommunicable diseases