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

Chapter 4
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In addition, many of the social determinants of health, which
lie outside the health sector, are addressed under the broad
framework of the National Social Partnership Agreement,
including income support, education, employment and
activation, and housing. The Social Partnership, initiated
in 1987 and renewed every three years, has been credited
with playing a vital role in Ireland’s impressive social
and economic development (43). Negotiated agreements
between the state, employers’ organizations and the trade
unions to keep wage demands and strike action in check,
thus encouraging economic growth, are offset by government
benefits in terms of health and social welfare provisions.
Progress in implementing the agreement is reviewed
every six months through the Prime Minister’s Department.
The adoption of a “problem solving approach”, with shared
analysis of economic and social problems and policies, is said
to have led to an important outcome in terms of consensus
building and shared understanding.
3. Infrastructure and resources for policies
to tackle NCD
3.1. Structures and processes
Ireland has a long history of promoting intersectoral action
for health. There have been notable successes in policy
formulation, monitoring and evaluation, but policy implementation
has proved more problematic.
Although bilateral collaboration on the whole continues to
work well, even cabinet-level intersectoral committees for
health have not been very effective. It has been difficult to
break down the “silo” mentality and there has been insufficient
incentive for teamwork. Where top-level structures
have been established, ministers or senior officials may
attend in the beginning but are gradually represented by
increasingly lower-level officials. The exception appears to
have been where committees are led by the Prime Minister’s
Department. Attempts are being made to understand
better what makes partnerships work or fail (44).
Some of the large health-related NGOs are well-endowed
financially and include top experts among their members.
These NGOs have considerable influence in instigating
research and lobbying for action and are active participants
in the formulation and evaluation of public health policies.
Significant efforts have also been made to develop the
methodology and techniques for HIA (45) and to offer
training for understanding and carrying it out. Much of this
work has been carried out in collaboration with Northern
Ireland, where the possibility of developing “integrated”
impact assessment has been considered. The implementation
of HIA does not appear to have progressed as quickly
as might have been hoped for (46), but respondents felt
that there is at least a tendency for policy-makers in other
sectors now to “think health” and to stop and consider
whether their planned actions might have an impact on
health.
Ireland has a long experience of setting quantified targets
related to combating NCD, their risks and determinants.
The first health promotion strategy outlined the key components
of target setting as follows: “Targets are specific
... Targets assume the availability of reliable basic data,
effective strategies to achieve change and means of measuring
that change. Setting targets makes it possible to identify
and quantify progress towards the achievement of goals.
Targets need not be numerous nor elaborate to begin
with but need to reflect key national priorities for a stated
time period whose attainment is as measurable as available
indicators permit” (13).
The broad health policies in Ireland and specific policies to
tackle diseases and risks such as smoking, and to promote
the health of population groups such as older people, all set
quantified targets. Setting, implementing and monitoring
targets and revising them as necessary are considered to be
among the most important elements of the NAPS (47).
Case studies: policy development in countries for tackling noncommunicable diseases