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

Chapter 4
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tional policies. At the moment, it would be premature to
try to assess the possible implications for NCD policy.
The Parliamentary Joint Committee on Health and Children
does not simply react to reports put before it but has
instigated action, calling for example for an anti-smoking
strategy. Furthermore, judging from the reference made by
ministers to policy documents of their predecessors, there
is some level of political consensus on certain health issues.
There are excellent examples of progress in certain regions
of the country, but more could be done to share the good
practice and experience of progressive regions.
NGOs related to the main NCD and their risk factors have
been active in Ireland for many years. Their vast experience
informs the work of task forces formulating or monitoring
policy, and they play an active role in evaluating progress.
5. Lessons from the Irish experience
Ireland employs a complex array of broad health and health
promotion policies to combat NCD, complemented by a
range of policies and strategies to tackle specific NCD and
their risk factors. Most of these are then picked up or reflected
in policies for settings such as schools, the workplace
and hospitals and, as appropriate, in separate policies for
specific groups of the population.
5.1. The policy environment
Ireland has enjoyed rapid economic growth in recent years,
shifting from an exporter of human resources to a country
with net immigration. The need for a healthy and growing
workforce has contributed to a receptive environment for
health promotion arguments, put forward by national public
health experts closely involved in the WHO Health for All
and health promotion movements. From the late 1980s,
health and development have been linked, with health
components included in efforts for economic growth and a
change in the pattern of economic development.
The national social partnership agreements initiated in
1987 brought health on to the negotiating table between
the state and the trade unions at a level not seen in most
countries. These agreements were possibly conducive to
strengthening the culture, already evident, for searching for
a degree of consensus.
Health does not appear to be an issue for intense party
political polarization.
5.2. Indications of the value system underlying policy
development
Practically all the policy documents examined refer in detail
to the WHO Health for All policy and its values. There is a
clear focus on equality issues. Supporting this, a new unit for
primary care and social inclusion has been established in the
DoHC. The equality focus is strengthened by links to the
anti-poverty strategy and the attention paid to vulnerable
groups such as Travellers.
Tackling the determinants of health has been less obvious.
Certain policies examined introduce the right argumentation
but their proposed interventions are sometimes rather
disappointingly focused on equality in access to care or
health education interventions, with less attention paid to
the determinants of inequalities.
5.3. From awareness building to policy action
There is now a comparatively good research and information
base. Some respondents felt, however, that research
does not necessarily trigger policy development and that
excellent information had been available without being
acted on. Ireland’s ranking among other EU countries in
relation to health status was a clear motivator for action in
a number of policy documents examined.
Case studies: policy development in countries for tackling noncommunicable diseases