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

From interviews conducted, it was felt that the historical
pattern of developing both umbrella and issue-specific policies
was largely ad hoc, but had been influenced to some
extent by international developments such as the Ottawa
Charter and the WHO Health for All policy. This is borne
out by specific references to these international movements
in the policy documents examined. Partly in response to
international developments, earlier policies were more
settings-focused, with the determinants of health being
introduced rather later. The availability of funding has also
influenced the direction of policy development.
The focus on particular diseases or risks appears to have
been largely led by the interests of political leaders, public
health experts and lobby groups, backed by improved
information. The main NGOs are extremely influential
and include the top specialists among their members. The
Irish Heart Foundation, for example, successfully promoted
the development of a national strategy for stroke prevention.
Interest in issues where the stakeholders, the means
of disease prevention and management, and indicators of
progress are more easily defined has proved easier to maintain
than for broader policies that can become “everyone’s
and no one’s baby”, as is apparently the danger in the case
of obesity.
There is clear cross-referencing between policies dealing
with the same issue. For example, targets set for heart
health in an umbrella policy are adopted in the separate
heart health policy and related risk factor policies. An
integrated or coordinated approach cutting across policies
dealing with different issues is less easy to define. The new
Policy framework for the management of chronic diseases (8) is
intended to bridge that gap, mainly in the health care field,
improving the identification and registration of all NCD
patients and ensuring planned approaches for patients with
long-term conditions.
Following the transformation of the health services, there
has been some discussion of money for health care being
attached to specific strategies. This could mean that the
health services will be prepared to tackle only one issue at a
time. It could also mean a stronger focus on issues that are
more clearly defined and concrete, and where results can
be monitored, for example in patient support programmes.
5.4. Sustaining policy implementation, monitoring
and revision
Given that population health surveys have been established
on a regular basis, and posts for policy implementation have
been established and funded at national and regional levels,
NCD can be expected to remain on the policy agenda, supported
by an adequate number of professional proponents.
Some umbrella and issue-specific policies and strategies are
already on their second or third revision.
Expert task forces and committees monitor implementation
of the various policies at interim periods and at the end
of the planning period. This is a transparent process with
regular public reporting of their findings, most of which are
easily found on the Internet. The policy dialogue between
the stakeholders is therefore continuously fuelled by a serious
knowledge base.
Continuous reference is made to intersectoral action,
although the composition of many of the policy formulation
groups is frequently still rather oriented towards the health
sector. High-level intersectoral structures for the implementation
of health policy have been tried, with limited success.
Some respondents felt that “joined-up thinking” would be
best achieved with “joined-up funding”. It was also felt that
strong leadership has been lacking, and that this might best
be provided outside the health sector, particularly from the
Prime Minister’s Department. Consequently, in 2007, it was
decided to latch on to an existing, successfully operating
mechanism for intersectoral action: the cabinet subcommittee
dealing with social inclusion, operating and chaired by
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Case studies: policy development in countries for tackling noncommunicable diseases