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

Chapter 4
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The active involvement of the public, communities, local
governments and NGOs is a guiding principle of the CVD
prevention component of Manas Taalimi (2):
A significant role will be assigned to local health committees,
arterial hypertension societies and coronary-lipid societies established
with the aim of training patients and family members to
be aware of CVD preventive measures and training programmes
aimed at risk reduction (overweight, imbalanced nutrition, lack
of physical exercise, stress, arterial hypertension and hyperlipidaemia).
Likewise, it is necessary to use the media on a broader
basis, as well as to disseminate booklets and brochures, on
measures of controlling and preventing CVD.
These measures reflect to some extent surviving traditional
ideas of health education in Kyrgyzstan.
The strategy includes a rather brief mention of the need
to develop legislation in the field of CVD risk factors, such
as smoking and excessive alcohol consumption, to support
public policy dealing with healthy nutrition and food safety,
and to incorporate training on healthy lifestyles into the
secondary and higher education curricula. These ideas also
appear in the health promotion strategy (see below) but in
a broader context.
One of the explicit and very ambitious targets of Manas
Taalimi is to reduce the CVD mortality rate to EU levels by
2015. In this context the following activities are to be carried
out:
• promotion of healthy lifestyles and preventing CVD
through the reduction of risk factors;
• publication of brochures for the whole population on
measures to control and prevent of CVD;
• assistance in the creation of outpatient “arterial hypertension
clubs” and “coronary-lipid societies” and
others at local level with the aim of providing training for
patients and their families; and
• developing and introducing modern and efficient prevention
technologies and diagnostics.
All this is based on an optimistic vision and the chances of
its implementation greatly depend on overall economic
and social development and success in tackling the broader
socioeconomic determinants of health. It is difficult to
understand why these ideas are not integrated into a more
explicit and broader framework of NCD prevention, and
why cancer prevention does not appear in the strategy. The
influence of the Institute of Cardiology and the cardiological
background of some top-level decision-makers is one
explanation. The public health components of the strategy
are coordinated at deputy minister level, indicating the high
policy priority given to the issue.
2.3. The national health promotion strategy for
2007–2015
Within the framework of Manas Taalimi, the National
Centre for Health Promotion was requested to develop a
long-term health promotion and NCD prevention strategy
to serve as a basis for medium-term and annual action plans
in this field. The strategy planning process started in autumn
2006. Representatives of all ministries were involved in the
preparatory activities in most cases with a rather limited
technical input. The WHO Regional Office for Europe provided
genuine technical support while stimulating progress
and emphasizing the focus on equality, social and economic
determinants of health, and regional and local participation.
The draft strategy was circulated among the various key actors
(ministries, health experts, international organizations
and donors) in order to build a consensus. Following a national
workshop in July 2007, the process of implementation
began and the first annual plan was developed. The first
experience of multisectoral coordination in October 2007
was rather promising. The representatives of the different
ministries carefully studied the draft strategy and contributed
constructively to the discussion. The next phase of
Case studies: policy development in countries for tackling noncommunicable diseases