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

health insurance system. Overall, it appears that a good
working relationship has been achieved between the Ministry
and the Board. The alignment of the opinion of these
two bodies with that of the Parliamentary Health Committee
has been one of the factors in putting and keeping public
health on the map. An additional player is the President’s
Health Adviser, who can also be influential.
Involvement of the general public is less evident, although
attempts are being made to address this and, as seen
above, parliamentary discussions on health are broadcast
on national radio. A report from the Open Society Fund
states that “the citizens of Lithuania are rather hesitant to
participate in the formation of national policy” (12) and that
public policy regarding joining the EU, for example, was
consigned exclusively to government institutions. The same
report argues that the dominant attitude is still that only a
strong state can satisfy the needs of ordinary citizens.
2.1.3. Values and principles
Policies formulated following independence have been explicitly
based on the promotion of equality and solidarity in
health. This appears to have been influenced by strong and
continued links to activities related to the WHO Health for
All policy and by largely successful attempts to improve the
reflection of possible inequalities in the information base.
Participation in multicountry programmes, particularly
CINDI, ensured the continuous improvement of the epidemiological
information base. The Lithuanian health report
– 1990s (10), presented to the First National Conference
on Health Policy in 1993, presented regional inequalities in
infant and overall mortality and pointed to the falsity of the
traditional belief that in a relatively small country like Lithuania
the distribution of problems would be more or less
homogeneous. This report apparently became a best-seller
and was repeatedly reprinted.
As part of a WHO programme, Lithuania began in 1997
to identify all potential sources collecting equality-related
information (either routinely or through surveys) and, on
this basis, to make detailed, extensive analyses of existing
data. The resulting report on inequalities in health and
health care (13) was presented to Parliament and caused
considerable discussion among researchers, politicians and
the media.
The National Board of Health keeps the issue of equality on
the agenda through its annual reports to Parliament. Health
and inequalities in health are a constant focus of the mass
media, particularly the local press. Public awareness can
be said to be high, therefore, and political commitment to
reducing the gaps is constantly iterated in policy documents.
Some of the changes in the health sector have hit the
economically weaker groups of the population hard. The
plethora of health-related legislation, however (including, for
example, the funding of the new health insurance system),
indicate a high concern for solidarity and the protection of
vulnerable groups. It is less easy to discern a broad, systematic
attempt to deal with this challenge by tackling the social
and economic determinants of health.
Work is currently under way on formulating a policy specifically
to tackle inequalities in health.
2.1.4. Setting the agenda
There is a very strong tradition of epidemiological research
in Lithuania. Constant attempts are made to improve the
quality and accessibility of epidemiological data for policy
development, particularly through active participation in
international research projects, thus further motivating and
legitimizing local activities.
Routine surveys of population health have been carried out
over a number of years, linked to the CINDI programme,
and more recently there have been surveys of the behav-
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases