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

Chapter 4
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added weight of being part of an internationally recognized
problem.
A small number of highly respected leaders in public health,
some fulfilling multiple roles, have played an enormously
influential part in guiding policy developments within the
country and in making Lithuania’s presence felt at the international
level. The role of these key movers in this relatively
small country has been decisive.
The National Board of Health retains considerable independence
from the Ministry of Health and, given its regular
meetings, would appear to be extremely active. The
strongly expert-led policy process facilitates rather efficient
policy-making but leaves much to be desired regarding the
inclusion of a wider opinion base.
A valuable and accessible information base has already been
created, and strong efforts are made to reflect socioeconomic
inequalities in health. More specifically:
• regular surveys of health behaviour and health status
have become standard practice, allowing the monitoring
of long-term trends; and
• public health reports are published regularly, submitted
to Parliament and discussed openly.
Parliament has played an unusually strong role in the area of
public health, including the tackling of NCD. The degree of
party political consensus on health issues and confidence in
national experts means that Parliament is proactive in calling
on its national experts to examine emerging health challenges
and propose solutions. This allows for considerable
conservation of energy and effort. Rather than reinventing
the wheel with every change of government, policy-makers
and planners have built on much of the scientific work
previously carried out.
The involvement of ministers from other sectors in the
health debate has been ongoing, enhancing understanding
of the need for intersectoral action. It is not clear how far
this translates into specific action, or if awareness of the
need for cross sector collaboration trickles down within the
ministries or to the agencies for which they are responsible.
Although the settings approach seems to have been used
quite widely in schools and to some extent at the city
level, relatively little focus seems to have been given to the
workplace. Given the potential of the workplace as a setting
for tackling NCD, and coupled with the fact that Lithuania is
undergoing rapid economic growth, developing the concept
of “socially responsible corporations” might offer considerable
benefits.
The medical and nursing professions have continued to
provide basic care under difficult conditions. Attempts are
being made to enhance their capacity for health promotion.
However, if top priority is not given to strengthening PHC,
it is difficult to see how the NCD policy can be effectively
implemented.
The setting of clear objectives and quantified targets related
to NCD has focused the policy discussion and encouraged
adherence to strict epidemiological monitoring and evaluation.
More attention will need to be given to evaluating the
process of NCD policy development in terms of whether
or not the necessary human and financial resources were in
place, whether the various partners had a clear understanding
of their expected roles, and what has worked or not
worked and why.
Regular health policy conferences broaden the debate, as
do the mass media. More could be done to popularize
information on NCD prevention and health promotion and
involve the public in defining the challenges and considering
the policy options.
Case studies: policy development in countries for tackling noncommunicable diseases