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Chapter 3 Methodology, underlying concepts and values Anna Ritsatakis This chapter discusses why and how the present study was designed and carried out. Rather than simply providing a glossary, the basic concepts and values underlying the study are also discussed within the body of the chapter for three main reasons: to ensure a common understanding of terms used throughout the study; to offer a deeper insight into the thinking behind the study design; and to provide essential information for policy-makers intending to assess their own processes for NCD policy development. Objectives of the study This study was carried out in the framework of the European NCD Strategy (1). It is part of a broad package of products and actions being developed to promote a comprehensive approach to tackling NCD in European countries. Following on the WHO global survey on the progress in national chronic diseases prevention and control, referred to in Chapter 2 (2), the present study was expected to explore NCD policy development in Europe in greater depth. Its main objectives were to: • carry out a qualitative analysis of NCD policies and their development in a sample of countries; • provide a general analysis of the patterns and characteristics of NCD policy development experience in Europe, based mainly on the sample countries; and • draw conclusions, learn lessons and identify challenges and opportunities that could prove useful to other countries as they attempt to tackle NCD. Setting up and designing the study The study was conceived in mid-2006 by the then Coordinator, Noncommunicable Diseases at the Regional Office, Jill Farrington. Two principal researchers (Péter Makara and Anna Ritsatakis), both experienced in international and national health policy development, implementation and analysis, were commissioned to carry out the task. Their work was supported by policy analyst Zsófia Németh. The work was steered by the programme of noncommunicable diseases at the Regional Office, assisted by an advisory group of experts, academics and national counterparts drawn from countries within and outside the study. This group met together with WHO staff and the researchers four times from August 2006 to December 2007 to: discuss and advise on the methodology and approach; review the draft case studies and the preliminary steps towards a synthetic analysis; and comment and advise on the draft conclusions of the synthetic analysis. The work was supported by the WHO collaborating centre on noncommunicable disease policy in Ottawa, Canada and Chapter 3 13 Methodology, underlying concepts and values
Chapter 3 14 co-funded by the Public Health Agency of Canada and the Department of Health in the United Kingdom (England). The present study was to complement those quantitative surveys on NCD policy and their risks factors previously carried out by WHO at the global and European levels, using qualitative research methods to go deeper into the NCD policy development process in a small number of countries. In particular, the interviewing of key informants was expected to uncover aspects of policy development that could not be obtained in other ways. Selecting the country case studies The intention was to include countries from different parts of the WHO European Region, ensuring examples of countries with a long history of systematically tackling NCD and some relative beginners. The following criteria for country selection were therefore agreed: • a reasonable geographical distribution; • different levels of economic development across Europe; • a range of political, administrative and health care systems; and • different lengths of NCD policy experience. Time and financial resources indicated that no more than eight case studies could be carried out. For practical reasons, the researchers’ countries of residence influenced the choice of Greece and Hungary as central and southern European countries. This opportunistic selection was strengthened by the fact that these two countries offered examples of relatively early and late beginners and different health systems. The following eight countries were therefore selected: Albania, Finland, France, Greece, Hungary, Ireland, Kyrgyzstan and Lithuania. Designing the case studies – scope and dimensions In defining the scope and dimensions of the proposed case studies, the researchers were mindful of the fact that the main aim was to use these as a source of information and experience from which countries across Europe might learn. It was necessary therefore to be clear about certain concepts. What is meant by policy development? For practical purposes, the term policy was defined as “an agreement or consensus on the issues, goals and objectives to be addressed, the priorities among those objectives and the main directions for achieving them” (3). Government policy, which is the main concern of this study, is manifested in many ways. It may be discerned, from the provisions of acts of parliament, local by-laws and regulations, or be seen to evolve as the result of incremental administrative decisions or regulations (4). Even the lack of a discernable policy statement may be considered a policy in the sense that it indicates a lack of interest in a particular issue. Policy aims and objectives are frequently stated in published “policy documents”. In policy/planning terminology, a “strategy” or “action plan” is more specific than a policy, and defines the broad lines of action to achieve policy goals and targets. In practice, countries frequently use the terms policy, strategy and action plan interchangeably. For reasons of practicality, in this study the central focus is on published policy or strategy documents. The intention was not to analyse the content of such policy documents in detail but to check how far they related to NCD prevention and control, and briefly to examine the range of policy instruments used, such as: Methodology, underlying concepts and values
Page 1 and 2: Gaining Health Analysis of policy d
Page 3 and 4: Abstract There is no greater threat
Page 5 and 6: Abbreviations The abbreviations sho
Page 7 and 8: vi Preface The WHO European Strateg
Page 9 and 10: Contributors Jill L. Farrington was
Page 11 and 12: Chapter 1 2 the European Region, sh
Page 14 and 15: Chapter 2 History and context of po
Page 16 and 17: tions and strategies to achieve the
Page 18 and 19: • Of the countries responding in
Page 20: Washington, D.C., US Government Pri
Page 25 and 26: Chapter 3 16 determine policy outco
Page 27 and 28: Chapter 3 18 • policies for older
Page 29 and 30: Chapter 3 20 developing methodologi
Page 31 and 32: Chapter 3 22 References 1. Gaining
Page 33 and 34: Appendix 1 Key informants interview
Page 35 and 36: Chapter 4 26 Albania Péter Makara
Page 37 and 38: Chapter 4 28 The strategy was final
Page 39 and 40: Chapter 4 30 for these organization
Page 41 and 42: Chapter 4 32 The directorates are a
Page 43 and 44: Chapter 4 34 etc. will continue to
Page 45 and 46: Chapter 4 36 thinking is still domi
Page 47 and 48: Chapter 4 38 Finland Anna Ritsataki
Page 49 and 50: Chapter 4 40 Both the state and the
Page 51 and 52: Chapter 4 42 2.1. Broad policy for
Page 53 and 54: Chapter 4 44 • the principle of u
Page 55 and 56: Chapter 4 46 Broad use is made of
Page 57 and 58: Chapter 4 48 MSAH prepares for appr
Page 59 and 60: Chapter 4 50 private donation. Ther
Page 61 and 62: Chapter 4 52 2.4.4. National demons
Page 63 and 64: Chapter 4 54 been the case at the E
Page 65 and 66: Chapter 4 56 materials or to check
Page 67 and 68: Chapter 4 58 The employer, in both
Page 69 and 70: Chapter 4 60 2.8. Broad intersector
Page 71 and 72:
Chapter 4 62 was medically and econ
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Chapter 4 64 adequate, whereas that
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Chapter 4 66 planning philosophy an
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Chapter 4 68 any meaningful attack
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Chapter 4 70 In the overall improve
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Chapter 4 72 15. Strategies for soc
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62. International evaluation of the
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Chapter 4 76 The low cardiovascular
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Chapter 4 78 A characteristic featu
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Chapter 4 80 • cancer • CVD •
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Chapter 4 82 INPES carry out data c
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Chapter 4 84 the fight against canc
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Chapter 4 86 published in early 200
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Chapter 4 88 information was not su
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Chapter 4 90 intoxication, improves
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Chapter 4 92 research (see section
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Chapter 4 94 on public health repre
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Chapter 4 96 groups and the health
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Chapter 4 98 19. Chauliac M. Progra
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Chapter 4 100 recent years, Greece
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Chapter 4 102 the wake of political
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Chapter 4 104 telecommunications, h
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Chapter 4 106 2.3.3. Setting the ag
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Chapter 4 108 They were asked to se
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Chapter 4 110 been responsible for
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Chapter 4 112 companies. Neverthele
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Chapter 4 114 comparative analysis
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Chapter 4 116 an important effect o
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Chapter 4 118 2.8. Policies for spe
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Chapter 4 120 public health service
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Chapter 4 122 in defining inequalit
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Chapter 4 124 5.3. From awareness b
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Chapter 4 126 15. Draft Development
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Chapter 4 128 Hungary Péter Makara
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Chapter 4 130 The main functions of
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Chapter 4 132 management at an appr
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Chapter 4 134 The Public Health Pro
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Chapter 4 136 • tobacco control
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Chapter 4 138 • positive changes
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Chapter 4 140 Finally, a Platform f
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Chapter 4 142 • health care and g
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Chapter 4 144 to be sharp. The prop
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Chapter 4 146 able reasons, the Min
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Chapter 4 148 2. Kopp M, Réthelyi
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Chapter 4 150 1.3. The main feature
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Chapter 4 152 from outside the DoHC
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Chapter 4 154 to incorporate an exp
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Chapter 4 156 In 2004, there was an
Page 167 and 168:
Chapter 4 158 ing socioeconomic var
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Chapter 4 160 The strategy is seen
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Chapter 4 162 2.5.2. Nutrition Some
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Chapter 4 164 The national lifestyl
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Chapter 4 166 A first policy for ol
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Chapter 4 168 In addition, many of
Page 179 and 180:
Chapter 4 170 The strategy calls fo
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Chapter 4 172 tional policies. At t
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Chapter 4 174 the office of the Pri
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Chapter 4 176 28. Towards a tobacco
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Chapter 4 178 Kyrgyzstan Péter Mak
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Chapter 4 180 In the case of Kyrgyz
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Chapter 4 182 The active involvemen
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Chapter 4 184 disease prevention at
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Chapter 4 186 The existing, often f
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Chapter 4 188 ment. One part of the
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Chapter 4 190 fell rapidly from 199
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Chapter 4 192 the health field were
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Chapter 4 194 An attempt was made t
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Chapter 4 196 iour of schoolchildre
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Chapter 4 198 Lithuania reports reg
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Chapter 4 200 risk factors have bee
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Chapter 4 202 closer state control
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Chapter 4 204 of industrial disease
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Chapter 4 206 ensure that in the lo
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Chapter 4 208 in order to deal with
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Chapter 4 210 added weight of being
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Chapter 4 212 2. World development
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Chapter 5 Reflections on experience
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whether lifestyles can be affected
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over the years. In these countries,
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In countries where the process has
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Policy formulation This section dis
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Capacity mapping The policy formula
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during policy formulation. Naturall
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civil servants have a degree of per
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It can be quite a challenge for the
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• the extent of the health proble
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example, improving health literacy
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The policy content The content of s
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With the possible exception of Finl
Page 250 and 251:
tation, and an important investment
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We would add that more use needs to
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On the whole, “revised” policy
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arguments for applying an integrate
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the most appropriate prerequisites
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(http://www.euro.who.int/document/e
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Chapter 6 254 As premature deaths f
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Chapter 6 256 goods”, including f
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Chapter 6 258 be conflicting, and t
Page 269 and 270:
Chapter 6 260 effectiveness of inte
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Chapter 6 262 • Examining the cos
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Chapter 6 264 ments/ev_060302_rd06_
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