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

Chapter 5
Reflections on experiences
Anna Ritsatakis & Péter Makara
Introduction
This chapter reflects mainly on the material presented in
the eight case studies, drawing out the main lessons to
be learnt from across all of them. Taking into account the
target audience, however, benchmark examples from other
countries are brought in where appropriate to further
inform the discussion. In this way, it is hoped to highlight
issues of interest to policy-makers as they reflect on their
own experience and situation.
In keeping with the structure of the case studies, this
chapter refers first to aspects of the policy environment
that shape NCD policy development. The types of policy
developed in the eight countries are then discussed. This is
followed by an analysis of country experiences through the
steps of the policy cycle used as a framework for this study
(see Fig. 1 in Chapter 3): awareness building, policy formulation,
implementation, monitoring and evaluation, and revision.
The chapter ends with general conclusions.
At each stage of policy development, consideration is given
to: the processes, structures and institutions utilized; the
information, expertise and skills available; and the people involved.
Thus a topic may be highlighted under a number of
headings (for example, information cuts across all stages of
the policy cycle, with basic epidemiological data being used
to raise awareness, inform policy formulation and monitor
progress).
The policy environment
It is clear from the case studies that policy-makers in Europe
are faced with an increasingly complex and unpredictable
situation. On a broader level, the influence of globalization,
EU enlargement and the shifting balance of international,
national and local decision-making roles have significantly
changed the policy environment. The health sector and
NCD policy development are affected, for better or for
worse, by the political, social, cultural and economic situation
at any given time. The following brief examples from
the case study countries indicate the importance of taking
the overall policy environment into account when developing
NCD policies.
The level of NCD policy development in Albania is closely
related to the country’s overall development. Following half
a century of isolation and a difficult decade of transformation,
and despite considerable progress, Albania is still one
of the poorest countries in Europe. The main dilemma is
how to shift from crisis management to planning for development
aimed at social inclusion and poverty reduction.
International organizations play an outstanding and sometimes
dominating role in stimulating political processes. The
stabilization and economic growth in recent years and the
prospect of EU accession may offer new opportunities for
NCD policy development.
Following the Second World War, Finland moved rapidly
from a rather poor agricultural society to a wealthy industrialized
country. Challenges were defined and tackled
in a coherent way, helping to create a culture of planning
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Reflections on experiences