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

Chapter 5
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through consensus building. This was facilitated by the small
population of the country and easy relationships between
people in power, and strengthened by public confidence in
experts and bureaucrats. The commonly agreed values of
the Nordic welfare model provided a clear framework for
policy-making. Active participation in strategically selected
international networks opened up opportunities for sharing
experiences.
France is one of the largest and most developed countries
in the EU, where present institutions are significantly
influenced by deep historical roots. The overall characteristics
of French public administration are clearly reflected in
the structures and processes of NCD policy development
based on the balance, within defined boundaries, of interrelationships
between multiple stakeholders. The relatively
limited influence of international factors in French health
policy development reflects the historical and cultural traditions
of the country.
Greece also went through rapid economic development
and political trauma in the second half of the twentieth
century. Social development, including modernization of
public administration, development of the education system
and a culture of negotiation and collaboration, does not appear
to have kept pace with economic growth. Apart from
areas such as nutrition, international links are not strong but
the EU environment is gradually changing the policy-making
scene.
Health policy development in Hungary is influenced by the
transition to a market economy and democracy. The historical
changes and the EU accession process were controversial,
creating a sharp political divide and increasing inequities.
Slow economic growth, the alarming budget deficit and high
external debt limit the Government’s freedom of action
and impose restrictive measures in the public services, including
public health. The country is going through a radical
health care reform, creating passionate debate and marginalizing
other strategic health issues. Simultaneously, the EU
integration process, including the use of structural funds,
offers a window of opportunity for linking NCD policy and
development.
Ireland has totally redefined itself within a few years, from
being a small, relatively poor agricultural country to becoming
one of Europe’s fastest growing and globalized economies.
This was facilitated by social agreements between the
state and trade unions, again creating a level of consensus
building. Efforts to reduce poverty and social exclusion offer
intervention points for health promotion.
Opportunities for NCD policy development in the newly
independent Kyrgyzstan are closely linked to the economic
and political processes of transition. In the context of
striking poverty and underdevelopment, in a complicated
geopolitical situation, innovative approaches and strategic
thinking are of outstanding importance. In these conditions,
the international community has a special responsibility to
support key developmental issues in the country.
In Lithuania, independence provided an opportunity for
totally rethinking health policy, based on a strong consensus
around WHO Health for All values. Strong international
links were already in place and were put to good effect.
In recent years, solid economic growth and healthy public
finances have created a positive climate and enabled structural
reforms.
Types of policy – patterns of policy
development
As reflected in Gaining health (1), WHO’s European NCD
Strategy, there is broad discussion throughout Europe on
tackling NCD. Key questions include the appropriateness
of tackling individual lifestyle factors separately or whether
changes in different aspects of behaviour are so interlinked
that they can only be effectively tackled together; and
Reflections on experiences