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

whether lifestyles can be affected in a sustainable way without
explicitly tackling their underlying determinants. As the
present case studies and relevant WHO reviews indicate:
• there is no clear historical pattern of policy development
for tackling NCD in Europe, although certain
countries indicate partially similar trends;
• among the eight countries studied, there does not appear
to be a common pattern or package of policies
(though this relates partly to the manner in which these
countries were selected and their small number); and
• no country has developed a specifically designated
“NCD policy” (although Ireland has recently formulated
a framework for the management of chronic disease and
Lithuania is preparing a similar policy).
Over a period of 2–3 decades in Finland and Lithuania, and
partly in Hungary and Ireland, an initial focus on CVD prevention
was followed by a broadening of the policy framework.
This introduced the concept of tackling inequalities in
health and their social and economic determinants through
umbrella policies, influenced largely by the WHO Health for
All policy. These Health-or-All-type policies have been continually
revised in these countries and issue-specific policies
have been developed simultaneously. More recently, and
partly influenced by the EU, there has been a stronger focus
on including health components in more general development
or social inclusion plans.
Even these four countries, however, have different “packages”
of policies in place. From the start, Ireland developed
separate health promotion policies to complement the
broad umbrella policies, and is presently making a third
revision of the health promotion policy. There are mediumterm
policies for individual NCD and their risk factors, a
long-term policy for cancer (to 2015) and recently a policy
for the management of chronic disease. Parallel to its longterm
umbrella policy, Finland has medium-term (4–6-year)
plans and strategies for heart health, alcohol control and
nutrition, for example, and is currently preparing a health
promotion policy. Lithuania has a strategy and action plan
for nutrition up to 2010 and is developing separate policies
for equity in health and for NCD, but uses “programmes”
to tackle the specific NCD and their risks covered in the
umbrella policy. In Hungary, after experience with CVD
prevention, four different Health-for-All-type public health
policy frameworks have been elaborated by successive
governments over the last two decades. Topic-based and
largely autonomous policies were later developed, referring
to the umbrella document and influenced by international
developments in, for example, tobacco and nutrition.
France offers a special case, whereby a legal instrument
serves as the umbrella framework but the driving force
behind implementation is based on the various topic-based
policies. Greece has a strategic plan for cancer and a policy
for mental health and is now embarking on a broad public
health policy. Kyrgyzstan starts with the broadest framework
policy document, Manas Taalimi, offering a strategy
for all the priority areas of health policy and health care
development. In Albania, the umbrella document at the
moment lacks real political commitment and NCD policy
development is incremental and opportunistic in different
programme areas. A national cancer control programme
was developed by the Ministry of Health during 2006/2007
but an action plan for implementation is still awaited
It is apparent, therefore, that one size does not fit all and
that, in this small group, there are almost as many “patterns”
or “packages” as there are countries. Some common
traits may be discerned, however.
• All eight countries ratified the WHO FCTC between
October 2004 (France) and May 2006 (Kyrgyzstan) and
at least seven of them had a clear tobacco control policy
and/or legislation in place by the time of the study.
Chapter 5
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Reflections on experiences