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

Chapter 5
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• Six (all but Greece and Kyrgyzstan) have additional risk
factor strategies or action plans for alcohol control and/
or nutrition, in some cases dating back to 1996 (Ireland).
• Seven (all but Kyrgyzstan) have disease-specific programmes
for cancer and/or CVD prevention (heart
health and/or stroke).
• Two countries (Ireland and Lithuania) were developing
specific NCD or chronic disease frameworks at the time
of the study.
The countries where umbrella-type policies have been
implemented and sustained over a long period of time are
those in which three factors converge:
• a sound evidence/knowledge base
• a strong core of public health/health promotion experts
• a working level of consensus building.
Such umbrella policies entail a shift from the traditional
health care/medical model to a focus on intersectoral
action. Particularly in Finland and Lithuania, and to some
extent in Ireland, active and continued involvement in
international programmes and policy development has also
played a significant role in strengthening the credibility of
such national efforts, engaging local experts and improving
the quality of information for policy-making.
The coordination or harmonization of issue-specific policies,
either with each other or with an umbrella policy, is not
entirely clear in any of the countries where such a combination
of policies exists. Some concern was also expressed
by experts in the field that issue-specific policies might lose
the dynamism created by their proponents if they were
“mushed” together.
Awareness building
Moving an issue onto or higher up the policy agenda
involves a number of processes relating to problem recognition
and representation, the prevailing policy environment,
and key actors involved in the policy process. An
opportunity may be created when a number of these issues
converge.
Problem recognition
In the study countries, epidemiological data on NCD mortality
and the comparison of such data within and between
countries have been among the main pathways for NCD
reaching the policy agenda.
For example,
• North Karelia had much higher rates of mortality from
CVD than the rest of Finland.
• Ireland saw itself as lagging behind other EU countries.
• The report on inequalities in health in Lithuania caused
local regions to question why they diverged from their
neighbours.
• Very unfavourable trends in life expectancy and NCD
mortality among the middle-aged were decisive in mobilizing
Hungarian politicians to take policy action.
Conversely, comparatively good mortality rates in France
and until recently in Greece may have led to a degree of
complacency.
The issue is not only that of securing reliable information
but of presenting it in such a way as to be meaningful to
policy-makers. Analysis of mortality and morbidity data and
discussion of their possible causes and implications for the
economy and quality of life can be important in influencing
the policy process. In some countries in Europe, public
health reports are still presented in the traditional form of
lengthy statistical tables and cover only a limited number of
topics. In others, such as the study countries Finland, France
and Lithuania, but also in other countries such as Denmark
and the United Kingdom, for example, the form and
content of public health reports has changed quite radically
Reflections on experiences