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

Chapter 3
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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