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

In countries where the process has only recently started, a
second generation of leading experts can be identified, initiating
the NCD policy process both in technical and political
terms. This is true for Albania and Kyrgyzstan.
There is no example of isolated, successful prime movers.
In all countries where we have identified such people, as in
Finland, Hungary, Ireland and Lithuania, they were part of a
team of experts characterized by close, friendly working relationships.
In some countries, professional and institutional
rivalries may have hindered the process, or emerging prime
movers lost their influence with a change of government.
Other key experts played an initiating role as consultants
for international organizations such as WHO and the
World Bank, facilitating and pushing NCD policy development
in the Balkan countries and in the countries emerging
from the former USSR.
Obviously, “key players” cannot be produced at will but
certain factors seem to have encouraged their emergence
and impact, including:
• sufficient stability within public administration when
governments change, encouraging strong commitment
and accumulative capacity building;
• close links between academia and the bureaucracy; and
• strong links to international networks.
The right person in the right place at the right time can
make a difference. The public health expert in Hungary,
who was elected member of Parliament and quickly proposed
the drawing up of a new public health strategy, is
such an example.
Advocacy groups
NGOs clearly play an influential role in raising awareness
(and in policy formulation), particularly in the case of specific
diseases or risk factors. Countries such as Finland, France
and Ireland have a very long history of extremely active
NGOs in the health field, with prestigious, long-standing
and wealthy NGOs having a substantial influence on cancer
prevention and heart health at national level. In France, the
League Against Cancer founded in the 1920s has had a considerable
international impact on cancer prevention policies.
In Ireland, the National Heart Health Alliance, representing
about 40 NGOs, has an influential role on the governmental
NCD prevention policy. Many of the Finnish NGOs are
headed by top experts and are regularly consulted by the
public sector. Greece offers a characteristic example of the
determining role of a nutritionist society and a prime mover
pushing for nutrition policy in the country.
In central and eastern European countries, health-related
NGOs have considerably increased in number in recent
years and are making their voices heard. In Albania, the
NGO “For a tobacco-free Albania” played a prominent
role in bringing the need for tobacco control into the public
domain, and its representatives play a leading role in reporting
on the implementation of the tobacco control law and
raising awareness about the issue.
Most of the NGOs referred to in the case studies focus on
specific NCD or risk factors, and frequently compete to be
heard and to promote “their” area of concern. Such issuespecific
NGOs are less prepared to promote broad NCD
policy issues. There are, however, a number of broaderbased
NGOs, such as associations of public health experts,
who may have an important role even in the initiation of an
umbrella policy, as in Finland and Hungary. In Lithuania, the
Medical Association developed the first “National Health
Concept “ and a recently established Public Health Association
offers general support to health policy development
The media
The important role of the media in the initial phase of
the policy cycle is clearly demonstrated in the case of the
North Karelia project in Finland. Positive media interest
Chapter 5
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Reflections on experiences