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

Chapter 5
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was detected from the very beginning and lively public
debate followed the implementation of the project, ensuring
public attention at national level for CVD prevention.
Ireland presents an example of public awareness building,
whereby a broad national media campaign was launched for
the programme “Ireland needs a change of heart” with an
accompanying information pack and a handbook distributed
to all households. Intensive discussion in the media over a
number of months prepared the way for strong tobacco
control in that country. In Hungary, round table debates on
the causes of declining life expectancy preceded the formal
start of the policy planning process, and some of the prime
movers used the public television and daily newspapers for
political advocacy and to put pressure on decision-makers.
In France, advocacy through the media was an important
precursor to initiating major steps in alcohol policy. In Lithuania,
parliamentary discussions of emerging health challenges
are regularly broadcast over the national radio.
The media appear to have influenced public opinion substantially
regarding key topics such as nutrition, overweight
and smoking, particularly over the last decade. A high
proportion of articles in journals and newspapers deals with
such issues, and all countries use television spots to reach
the public. Not all media messages are in harmony with the
objectives of NCD policy, however. There is a danger of the
mass media oversimplifying and sensationalizing issues, with
the result that complex questions may be misrepresented
or that opponents such as the tobacco industry or certain
food producers, for example, may use the media to present
misleading information, as seen in Finland and Ireland.
Web sites have been developed very rapidly in recent
years, and in some countries offer considerable information
in an easily accessible form. The use of the Internet by NCD
self-help and support groups is very significant but excludes
those without access, possibly increasing health gaps. With
increasing use comes the need to protect users from unreliable
information, but this issue was not examined in the
study.
International players
In the field of NCD policy development, governments are
increasingly affected by international influences. The work
of international organizations offers important channels
for discussion of NCD policy issues, and agencies such as
WHO, the EU, the World Bank and to some extent the
Council of Europe act as pressure groups for particular
policy choices.
The initiation of NCD policy development processes in almost
all of the case studies was strongly related to contact
with international organizations. The role of WHO cooperation
was a determining factor in both Lithuania and Hungary,
and Finland made judicious use of WHO to legitimize
and at times revitalize the policy process. As compared to
the other observed countries, France and Greece demonstrate
a special case wherein the influence of international
factors has been much more limited.
More specifically, the role of the WHO Health for All policy
has been particularly important in influencing the underlying
values for NCD policy development, with reference still
being made in current policy documents to Health for All
values. Most recently, the WHO FCTC has been particularly
influential in the formulation of national tobacco control
policies.
International NGOs such as IUHPE, EuroHealthNet, the
European Public Health Association, the European Public
Health Alliance and the different professional associations in
the field of cancer and CVD have also played an outstanding
role in raising awareness, mainly among professionals,
and produced key guidance documents for policy-making.
Reflections on experiences