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

Policy formulation
This section discusses the information and evidence on
which policy formulation is based, the key players, the
mechanisms and processes employed, and the tasks undertaken.
Information for policy formulation
In the countries studied, in addition to the so-called “hard”
data on epidemiology and health resources, we were able
to draw on the expertise and experience of those involved
in the process, political directions from policy-makers, information
from international organizations and other countries
and, in some cases, other “soft” information on attitudes
and opinions.
Epidemiological data
As could be expected, basic epidemiological data constituted
an essential input to policy formulation in all case-study
countries, although there was wide variation found in its
availability. Given the short time frame frequently imposed
by politicians, this was based mainly on the gathering and
processing of existing knowledge and less frequently on
new research.
Mortality data according to international classification are
available across Europe and can frequently be disaggregated
by age, gender and geographical area (even, in some
countries, reaching down to postal districts or political
constituencies. Much of the basic data in Finland can be
linked to a personal identity number and it is even possible
to link different databases, allowing for extremely sophisticated
analysis. Regional differences are frequently referred
to in the policies of countries where equality in health is
high on the agenda, though gender differences seem to be
given less attention. In other countries, such as Albania and
Kyrgyzstan, concerns remain over the validity of even basic
mortality data; there are considerable deficiencies in the
information system, and data collected by different institutions
are not always consistent or comparable.
Information on NCD morbidity is less complete. There is a
degree of fragmentation and a lack of standardization, and
surveys are often carried out on restricted populations,
sometimes without systematic statistical sampling. The
result is that clear trends in the prevalence and incidence of
NCD at population level cannot be described.
Finland, Lithuania and, more recently, Ireland have carried
out regular surveys on lifestyles and behaviour for many
years and are able to utilize information on long-term
trends for policy purposes. On the whole, however, WHO
surveys indicate that such information is less widespread
than mortality data, particularly in relation to socioeconomic
characteristics. In all of the countries examined, there are
some data on CVD risk factors and partially on those for
cancer. At least smoking prevalence, cholesterol and blood
pressure levels and body mass index are observed in most
of the countries in a more-or-less systematic way, though
not always at national level and sometimes reported rather
than actually measured. Information on alcohol consumption
is less satisfactory. In practically all observed countries
there is a fair description of nutrition based on household
statistics, food balance sheets and commercial data. Information
on physical activity, which is less easy to observe,
is more superficial. Much of the information collected is
limited to leisure-time physical activity, failing to reflect the
enormous impact on physical activity of changes in the
workplace, transportation and urban planning. Albania,
Greece and Kyrgyzstan are particularly short on such data.
The role of the WHO was crucial in standardizing data in
Finland and Lithuania, for example, in the initial stages of
tackling NCD. Together with that of the EU, WHO’s role
is still vital, particularly in countries with less sophisticated
information systems. The CINDI programme and MONICA
Project have been particularly influential in the participating
countries, ensuring the production of regular, systematic
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Reflections on experiences