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

Capacity mapping
The policy formulation process requires not only an analysis
of the health status of the population but also of capacities
for policy implementation and the potential for cooperation
and synergy, including potential relationships with other
existing policies. Little assessment of feasibility, capacities or
assets is evident among the sample countries: even in those
countries with the richest knowledge base for policy formulation,
capacity mapping is one of the weakest areas.
This is in accordance with the findings of a WHO project to
map capacities in European countries (7), which concluded
that “the connections between policies in other sectors and
their impacts on health are not well understood and implemented.
Possible assets for policy implementation outside
the health sector are rarely referred to, which is perhaps
to be expected given the relatively recent inclusion of the
social determinants of health in the policy formulation process.
However, this does seem to be slowly changing with
the influence of EU membership and other international
support programmes”. A point worth noting in this respect
is that countries requesting support from international funding
agencies for policy implementation are usually required
to indicate available resources.
Utilizing “softer” information
There was little evidence of the use of information on the
feasibility and acceptability of taking action, including the
position and opinions of stakeholders and potential partners,
in most of the countries studied. Ireland is notable,
however, for having made considerable efforts to elicit the
views of stakeholders. In Hungary, the role of such “softer”
knowledge in the policy-making process, and the need to
balance “soft” knowledge and “hard” epidemiological data,
has been explicitly discussed in recent years.
Information technology and organizing the database
The case studies offer numerable examples of new information
technologies and communication tools being developed
and utilized for policy development. This is further encouraged
by the availability of considerable EU funding for such
projects. Naturally, there is a huge potential for strengthening
the information base for policy development through
the creation of integrated databases and of clearing houses
offering examples of policies, guidelines and best practice.
One major restriction, however, is the frequent lack of longterm
funding for the institutionalization of such databases.
The WHO Regional Office for Europe organized a technical
meeting on the use of national databases in decision-making
(8), which concluded that most countries have some problems
with date sources and that they should:
• try to ensure a legislative basis for data exchange; and
• make greater efforts to have a comprehensive database
with a variety of data normally used by decision-makers.
Some of the reasons for not using evidence-based information
are relevant for NCD policy-making and were reflected
in some of the case studies:
• frequent changes and lack of continuity of staff at
ministries of health, lack of collaboration between data
producers resulting in duplication and errors, and lack of
collaboration across ministries;
• inappropriate presentation, as expressed by the wrong
level of disaggregation (too detailed), uninformative
statistical tables, or a lack of the time, resources or motivation
to issue information in a digestible format;
• data not available when needed;
• users not trained to find and use data or data not userfriendly;
• failure to actively disseminate and advertise available
information;
• no agreement on priorities or how to prioritize; and
• communication difficulties between producers and
users.
Chapter 5
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Reflections on experiences