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

during policy formulation. Naturally, they tend to focus on
their own area of expertise and, in some cases, have played
a highly visible role in getting attention for NCD problems
through collaboration with the media. The focus of those
dealing with diseases rather than lifestyles and NCD risk
factors can lean more towards health care and medical
models of policy development rather than health promotion.
A small but eloquent elite group of NGOs, owing to their
strength and influence, sometimes dominates the debate or
is given a leading role by policy-makers. In Hungary, for example,
the Prime Minister commissioned competent NGOs
to prepare the first drafts of the heart health and cancer
programmes.
The general public often has less information on the health
situation and little input to the policy formulation process.
However, surveys such as the EU Eurobarometer and the
increasing use of opinion polls are bringing to the fore the
weight given by people in Europe to various health policy
issues.
Certain key players have had a decisive role throughout
the policy cycle in the countries studied. Particularly in the
smaller countries, they frequently play multiple roles as
advocates, leaders in the policy formulation process and
participants in monitoring and evaluation. Those who have
been in place for a number of years became a guarantee
of policy sustainability. Some have dominated the scene for
the last two decades, and their successors are not clearly
evident.
WHO and the EU have also played a vital role in stimulating
the development of health policies and strategies. Their
documents shape norms for the behaviour of national
governments by creating international expectations to
develop NCD policies. All international agencies in this field
have a strong concern for equity, and have gradually created
interest in tackling the social and economic determinants of
health. The EU funding systems, including programmes to
fight poverty and social exclusion, also stimulate the link of
health and development in the area of NCD policies. The
EU structural funds offer a unique and important funding
opportunity and create special interests. This is characteristic
for recent practices in Greece and Hungary, for example.
The role of international organizations can sometimes be
controversial, however. In the Balkan countries and the
countries emerging from the former USSR, the development
of a public health policy was negotiated as a condition
of a World Bank loan. In some cases, health policy documents
were actually written by international experts and
the resulting lack of ownership in the countries in question
meant that these strategies remained on the shelf. The
experience of Albania and Kyrgyzstan clearly shows both
the outstanding responsibility of international agencies in
low- and medium-income countries in shaping such policies
and the limits and pitfalls of such action.
Mechanisms and processes
Responsibility for the process
The main focus of this study was on national policies. In
the countries studied, requests for policy formulation came
through a presidential decree (as in Kyrgyzstan), from
parliament (as has frequently been the case in Hungary and
Lithuania), as a request from the prime minister (as in the
case of the Heart Health Programme in Hungary) or, more
frequently, through decisions by ministers of health.
A request emanating from parliament is naturally the
consequence of prior parliamentary discussion, or follows
the work of a parliamentary health committee. From the
countries examined, the involvement of parliament at an
early stage builds broader cross-party consensus, which in
turn is probably conducive to longer-term sustainability or
at least prevents NCD policy slipping completely from the
agenda. In Hungary and Lithuania, for example, the Parlia-
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Reflections on experiences