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

• the extent of the health problem as a major cause of
mortality or morbidity;
• the scope for improvement through effective and acceptable
intervention;
• public and professional opinion of whether the health
problem is a major concern;
• whether progress towards achieving the targets can be
measured through available data or data that can be
easily collected, and whether reliable indicators exist to
monitor progress;
• whether solving a health problem would reduce inequity
in health; and
• other constraints imposed by policy or societal characteristics,
including cost constraints (for example,
substantial sick leave).
The following is an example from a public health policy
from the Netherlands published in 2007, which refers also
to possible social consequences (19).
“These main problems have been selected on the basis
of the following criteria.
• They present sizeable health problems, with significant
(future) social consequences for the use
of medical facilities and employment, for which a
healthy lifestyle can (partially) affect the cause, and
for which suitable (cost) effective interventions are
available to prevent or reduce the health problem.
• These interventions are not yet being implemented
on a wide scale, and where the central government
and local authorities can play a role in tackling the
health problem.”
From the information available, it appears that priorities are
frequently set on a rather narrower basis than the above.
Topic-based epidemiological data dominate the initial analysis,
and priorities are then set according to whether action
should be taken through the settings approach or according
to lifestyles and the life-cycle. Those living in poverty are of
concern in many countries, as are particular social groups in
some countries, such as the Roma in Hungary and Travellers
in Ireland. Although the EU countries in particular link
health and development through policies to tackle poverty
and regional development, specific objectives and targets
linking health and development policies are not always clear.
Although discussion regarding the selection of objectives
deals with policy options at one level, there is little evidence
of consideration of policy options to achieve the selected
objectives. Finland is apparently one exception: in reply to
the question of how long-term civil servants interact effectively
with politicians of different parties, the reply was that
the usual practice when politicians outline their objectives
is for civil servants to offer two or three options, indicating
the possible implications of each.
Finally, even when taking an intersectoral approach, practically
all the policy documents examined see this from the
perspective of other sectors contributing to the achievement
of health objectives. There is almost no consideration
of how the health sector might contribute to meeting the
objectives of other sectors.
Target setting
With the setting of 38 targets for Europe through the
Health for All policy and its subsequent revisions, a number
of countries basically adopted the European targets
in formulating umbrella policies, including those related to
tackling NCD, rather than setting their own targets as had
been intended. Other countries, including Finland at first,
were not comfortable with setting quantified targets.
Health21 sets out the main arguments for setting targets
(11).
Chapter 5
233
Reflections on experiences