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

Chapter 5
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• The process of setting targets requires an assessment of
the present situation and expected future trends, on as
scientific a basis as possible.
• Monitoring the targets offers an excellent learning
ex perience through the discussion of what had been
hoped for, how far this was achieved and why.
• Targets provide a powerful communication tool.
• Targets indicate to potential partners what must happen,
and what their role might be in making this happen.
• Targets can provide a rallying call for groups at the
grassroots level to demand action.
• Targets can be an excellent tool for strengthening accountability
for health (which is one reason why some
groups would like to avoid them).
• Certain targets can provide a reference point for assessing
the advisability of day-to-day actions.
• Involving people in the process of setting targets raises
awareness and can be the first step in implementing
health policy.
The main reasons deterring some countries from setting
quantified targets in the past have been (18):
• the difficulty in providing scientifically credible evidence
for some important targets;
• the reluctance of politicians and health professionals
to set targets for which they will be held accountable,
especially in areas in which they have little or no influence;
and
• the danger of appearing to give priority to issues for
which targets can be easily quantified, when other issues
that are less easy to quantify might be considered
equally or even more important.
Also, in central and eastern European countries, there may
exist an aversion created by the previous system of planning
by targets.
It has been suggested that targets have been used for three
main reasons: inspirational use at the political level, managerial
use at the policy level and technical use at the practical
level (20). The review of health policies in Europe carried
out in preparation for the 1994 Ministerial Health Policy
Conference indicated the use of different types of target
(18):
• outcome (or primary) targets, such as reducing infant
mortality by 15% during the planning period;
• intermediate targets that must be reached in order to
achieve the primary targets, relating to:
– health conditions or symptoms
– exposure to risks or hazards
– behaviour;
• input and output targets relating to resources and services
that must be available to achieve primary and/or
intermediate targets;
• process or action targets, such as involving other sectors
in public health, establishing appropriate infrastructures
for delivery or developing guidelines or standards; and
• targets relating to equity in health through socioeconomic
determinants of health.
More recently, in the work carried out prior to the latest
revision of the WHO European Health for All policy, an
analysis of the targets in 40 national Health for All policies
indicated that three appear in three quarters of the policies:
“improving mental health”, healthier living”, and “reducing
harm from alcohol, drugs and tobacco” (21), all of which
relate to NCD.
There is a danger in considering only those outcome targets
for which epidemiological data are available for their
measurement. Many outcome targets need a considerable
period of time for their achievement and, although progress
may appear slow, in the mean time there may have
been success in achieving intermediate targets such as, for
Reflections on experiences