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

example, improving health literacy or developing valuable
guidelines.
The latest public health policy in the Netherlands referred
to above, which focuses entirely on the risks to NCD, sets
quantified targets related to smoking, alcohol, overweight
(exercise and nutrition), diabetes and depression. Some set
a specific level to be reached, for example, “in 2010 only 20
percent should be smokers” while others point to a desired
trend, for example, “the percentage of overweight adults
should not rise” (19).
The Lithuanian Health Programme highlights quantified
targets relating both to overall health and to NCD, including
CVD, cancer, mental health and diabetes, and related
lifestyle issues such as tobacco use, alcohol consumption,
nutrition and physical activity. Finland, although originally
preferring policy statements indicating the direction in
which it wanted to go rather than specific, quantified
targets, now sets quantified targets relating to NCD. One
of the reasons given for this change of heart was that, with
a decentralization of the policy development process, it
became feasible to set targets for the local level. Ireland has
a very strong focus on target setting.
There is clearly a need for balance in setting more-or-less
quantified targets. More targets indicate the broad nature
of the NCD challenges, but fewer are probably more easily
manageable. While considering annual action plans for the
implementation of the Hungarian Public Health Programme,
it has been repeatedly stated that fewer targets would be
more easily managed. A similar position was reached in
New Zealand, where health targets have recently been introduced
for 2007/2008, half of which relate to NCD. Their
comparison of this recent attempt to utilize targets as a tool
for policy development, compared to previous efforts, is
interesting for our purposes. Only a small number of targets
are set, “reflecting the need to focus on a manageable number
of priority areas” (22).
Only a few countries (including Finland and the United Kingdom)
have set explicit, quantified targets for the reduction
of inequalities in health. Sweden’s national strategy for public
health, referred to earlier, also sets targets relating to the social
determinants of health, such as those related to reducing
poverty and creating a satisfactory physical environment.
In recent years, there has been a general renewal of interest
in setting quantified targets, partly encouraged by the
EU (where targets are set and monitored, for example, for
the NAPs) and by the funding agencies in countries where
external financial support is requested. A number of public
health experts also encourage this approach (23).
Legitimization
The way in which policies are legitimized depends on the
cultural, political and legal framework in a specific country.
NCD policies require collaboration across sectors, and
must be sustained over the long term if their aims are to be
achieved. It is particularly important, therefore, that legitimization
comes from as high a level as possible to ensure
the necessary degree of status, stability, sustainability and
harmonization of action.
Parliament constitutes the highest level of legitimization, and
certain NCD policies are enshrined in legislation. In many
countries, however, a formal and binding form of law is not
considered appropriate, particularly for a broad, intersectoral
NCD policy. Finland and Lithuania, for example, have
the tradition of a less formal discussion and approval by
parliament. Parliament is a naturally intersectoral body and
discussion at this level should also help improve understanding
of the need for collaboration across sectors.
The role of the parliamentary health committee or its
equivalent is particularly strong in countries such as Hungary
and Lithuania. The specific case of the Parliamentary
Commission set up in Sweden has been referred to above.
Whatever form it takes, the close involvement of Parliament
Chapter 5
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Reflections on experiences