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

Chapter 3
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determine policy outcomes, but a highly political process in
which power and interest are the main driving forces”.
Partly because of the non-linearity of real life, and of issues
that cut across all stages of the process, some of the stages
of the policy cycle were merged so as to avoid repetition
when presenting the findings of the case studies.
Types of policy for tackling NCD
The European NCD Strategy (1) defines NCD as:
a group of conditions that includes cardiovascular disease,
cancer, mental health problems, diabetes mellitus, chronic
respiratory disease and musculoskeletal conditions. This
broad group is linked by common risk factors, underlying
determinants and opportunities for intervention.
The focus of the European NCD Strategy, and consequently
of the case studies, was therefore on how countries tackle
these diseases, excluding other noncommunicable conditions
such as accidents.
The results of the WHO survey (2) indicated that European
countries tackle NCD through a wide range of policies,
implemented at different levels of authority and in different
settings. These include:
• broad or “umbrella” health policies
• public health and health promotion policies
• health services policies
• issue-specific policies (dealing with specific diseases or
health risks)
• levels and settings of policy development
• general policies with a health component.
It was clear, therefore, that the case studies would need to
examine this wide range of policies. To ensure a common
understanding of terms used and the different types of
policy of concern, these are briefly described below. Broad
or “umbrella”-type policies could be found under different
headings in different countries, including policies for health
for all, public health, health promotion, health systems
or health care. They were variously labelled as policies,
programmes, plans, strategies or resolutions, according to
the usual usage in the country (and the translation from the
original language version). These “categories” are frequently
overlapping or blurred. “Umbrella”-type policies may be
formulated at national, regional or city levels.
Since the adoption in the mid-1980s of the WHO European
Health for All targets (8), many countries have developed
their own Health for All policies at national, regional and/or
city levels. A Health for All policy is defined as one “based
on principles of equity and democratic participation in decision-making.
It deals with issues of lifestyles, environment
and health care” (9). Thus a Health for All policy is perhaps
the broadest type of health policy and, most importantly, is
based on explicit values or, as expressed in the 2005 update
of the WHO European Health for All policy (10), is “valuesbased,
values-driven”.
In the context of the 2005 update, 52 national health policies
were analysed according to four criteria (10):
• the policy commits itself to the goal of Health for All in
a document;
• it introduces a multisectoral perspective;
• it is explicitly values-oriented; and
• it includes health targets.
Forty policies satisfied all four criteria.
It can be difficult to distinguish between “public health” and
“health promotion” policies, and in practice it is frequently a
question of labelling in a particular country. Over the years,
the focus of public health has expanded from what might
be called issues of “hygiene” (mainly providing clean water,
sewage disposal and protection from communicable diseas-
Methodology, underlying concepts and values