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

Chapter 5
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The impact of international networks and
organizations
Involvement in international networks has obviously had
a strong impact in some of the countries studied. Those
countries participating in the MONICA Project and CINDI
programme not only have a strong history of monitoring
and evaluation but, partly through their involvement
in these projects, continually improve the capacity of their
expert teams. Reporting back to WHO, and more recently
to the EU, also improves these processes and contributes
to greater comparability of international data. Finally in this
respect, Finland and Lithuania are closely involved in monitoring
and evaluation through the Nordic and Baltic groups
of countries, providing them with interesting examples for
comparison of progress being made.
In countries with a heavy dependence on external funding
(EU and the World Bank), the donor or funding agencies
require mandatory monitoring, particularly of financial
resources used but also of progress in achieving aims and
objectives. In EU countries such as Greece, for example,
where NCD policy development is still at an early stage,
reporting back on health components of EU regional or
structural funding, which is perforce regularly carried out,
could gradually improve the overall monitoring and evaluation
culture.
HIA
One of the tools or approaches for strengthening the
evaluation process is that of HIA (also known under other
names in Finland and Ireland. HIA is, however, a tool for
assessing policies outside the health sector that were not
originally designed to have an impact on health. Its effect on
the NCD policy process must therefore be rather indirect.
The introduction of the tool, the improvement of the HIA
methodology and the training of HIA practitioners can at
the least encourage HIA thinking, as seen from the efforts
of the Institute of Public Health in Ireland, for example (29).
The development of the method also holds promise from
the perspective of flagging up areas of interest for future
NCD policy. Recent research, for example, indicates that
the modern knowledge economy may be damaging its
“mental capital” as workers are pressured to be ever more
productive (30).
Although it is suggested that HIA should be concerned not
only with the aggregate impact of a policy on health but
also with the distribution of its impact on different social
groups (31), this was rarely seen among the countries studied
or in Europe in general.
Peer review
Finally, Finland presents a special case of using reviews by
external experts to evaluate progress, not only of its Health
for All and health promotion policies but also of research
institutions that support the policy process. These reviews
were carried out with absolutely no restrictions on the
material to be examined and the questions to be asked.
Such openness naturally requires a particular culture, but
the results of such endeavours appear to have been well
worth the effort (32). The regular external policy reviews
carried out by OECD in the educational, environmental and
economic sectors, for example, have been considered for
many years to have been of considerable value, both to the
countries being reviewed and to those participating in the
review process.
Policy revision
In countries where there has been long-term sustainability
of NCD policy development, such as Finland, Ireland and
Lithuania (and France in relation to issue-specific policies
for cancer and nutrition), monitoring and evaluation leads
to policy revision. Such revisions can be differentiated on
the basis of whether the revision is carried out by the
same government or minister responsible for the previous
document or whether it is carried out by newly appointed
politicians who might be more critical of the work of their
predecessors.
Reflections on experiences