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

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On the whole, “revised” policy documents give less weight to analysing the NCD situation, since this has probably not changed significantly. Particularly if this is a ”same party” revision, there is perhaps a tendency to overemphasize the positive results in self-justification of the original policy and minimizing possible weaknesses and failures, although there are refreshing examples of a critical approach. Since the revised policy is the next step in a longer-term process, the need to clearly identify the challenges ahead can be one way of ensuring that there is some critical analysis of what might have gone wrong the first time around. The revision process is frequently handicapped by a lack of evaluation of the effectiveness of policy measures. From the examples examined, it tends to be largely limited to changes in epidemiological data, without a serious attempt being made to disentangle the real causes of the changes. In most cases of policy revision, there is little change in the underlying values, which are frequently reiterated. New or additional objectives may be listed and reference is usually made to related actions in the field of interest carried out in the previous planning period, such as new steps in antitobacco legislation or nutrition programmes in schools. Discussion This chapter has reviewed the findings of the eight case studies and relevant literature, drawing together the key points emerging from the cross-analysis for each stage of the policy cycle. While recognizing that this is not a statistically representative sample of European countries, nevertheless certain themes emerge that may be useful for broadening understanding of the policy-making process for the prevention and control of NCD and the conditions that influence it. From the work carried out, it appeared that the most frequently asked questions related to the implementation of a policy process along the lines of the European NCD Strategy (1) are the following. • What is an NCD policy in reality? • Is an overall, integrated NCD policy necessary? • Are there certain basic prerequisites for the successful development of NCD policy? What is an NCD policy in reality? As stated in the Introduction, NCD policy needs to address a set of conditions that includes CVD, cancer, mental heath problems, diabetes mellitus, chronic respiratory diseases and musculoskeletal conditions. This broad group is linked by common risk factors, underlying determinants and opportunities for intervention. Although the study touched on overall approaches to tackling NCD, particular attention was paid to explicit (and thus documented) formal decisions by an executive agency to solve challenges related to NCD. These decisions were reflected in policy documents establishing of a set of goals and objectives, the priorities between them and, in many cases, quantified targets to be met within a specific timeframe, and outlined the deployment of specific resources for their achievement. For such goals, objectives and targets to be translated into operational form, countries defined various “interventions” or “policy instruments”. A policy to tackle NCD is not therefore simply an “intervention”, but a higher and more complex arrangement that defines and orders sets of interventions. None of the countries studied was found to have a national-level policy specifically designed to tackle NCD in an integrated way. Although there were examples, in some cases reiterated over a number of years, of broad Health for All-type policies or other public health strategies, none of these countries with such a broad “umbrella” policy had clearly linked sub-policies for NCD originating from it. Instead, countries did have a large variety of different types Chapter 5 245 Reflections on experiences
Chapter 5 246 and levels of policies and strategies tackling NCD in moreor-less explicit ways, with a limited degree of coordination between the various elements. In some cases, certain NCD policy objectives were included in public health policies with a wider remit. In other cases, countries had separate policies to tackle individual diseases or various risk factors for NCD. In practice, from the countries studied, NCD policy development is a process based on existing policy development experiences and structures and is less a question of putting the NCD label on new processes. Throughout Europe, there appears to be a rich array of approaches to tackle different elements of NCD prevention and care and health promotion. The formalized policy framework for this type of action is either linked in some way to a broader health policy document or packaged in different ways (e.g. heart health programmes). In many ways, this fits with the findings of the WHO survey (33) that approximately 75% of the 38 European countries responding (which included all 8 case-study countries) said that they had an NCD strategy, even though none of them had a single document of that name. Rather, countries appeared to have policy “packages” that collectively responded to the challenge of NCD. This leads to the next question. Is an overall, integrated NCD policy necessary? In considering this question, it is important to distinguish between “coordination” and “integration”. Coordination is concerned with bringing actions of equal rank or order of importance into harmony in order to ensure greater effectiveness. Integration is concerned with combining such actions into a unified form to meet a common objective. Generally speaking, policy integration is the process of attaining close and seamless coordination among several policy elements or systems. An integrated NCD policy should be more than the sum of separate policy elements. Policy issues to tackle NCD are increasingly cross-cutting, and policy integration has therefore become an attractive concept. Good governance of health systems focuses on the interdependence of different policy fields, while integration contributes to identifying synergies and trade-offs. NCD policy integration is certainly not a trivial process. It is concerned with the progressive linking and testing of policy components to merge their functional and technical characteristics into a comprehensive system. The process includes the strategic alignment of different NCD-related programme resources to increase the effectiveness and efficiency of each activity in a partnership without compromising the integrity of separate NCD programme objectives, or at least to minimize contradictions between overall NCD policy aims and different specific programme activities. For the different actors in NCD policy development, integration also means: • building on common interests • finding points of linkage • eliciting resources. Consequently, the process of integration includes not only appropriate procedural and organizational changes in policymaking but also a wide range of practical efforts such as: • common information systems • NCD coalitions • joint planning and priority-setting activities • joint project implementation • shared or combined funds • joint training • common media messages. Thus, from the perspective of good governance of health systems and intersectoral cooperation, there are decisive Reflections on experiences
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Gaining Health Analysis of policy d
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Abstract There is no greater threat
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Abbreviations The abbreviations sho
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vi Preface The WHO European Strateg
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Contributors Jill L. Farrington was
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Chapter 1 2 the European Region, sh
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Chapter 2 History and context of po
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tions and strategies to achieve the
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• Of the countries responding in
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Washington, D.C., US Government Pri
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Chapter 3 14 co-funded by the Publi
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Chapter 3 16 determine policy outco
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Chapter 3 18 • policies for older
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Chapter 3 20 developing methodologi
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Chapter 3 22 References 1. Gaining
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Appendix 1 Key informants interview
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Chapter 4 26 Albania Péter Makara
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Chapter 4 28 The strategy was final
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Chapter 4 30 for these organization
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Chapter 4 32 The directorates are a
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Chapter 4 34 etc. will continue to
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Chapter 4 36 thinking is still domi
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Chapter 4 38 Finland Anna Ritsataki
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Chapter 4 40 Both the state and the
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Chapter 4 42 2.1. Broad policy for
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Chapter 4 44 • the principle of u
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Chapter 4 46 Broad use is made of
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Chapter 4 48 MSAH prepares for appr
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Chapter 4 50 private donation. Ther
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Chapter 4 52 2.4.4. National demons
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Chapter 4 54 been the case at the E
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Chapter 4 56 materials or to check
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Chapter 4 58 The employer, in both
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Chapter 4 60 2.8. Broad intersector
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Chapter 4 62 was medically and econ
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Chapter 4 64 adequate, whereas that
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Chapter 4 66 planning philosophy an
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Chapter 4 68 any meaningful attack
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Chapter 4 70 In the overall improve
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Chapter 4 72 15. Strategies for soc
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62. International evaluation of the
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Chapter 4 76 The low cardiovascular
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Chapter 4 78 A characteristic featu
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Chapter 4 80 • cancer • CVD •
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Chapter 4 82 INPES carry out data c
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Chapter 4 84 the fight against canc
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Chapter 4 86 published in early 200
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Chapter 4 88 information was not su
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Chapter 4 90 intoxication, improves
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Chapter 4 92 research (see section
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Chapter 4 94 on public health repre
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Chapter 4 96 groups and the health
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Chapter 4 98 19. Chauliac M. Progra
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Chapter 4 100 recent years, Greece
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Chapter 4 102 the wake of political
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Chapter 4 104 telecommunications, h
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Chapter 4 106 2.3.3. Setting the ag
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Chapter 4 108 They were asked to se
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Chapter 4 110 been responsible for
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Chapter 4 112 companies. Neverthele
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Chapter 4 114 comparative analysis
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Chapter 4 116 an important effect o
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Chapter 4 118 2.8. Policies for spe
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Chapter 4 120 public health service
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Chapter 4 122 in defining inequalit
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Chapter 4 124 5.3. From awareness b
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Chapter 4 126 15. Draft Development
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Chapter 4 128 Hungary Péter Makara
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Chapter 4 130 The main functions of
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Chapter 4 132 management at an appr
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Chapter 4 134 The Public Health Pro
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Chapter 4 136 • tobacco control
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Chapter 4 138 • positive changes
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Chapter 4 140 Finally, a Platform f
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Chapter 4 142 • health care and g
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Chapter 4 144 to be sharp. The prop
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Chapter 4 146 able reasons, the Min
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Chapter 4 148 2. Kopp M, Réthelyi
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Chapter 4 150 1.3. The main feature
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Chapter 4 152 from outside the DoHC
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Chapter 4 154 to incorporate an exp
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Chapter 4 156 In 2004, there was an
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Chapter 4 158 ing socioeconomic var
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Chapter 4 160 The strategy is seen
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Chapter 4 162 2.5.2. Nutrition Some
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Chapter 4 164 The national lifestyl
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Chapter 4 166 A first policy for ol
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Chapter 4 168 In addition, many of
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Chapter 4 170 The strategy calls fo
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Chapter 4 172 tional policies. At t
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Chapter 4 174 the office of the Pri
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Chapter 4 176 28. Towards a tobacco
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Chapter 4 178 Kyrgyzstan Péter Mak
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Chapter 4 180 In the case of Kyrgyz
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Chapter 4 182 The active involvemen
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Chapter 4 184 disease prevention at
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Chapter 4 186 The existing, often f
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Chapter 4 188 ment. One part of the
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Chapter 4 190 fell rapidly from 199
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Chapter 4 192 the health field were
Page 203 and 204: Chapter 4 194 An attempt was made t
Page 205 and 206: Chapter 4 196 iour of schoolchildre
Page 207 and 208: Chapter 4 198 Lithuania reports reg
Page 209 and 210: Chapter 4 200 risk factors have bee
Page 211 and 212: Chapter 4 202 closer state control
Page 213 and 214: Chapter 4 204 of industrial disease
Page 215 and 216: Chapter 4 206 ensure that in the lo
Page 217 and 218: Chapter 4 208 in order to deal with
Page 219 and 220: Chapter 4 210 added weight of being
Page 221 and 222: Chapter 4 212 2. World development
Page 224 and 225: Chapter 5 Reflections on experience
Page 226 and 227: whether lifestyles can be affected
Page 228 and 229: over the years. In these countries,
Page 230 and 231: In countries where the process has
Page 232 and 233: Policy formulation This section dis
Page 234 and 235: Capacity mapping The policy formula
Page 236 and 237: during policy formulation. Naturall
Page 238 and 239: civil servants have a degree of per
Page 240 and 241: It can be quite a challenge for the
Page 242 and 243: • the extent of the health proble
Page 244 and 245: example, improving health literacy
Page 246 and 247: The policy content The content of s
Page 248 and 249: With the possible exception of Finl
Page 250 and 251: tation, and an important investment
Page 252 and 253: We would add that more use needs to
Page 256 and 257: arguments for applying an integrate
Page 258 and 259: the most appropriate prerequisites
Page 260: (http://www.euro.who.int/document/e
Page 263 and 264: Chapter 6 254 As premature deaths f
Page 265 and 266: Chapter 6 256 goods”, including f
Page 267 and 268: Chapter 6 258 be conflicting, and t
Page 269 and 270: Chapter 6 260 effectiveness of inte
Page 271 and 272: Chapter 6 262 • Examining the cos
Page 273 and 274: Chapter 6 264 ments/ev_060302_rd06_
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