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

arguments for applying an integrated approach. The gains
from a managerial point of view are also important.
The most decisive argument in favour of an integrated
approach is the ample scientific evidence on the common
social and economic determinants of NCD (including
lifestyle factors). Further, in many cases these determinants
have an important influence on inequalities in NCD, so that
vulnerable social groups are also at risk for NCD.
This rationale related to health and inequality in health is
in itself a sufficient argument for the use of coherent policy
tools and an integrated approach. WHO Strategic Objective
No. 7 (34) seeks to address the underlying social and
economic determinants of health through policies and
programmes that enhance health equity and integrate approaches
that take into account poverty, gender aspects
and human rights. In this respect, the European NCD
Strategy (1) is part and parcel of overall policies to promote
social justice and inclusion and to reduce health inequalities.
It is difficult to define criteria for assessing whether NCD
policy integration has been achieved and to what extent.
Although countries have not formally articulated all the
principles of an integrated NCD policy at national level,
the absence of a formal national policy statement does not
necessarily mean that no attempt at integration is being
made. The process and elements of at least some degree of
coordination are observable in all the case-study countries.
Furthermore, given the stage of NCD policy development
in some countries in the sample, and the study’s focus on
process, it was possible to consider NCD policy integration
more fully at the early stages of policy-making. Thus more
focus on coordinated or integrated inputs and associated
processes than on outcomes could be observed, including in
a few cases examples of common objectives or targets.
It is possible that national Health for All-type policies,
long-term public health strategies and even national heart
health and cancer programmes could be key drivers in the
integration process. In the light of our results, however, such
broad umbrella policies are far from being a guarantee of a
better-integrated NCD policy process.
The countries where broad health policies have been
implemented and sustained, in some cases over many years,
are those characterized by a high quality of information and
expertise, participation in international level programmes,
and a culture of consensus building. The sustainability of
such efforts has apparently created long-term awareness
of NCD challenges and facilitated the potential for crosssectoral
working to tackle them.
On the other hand, policies focusing on relatively simple,
discrete issues seem to have had a higher potential for
achieving their aims than broader policies addressing
complex issues. In some countries, individual risk-factor
approaches have proved highly successful, mainly in the field
of smoking and nutrition and less so concerning alcohol use
and physical activity.
Arguments in favour of developing issue-specific policies
include:
• the issue may be more clearly defined and understood,
including links between cause and effect;
• measures for tackling the issue, as in the case of smoking,
may have been tried and tested;
• the number of potential stakeholders is reasonably
manageable; and
• such issues are frequently supported by strong lobby
groups.
The disadvantage is that there appears to be considerable
overlap and wastage between some of these vertical policies.
Their lobby groups compete for resources and those
with the loudest voices – not necessarily those with the
Chapter 5
247
Reflections on experiences