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

the most appropriate prerequisites for health in given situations.
Nevertheless, the persistence and scale of inequalities
in health status that exist within European societies and
between the populations of high-, medium- and low-income
countries make it necessary to identify the components of
policy development that are critical to closing the health
gaps in Europe. There is also a need to identify standards
and indicators that can be used to improve practice.
Intersectoral action and collaboration with multiple actors
is the essence of NCD policy, but the interests of potential
partners do not always converge with those of NCD policy
implementation. The case studies presented here offer
examples of both converging and conflicting interests, but
there does not appear to be any comprehensive assessment
of the possible converging and conflicting interests of other
sectors in relation to NCD policy development. It could
be interesting to assess this, not only from the perspective
of the health sector but from the perspective of the other
sectors themselves.
Finally, despite the diversity of the specific national experiences,
differences in health systems and different patterns
of economic and social development, the study provides
examples of a range of criteria for the successful development
of NCD policy:
• clear values, which are particularly important in the
context of NCD policy development, namely universality,
solidarity, equity and participation;
• key principles of governance in public services of special
relevance for an integrated NCD policy, namely transparency,
participation, accountability, effectiveness, efficiency
and quality;
• a long-term, consensus-oriented and inclusive strategy,
responsive to emerging challenges and with special
regard to political legitimacy and sustainability;
• decision-making processes that are participatory and
transparent to all stakeholders and citizens;
• development of the necessary culture and capacities
for policy analysis, advocacy and intersectoral action for
health in public administration and in the research arena;
• NCD policy-making and planning informed by the best
knowledge available, including contributions from all
relevant disciplines and experience, and built-in mechanisms
for monitoring and evaluation based on clear
objectives;
• application of the NCD policy development principles
mentioned above to both the public and the private
sectors of the health system and to all levels of governance
(national, regional, local) following the principle
of subsidiarity, to ensure an optimal allocation of tasks
among the relevant levels.
“Business as usual” is simply not good enough in this
complex policy environment, particularly in view of new
responsibilities being decentralized to local levels. A number
of countries in this sample are making intensive efforts to
modernize government and prepare their civil servants for
working in a more innovative and flexible way to cope with
a rapidly changing world. The need for a modern planning
system is also apparent from the intersectoral approach
essential for tackling NCD. To put this simply, the health
sector must be able to bring about action in fields over
which it has little or no control. The question is whether
traditional policy-making and planning systems in the health
sector are appropriate for cross-sectoral planning. On the
other hand, a strong focus in some countries on addressing
poverty and social exclusion could open new avenues for
tackling the determinants of inequalities in NCD.
References
1. Gaining health: the European Strategy for the Prevention and
Control of Noncommunicable Diseases. Copenhagen, WHO
Regional Office for Europe, 2006 (http://www.euro.who.
int/document/E89306.pdf, accessed 11 June 2009).
Chapter 5
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Reflections on experiences