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

Chapter 6
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As premature deaths from NCD decline, morbidity can
be “compressed” to a later stage of life and degenerative
diseases may have longer to develop, potentially laying a
heavy burden on health and social services and on informal
carers. Raising awareness of the value of health promotion
and preventive measures among policy-makers and older
people themselves may be needed, as many may believe
they are too old to benefit by changing their lifestyle (3).
Problems such as alcohol abuse often go unrecognized and
the benefits of taking up exercise or giving up tobacco, even
late in life, may be unappreciated. NCD policy needs to be
tailored to an ageing society.
The health of children and the way in which they are nurtured
through adolescence into adulthood will affect the
prosperity and stability of countries over the coming decades
(4). Although children in the European Region today
benefit from better health development than ever before,
and infant and child mortality rates in some countries are
among the lowest in the world, there are striking health
inequalities both across and within countries. The basis for
good health is established even before conception. Healthrelated
behaviour such as smoking, alcohol abuse, physical
activity and eating patterns can become established from
an early age. The prevalence of depressive illness among
the young appears to be increasing, and this is often linked
to poor educational attainment, antisocial behaviour and
substance abuse.
In harmony with the European NCD Strategy (1), the
Regional Office’s strategy for child and adolescent health
(4) recognizes the need for taking a life-course approach
in tackling chronic disease and disability, by addressing the
health challenges at each stage of development. State structures
for formal education are in place in all countries, and
the school has been an important area for investment in
health promotion (5). Much greater advantage could doubtless
be made of this particular setting, and the necessary
links be made to other sectors. For example, EU regulations
concerning the use of surplus agricultural production are
being adapted to encourage children’s consumption of fruit
and vegetables in school (6).
In many countries, immigration is vital for population size,
the labour market and economic growth. While some
studies suggest that chronic diseases are less prevalent in
certain migrant groups, others demonstrate that some
immigrants may be at higher risk for certain NCD, particularly
hypertension, diabetes and certain forms of cancer
(7), depending on their country of origin or lack of inclusion.
In many EU Member States, most of the migrants are
on the periphery of the labour market with all the signs of
social exclusion and the difficulties of social adaptation and
integration. Among them, the prevalence of harmful habits
can be extremely high. Residency status, language, literacy
and cultural issues can prove further obstacles to accessing
care and preventive services. Attempts are being made
to improve the knowledge of migrants’ health status and
health determinants, to identify good practice related to
access to health services, and to contribute to the definition
of health policies and strategies aimed at improving
migrants’ integration.
“Obesity presents Europe with an unprecedented public
health challenge that has been underestimated, poorly assessed
and not fully accepted as a strategic governmental
problem with substantial economic implications” (8). Rates
of obesity are rising in virtually all parts of the Region, and
particularly alarming is the rise in childhood obesity. Body
fat accumulates when the energy content of the food consumed
exceeds energy expended. Both sides of the energy
balance are of concern, but less attention has been paid to
physical activity. Simultaneously, working and living environments
become “obesogenic”, increasingly discouraging
physical activity. Tackling obesity requires a broad intersectoral
approach.
Pointers to the future