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

Alcohol abuse is a serious and not fully recognized challenge
for shaping policies tackling NCD. Alcohol is a significant
contributor to major conditions such as heart disease,
cancer and mental health problems, as well as injuries.
Alcohol is also the leading risk factor for both disability and
death among young people in Europe. Although a WHO
European regional framework and an EU strategy (mainly
emphasizing drinking among the young) are in place, alcohol
policy development is one of the weakest elements of European
health policy development. Policies to tackle alcohol
abuse require a high level of complexity and must face
deeply rooted historical habits, strong economic interests,
mixed messages and a limited number of successful policy
experiences.
The persistent challenge of inequalities in health
From ongoing research, it is clear that NCD and their risk
factors reflect, and contribute to, considerable inequalities.
A report from 2006 (9) indicates that, for 21 EU countries
with relevant data, mortality from CVD is higher among
those in lower socioeconomic positions, and smoking is also
likely to be a key factor. The same report states that, in 18
countries, national surveys showed that self-assessed health
was worse among those in the lower socioeconomic groups
and that these people frequently have poorer access to
necessary care.
The WHO Commission on Social Determinants of Health,
reporting in 2008, has gathered a huge body of evidence on
plausible causal relations; key areas in which action should
take place; and effective practices and interventions for
addressing socially determined health inequities (10). The
resulting work is accessible on the Internet (http://www.
who.int/social_determinants/en), offering examples of what
works.
Rethinking health care
There is now better understanding that equity in access to
care refers not only to the geographical distribution of services
but includes social, economic and cultural issues. The
focus is on “patient-centred care,” meaning that the patient
must clearly be seen to be part of the health care team.
NCD patients and their families are being given training in
coping with their disease, and “expert” patients are sharing
their experience with others, including health care professionals.
New technological developments may dramatically affect
NCD. The field of genetics already provides information
that can be used to determine both how diseases are
diagnosed and how new treatments or more specific drug
targets can be identified. Developments in pharmaceuticals
have shown success in treating hypertension and diabetes,
for example. Equality in access to such new developments
must be ensured for vulnerable social groups.
Some developments need new skills to ensure that a high
quality of care can be delivered to all. Developing capable,
motivated and supported health workers is essential to
achieving national health goals. WHO suggests a “working
lifespan” approach (11) encompassing: the stage when
people enter the health sector workforce, requiring investments
in education and recruitment; participation in the
workforce when worker performance should be enhanced
through better management; and reducing wasteful loss of
human resources when people leave.
Health services employ about 10% of the European workforce
(12) and human resources account for as much as
60–80% of recurrent expenditure on health services. Nevertheless,
information on human resources and their impact
on NCD is inadequate in many countries. Human resources
for health were the focus of a WHO European Ministerial
Conference on Health Systems in 2008 (13,14).
Apart from being a major employer, the health sector
accounts for a considerable amount of capital investment,
procurement of drugs, technical equipment and “household
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Pointers to the future