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

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• Utilizing programmes for poverty and social exclusion. Programmes to tackle poverty and social exclusion offer opportunities for elaborating the synergies between NCD and development, and indicating the potential benefits in both health and economic terms. • Making health an indicator of development. Reporting on changes in inequalities in NCD, during annual budget discussions, could help ensure that health is included in the concept of development. Health, including the prevention and control of NCD, can contribute to poverty reduction and economic development. Given this, several countries have adapted the Millennium Development Goal 6, (on combating HIV/AIDS, malaria and other diseases) to include chronic diseases or NCD (22). • Equity-oriented HIA. The WHO definition of HIA (23) explains that, in assessing the impact of policies in sectors other than health, their “potential effects on the health of a population and the distribution of those effects within the population” need to be judged. This equity aspect is rarely implemented. • Improved management of care for NCD. Not only the distribution but also the management of care for NCD must be improved if access to high-quality and appropriate care is to be ensured, at the right time and in the right place. Better understanding of the drivers of health inequalities, and modelling the specific interventions needed to reduce these, has also shown that greater access to cheap and effective treatment (such as the management of hypertension) could play a significant role in narrowing the gap between those living in the most deprived and the least deprived areas (24). • Examples of good practice. A compilation of well-evaluated examples of good practice would enable countries to consider innovative action and different options for tackling inequalities in NCD. Government decision-making should take place in a transparent manner Tackling NCD requires taking difficult decisions, some of which may be in conflict with the interests of certain groups or may be negatively received by the public. This, combined with the need to involve multiple partners, means that particular care is needed to ensure that government decisionmaking takes place in a transparent manner. • Time and resources. Broad and open consultations can take place only if sufficient time and resources are designated for this purpose. • Effective participation. There will be confidence in the process only if adequate attention is paid to feedback, making it clear that comments, suggestions and opinions offered are taken into account. • Strengthening civil society. Civil society, NGOs and consumer societies have an outstanding role to play in holding government and the private sector responsible for their actions and acting as a watchdog on policy implementation. In some countries, they may need training, capacity building and support, including information and funding, in order to carry out this role adequately. • Transparency in spending the money. Transparency in the allocation of funding is of outstanding importance. The criteria for funding, including the funding of research, must be clear and the priorities in line with NCD policy. Countries can build on existing experience and move forward from whatever point they have reached All countries have some experience in developing broad or issue-specific policies for NCD. Furthermore, comparative newcomers can learn from those with longer experience – there is no need to reinvent the wheel. • Evaluating actions. To build on what a country has, it needs to know what exists already and whether it works. Evaluation of NCD policies (as opposed to monitoring) is comparatively weak, as is evaluation of the Chapter 6 259 Pointers to the future
Chapter 6 260 effectiveness of interventions. A strong focus on reviewing and evaluating NCD policies, with the strengthening of intervention and implementation research, would greatly enhance knowledge on what works and what does not, particularly in building partnerships for NCD policy. • Funding for evaluation. In the planning phase of policies and programmes, an appropriate level of funding should be guaranteed within public administration to fund monitoring and evaluation. In addition, the research community should be encouraged by designated funding to help fill gaps on what does and what does not work. • Sharing the knowledge of what works internationally. There has been an expansion of “best practice” information in recent years but this may not be easily accessible. There is a need for new frames of reference for better understanding and more developed methodologies of adaptation to local needs. • Transfer of knowledge within countries. Most countries have examples of innovative action or pilot projects at the subnational level, but this is not always widely known or used. Stronger channels for sharing positive and negative experiences and for discussing what went right or wrong could help the dissemination of existing good practices within countries. Successful practices and pilots should be better integrated into the overall policy development process. • Capacity building in ministries of health. The capacity of the ministry of health to meet the needs for NCD policy development, and of public administration in general, is rather weak in some countries. It could be enhanced by training, in relation not only to tackling NCD but also to innovative and flexible policy-making and planning, modern public health approaches and the skills for intersectoral cooperation. • Ensuring the right care, at the right time, in the right place. Access to prevention and health promotion services, and to high-quality care and rehabilitation for NCD, and the results of such care, present a challenge for achieving equity in health. Review of the quality, appropriateness and timeliness of care for NCD is needed to ensure that effective interventions are given priority. Evidence-based guidelines are available in some countries, and their wider adoption and implementation could be facilitated through performance monitoring, funding mechanisms and incentive schemes. • Addressing long-term needs. Those who suffer from NCD, and their families, may live with the consequences of these diseases for many years. The way in which existing health and social services meet the long-term needs of patients and carers can be assessed, with a view to developing more integrated, patient-centred care closer to home. It may be worth considering testing and adapting innovations developed in certain countries. Establishing a unifying framework Many countries have a combination of broad policies for health (and/or policies for health promotion and health care), together with policies for specific NCD and/or their risk factors. In no case, among the countries studied, does there appear to be clear coordination or harmonization of these various efforts. Even within broad health promotion policies, individual NCD or health risks appear to be tackled in a vertical way. The European NCD Strategy provides the opportunity to establish a unifying action framework or “umbrella” that draws together the individual components towards a common goal. • Understanding the situation. A comprehensive situation analysis, both of the burden of NCD and the existing policies, strategies and actions for tackling them, would give a better understanding of the challenges and existing gaps. • Mapping a way forward. To support coordination among partners, it is essential to clearly state and disseminate widely: -- the overall objectives for tackling NCD -- the priorities between them Pointers to the future
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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
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Chapter 4 194 An attempt was made t
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Chapter 4 196 iour of schoolchildre
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Chapter 4 198 Lithuania reports reg
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Chapter 4 200 risk factors have bee
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Chapter 4 202 closer state control
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Chapter 4 204 of industrial disease
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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 254 and 255: On the whole, “revised” policy
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: Chapter 6 258 be conflicting, and t
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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