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In fact, the opposite is true. Action must be taken now so that the social and economic determinants of NCD do not deteriorate in this difficult climate, creating even greater problems for the future. The need to rethink economic and social policies provides opportunities for reshaping such policies (at least to be less harmful to health) and more optimistically to promote both health and development. Much of the necessary knowledge is available, though not all countries or cities have all the pieces. A concerted attempt to put NCD issues firmly in the middle of the ongoing socioeconomic discussions at international, national and local levels should create the necessary awareness, and pave the way for a rapid exchange of information and experience. The financial resources for creating an adequate evidence base across Europe are minimal compared to the vast amounts spent on health care (the annual cost of just one hospital bed in most countries would go a long way to covering it). In all countries, planning processes and structures are in place that can be adapted to tackle NCD. For countries with a broad experience of tackling NCD, an attempt at better coordinating and integrating these efforts should fit neatly into the overall climate of trying to improve efficiency and effectiveness. Those with less experience are fortunate in having available to them a wide array of models and experience to borrow and adapt. Europe is fortunate in having a vast pool of highly trained public health experts. This study has shown that, when there is the will, such experts can become champions of public health. The time is ripe for such champions to make the case and take practical steps to ensure that NCD issues are part of the ongoing development discussions. 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). 2. Lafortune G et al. Trends in severe disability among elderly people: assessing the evidence in 12 OECD countries and the future implications. Paris, Organisation for Economic Co-operation and Development, 2007 (OECD Health Working Papers No. 26). 3. Brenner H, Shelley E. Adding years to life and life to years. A health promotion strategy for older people. Dublin, National Council on Ageing and Older People, 1998 (http://www.ncaop.ie/publications/research/intros/ intro_50_Adding_Years_Comments.pdf, accessed 11 June 2009). 4. European strategy for child and adolescent health and development. Copenhagen, WHO Regional Office for Europe, 2005 (http://www.euro.who.int/document/ e87710.pdf, accessed 12 June 2009). 5. Grey G, Young I, Barnekow V. Developing a healthpromoting school. Copenhagen, WHO Regional Office for Europe 2006 (http://www.euro.who.int/document/ e90053.pdf, accessed 12 June 2009). 6. White paper on a strategy for Europe on nutrition, overweight and obesity related health issues. Brussels, European Commission, 2007 (COM (2007) 279 final) (http://ec.europa.eu/health/ph_determinants/life_style/ nutrition/documents/nutrition_wp_en.pdf, accessed 12 June 2009). 7. Padilla B, Pereira J. Health and migration in the EU: building a shared vision for action. Lisbon, Ministry of Health, 2007. 8. Branca F, Nikogosian H, Lobstein T, eds. The challenge of obesity in the WHO European Region and the strategies for response. Summary. Copenhagen, WHO Regional Office for Europe, 2007 (http://www.euro.who. int/document/e89858.pdf, accessed 12 June 2009). 9. Mackenbach JP. Health inequalities: Europe in profile. Rotterdam, Erasmus University, 2006 (http://ec.europa. eu/health/ph_determinants/socio_economics/docu- Chapter 6 263 Pointers to the future
Chapter 6 264 ments/ev_060302_rd06_en.pdf, accessed 12 June 2009). 10. Commission on Social Determinants of Health. Achieving health equity: from root causes to fair outcomes. Interim statement. Geneva, World Health Organization, 2007 (http://whqlibdoc.who.int/publications/2007/interim_statement_eng.pdf, accessed 12 June 2009). 11. The world health report 2006: working together for health. Geneva, World Health Organization, 2006 (http:// www.who.int/whr/2006/whr06_en.pdf, accessed 12 June 2009). 12. Human resources for health in the WHO European Region. Copenhagen, WHO Regional Office for Europe, 2006 (http://www.euro.who.int/document/e88365.pdf, accessed 12 June 2009). 13. Health workforce policies in the European Region. Copenhagen, WHO Regional Office for Europe, 2007 (document EUR/RC57/9) (http://www.euro.who.int/ document/rc57/edoc09.pdf, accessed 12 June 2009). 14. WHO European Ministerial Conference on Health Systems: “Health Systems, Health and Wealth”, Tallinn, Estonia, 25–27 June 2008. Report. Copenhagen, WHO Regional Office for Europe, 2009 (http://www. euro.who.int/Document/E92150.pdf, accessed 12 June 2009). 15. Enlargement strategy and main challenges 2006–2007. Brussels, European Commission, 2006 (COM (2006) 649 final). 16. Deacon B. The social dimensions of regionalism: a constructive alternative to neo-liberal globalization? Helsinki, STAKES, 2001 (GASPP Occasional Paper No. 8/2001) (http://gaspp.stakes.fi/NR/rdonlyres/02A8960F-764F- 4E8C-9477-B0CECCFC3478/0/gaspp82001.pdf, accessed 12 June 2009). 17. Labonté R, Schrecker T. Globalization and social determinants of health: the role of the global marketplace (part 2 of 3). Globalization and Health, 2007, 3:doi:10.1186/1744-8603-3-6. 18. Huynen mmTE, Martens P, Hilderink HBM. The health impacts of globalization: a conceptual framework. Globalization and Health, 2005, 1:doi:10.1186/1744- 8603-1-14. 19. Magnusson RS. Non-communicable diseases and global health governance: enhancing global processes to improve health development Globalization and Health, 2007, 3:doi:10.1186/1744-8603-3-2 http://www.globalizationandhealth.com/content/3/1/2, accessed 12 June 2009). 20. Rechel B, Shapo L, McKee M. Millennium Development Goals for health in Europe and central Asia: relevance and policy implications. Washington, DC, World Bank, 2004 (http://siteresources.worldbank.org/INTECA/Resources/MDGHealth.pdf, accessed 12 June 2009). 21. Global Business Special Report: Corporate social responsibility. Time, 1 October 2007:51–56. 22. Preventing chronic diseases: a vital investment. Geneva, World Health Organization, 2005 (http://whqlibdoc. who.int/publications/2005/9241563001_eng.pdf, accessed 13 June 2009). 23. Health impact assessment: main concepts and suggested approach. Copenhagen, WHO Regional Office for Europe, 1999 (http://www.euro.who.int/document/pae/ gothenburgpaper.pdf, accessed 13 June 2009). 24. Health Inequalities Intervention Tool. London, Association of Public Health Observatories and Department of Health, 2008 (http://www.lho.org.uk/health_inequalities/health_inequalities_tool.aspx, accessed 13 June 2009). 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
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Chapter 4 208 in order to deal with
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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 and 268: Chapter 6 258 be conflicting, and t
Page 269 and 270: Chapter 6 260 effectiveness of inte
Page 271: Chapter 6 262 • Examining the cos
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