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

of explicitly stating equality in health as an underlying value,
and understanding its implications for policy development,
was forcefully iterated through the WHO Health for All
policy, for two main reasons: health is an end in itself, contributing
directly to human well-being; and good health is an
important factor enabling people to function fully in society.
In the WHO European Region, the first of its 38 Health for
All targets called on countries to reduce inequalities in health
(8). Drawing on WHO’s subsequent publications (20–22) to
elaborate the concept, 1 the following working definitions are
used.
• Equality in health implies that ideally everyone should have
a fair opportunity to attain their full health potential and,
more pragmatically, that no one should be disadvantaged
from achieving this potential, if it can be avoided.
• Equality in access to health care implies equal access to
available care for equal need, equal utilization for equal
need, and equal quality of care for all.
Although the available literature offers no general agreement
on the way to conceptualize socioeconomic position
(26), socioeconomic differences are usually measured in
terms of levels of education, income or occupation.
The WHO Commission on Social Determinants of Health,
launched in 2005, defined equality in health as “the absence
of unfair and avoidable or remediable differences in health
among population groups defined socially, economically,
demographically or geographically” (27). Of particular interest
for NCD policy development is the suggestion that both
the range of differences in health within a population and
the position of the most vulnerable should be tackled, and
that priority should be given to those socioeconomic determinants
that contribute significantly to the health gap.
1
The WHO Healthy Cities programme has issued a guide for policy-makers
at local level entitled The solid facts (23), summarizing research around
the main determinants of inequalities in health in a language accessible
to policy-makers. Other documents (24, 25) present some of the latest
thinking on incorporating the value of equity in health into policy-making.
Solidarity is usually interpreted as a society’s sense of collective
responsibility (10). It implies that the vulnerable should
be protected and no one should be deprived of the basic
prerequisites to health owing to their inability to pay, including
access to health care. The principle of solidarity remains
strong in Europe and is behind many EU programmes. The
results of Eurobarometer surveys of attitudes to population
ageing in Europe indicate “a remarkably high level of
consensus across the Member States that those in employment
have a duty to ensure, through the contributions and
taxes they pay, that older people have a decent standard of
living” (28).
The European Health for All policy states that “health for all
will be achieved by the people themselves. A well informed,
well motivated and actively participating community is a key
element for the attainment of the common goal” (8). This
assumes that people have a right to participate in decisions
that affect not only their personal health but that of the
society in which they live. In the context of intersectoral action
to combat NCD, this implies that multiple stakeholders
should be involved in NCD policy development. Nevertheless,
even when the political will is evident, wide participation
in decision-making is easier said than done (3). The
most obvious challenges in partnership working include:
ensuring a common language; understanding and respecting
respective culture, values and objectives; facilitating participation;
ensuring access to information; and building capacity,
skills and opportunity for participation (3).
Whether referring to the main risk factors for NCD – such
as smoking and alcohol consumption, eating patterns and
physical activity – or tackling the “causes of the causes”,
the factors influencing the way people live and the barriers
to adopting a healthier lifestyle, there is no escaping the
need for action across sectors. From recognizing this need,
there has been a shift to stating more boldly that other
sectors are themselves responsible for their possible impact
on health, and must be held accountable. Countries are
Methodology, underlying concepts and values
Chapter 3
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