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

Chapter 3
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developing methodologies for carrying out health impact
assessment (HIA) (29).
Article 152 of the Treaty of Amsterdam states that “a high
level of human health protection shall be ensured in the
definition and implementation of all Community policies
and activities” (30). This was reflected in the ensuing
public health strategies and programmes for the European
Community, which aim to tackle the underlying causes of
ill health. Health in all policies (31) was given high visibility
in 2006, when Finland made it the main theme of its EU
presidency.
The principle of subsidiarity, defined in Article 5 of the
Treaty establishing the European Community, is intended to
ensure that decisions are taken as closely as possible to the
citizen (32). In tackling NCD, action should be taken at the
lowest possible level, close to the citizen, counterbalancing
what is frequently a top-down approach.
Socioeconomic status in childhood, as indicated by the
parents’ occupational class, frequently determines socioeconomic
status in adulthood. Lifelong exposure to low
socioeconomic status carries higher risks of ill-health than
does such exposure for only one stage of life (23). Many
health-related types of behaviour, such as eating habits and
smoking, are formed in childhood or adolescence. Specific
life events, such as unemployment or the loss of a spouse,
also have significant effects on health. Furthermore, the
exposure of men and women and of people in different
age groups to health determinants such as low income and
unemployment differ considerably. Consequently, it is considered
essential that NCD policies take a life course and
gender perspective.
For these reasons, therefore, it was considered essential
to examine the experience of NCD policy development in
countries through the prism of such values and principles.
Carrying out the case studies
For countries for which information was available, the initial
assessment was made on the basis of existing policy documents,
related bibliographies and material available on the
Internet. The first draft was submitted to key informants in
the country for comments. In countries where such information
is not yet well developed, interviews took place at a
preliminary stage in order to provide the basic information
for the first draft.
In all eight countries, information from written material
was complemented by semi-structured interviews with
key informants. A revised draft was then sent back to the
countries to check for possible inaccuracies.
The key informants interviewed or providing comments
on the drafts were mainly civil servants and experts in
ministries of health and other organizations, academics
and researchers (see Appendix 1). Members of NGOs
were interviewed in an attempt to reach people outside
the government system. Many of those interviewed had
been directly involved in the development of the policies
examined. Given the different phases and patterns of NCD
policy development in the eight countries, the common
outline for the semi-structured interviews was intended as
a checklist of the main issues to be covered rather than a
restrictive structure.
Data collection
Information from WHO
This included:
• responses by European countries to surveys carried
out by WHO headquarters and the Regional Office on
NCD policy and their risk factors;
• country profiles prepared by WHO, such as the Highlights
on Health (33) and HiTs (34);
Methodology, underlying concepts and values