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

It was envisaged that people would be staying in work 2–3
years longer.
It is recognized that health will be increasingly influenced by
action at a European level, and the preparation of EU decisions
is seen to be an important measure. Similarly, since
health must be taken into consideration across sectors,
tools were to be developed for assessing the health impact
of policies in other sectors.
The revised strategy in 2006 (53) states that employment
among the ageing had improved and that the retirement
age had begun to rise “as a result of legislative amendments
and improved efficiency for action programmes”. It defines
the purpose of social protection as “to promote the health
and functional capacity of the population, ensure healthy
working and living environments, and secure adequate
income and services” – in other words, the prerequisites
of health. The need for assessing the impact of decisions at
international, national and local levels was also more clearly
defined, including impacts on health, social welfare and gender,
so that health and welfare become part of a sustainable
development strategy.
The strategic direction of the previous strategy was considered
still valid, but problems of implementation had come
to the fore:
The more complex the problem at hand, the less effective
the administrative action we can take. There are
many issues for which legislation is an unnecessarily heavy
measure, but recommendations have little effect and the
provision of training produces slow change. Inefficient
implementation is worst for those in the most vulnerable
position, as their problems are also the most complex.
In an interesting discussion of what this means in practical
terms, the introduction by the Permanent Secretary states
that defining strategic lines is not enough. There is a need
to “answer the questions, where are we headed, what
can we do and how can we do it”. The strategy for 2015
therefore outlines the main lines of action under each of
the four strategic lines. Operations are to be based on the
guidelines of the Health 2015 public health programme (14)
and the Strategies for social protection 2015 (15). Action is to
be based on reducing risk factors for widespread diseases
and creating circumstances supportive to health. Attention
is to be given particularly to groups facing the biggest health
risks from smoking, alcohol and obesity, for example.
An attempt is also made to assess the potential economic
impact of the strategy in terms of: attaining a 75% employment
rate; reducing the age-related demand for care;
unemployment; and pressure on social protection expenditure.
It is estimated that the proposed measures could
hold social protection expenditure at under 30% of gross
domestic product (GDP) for the forecast period.
3. Infrastructure and resources for policies
to tackle NCD
3.1. Infrastructure
A National Public Health Advisory Committee was set
up in 1996 to coordinate approaches to public health, and
began by developing a health policy for 2020. The strong
research centres supporting health policy development
have been referred to above.
STTV was established to prevent health and social detriments
caused by alcoholic products, tobacco and chemicals.
STTV is responsible for overseeing and steering the implementation
of the alcohol, tobacco, chemicals and health
protection acts at national level.
MSAH’s National Advisory Board on Health Care Ethics
(ETENE) is another valuable resource that may be called
upon to provide expert opinion on issues relevant to NCD.
In 2006, for example, ETENE advised on whether or not it
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Case studies: policy development in countries for tackling noncommunicable diseases