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

Chapter 4
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A characteristic feature of the fragmented public health
policy is that there are currently 35 national programmes
in force in France, setting different priorities for improving
the health of the population. According to the principle of
subsidiarity, the construction of the programmes is mainly
top-down and the regions are expected to represent national
priorities in their regional action plans and to organize
projects in accordance with them. However, the necessary
facilities and financial resources are often not provided and
national programmes cannot be adapted to the regional
level.
In 2004, after many reforms and attempts at improving
the system, the Public Health Act was passed in order to
ensure a general framework with clear priorities and directions
for a national and regional public health policy over a
five-year term.
2.2. Awareness building and consultation process
The first important attempt at starting a consultation process
and building a coherent public health policy was linked
to the establishment of the High Committee on Public
Health (HCSP), an advisory body founded in December
1991 by the Ministry of Health. A significant impact of establishing
the HCSP was the differentiation between health
care and public health and, more importantly, the strong
advocacy for public health. The mission of the HCSP was
to define a multisectoral public health policy strategy, to
identify the needs, weaknesses and strengths of the French
public health system, and to improve transparency between
the actors and activities. Every four years, the HCSP publishes
a report providing a critical, global and intersectoral
perspective of the members in various working groups on
issues such as the health status of the population, health
inequalities and disparities, and resource allocation in the
health system.
The first report of HCSP, published in 1992, was a milestone
in French public health policy. It called attention to
the two major challenges of the public health system: the
high premature mortality and the issue of health inequalities.
The report argued for the continuation of decentralization
to enable greater autonomy in setting priorities, based
on specific regional needs. The Committee issued three
further reports in 1994, 1998 and 2002, but no report was
published in 2006 because the Act foresaw changes in the
structure of the Committee.
An important change in public health policy followed
intervention by the new French President in 2002, which
set new priorities in the dispersed prevention programmes.
The new President declared a “presidential initiative” in five
areas of prevention:
• cancer
• road safety
• disabled people
• environmental health
• rare diseases.
This was the first time that the President of the Republic
had become involved in public health programmes, and it
raised awareness of the issue of prevention. The initiative
led to new programmes and reinforced the implementation
of relevant national programmes as well.
The initiative for the Public Health Act came from leading
government officials in the health field and leaned on the
five priorities announced by the President. The fundamental
idea of the Act is the need for more synergy and coherence
between programmes and structures. In the consultation
process, government officials were appointed in 2003 to
design, plan, implement and give feedback. The views of the
public, service users, service providers and policy experts
were gathered about the governance of public health
services. Although municipal and professional organizations
were also keen to have a transparent, clear strategy and distribution
of tasks, the law was developed and compiled by
Case studies: policy development in countries for tackling noncommunicable diseases