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

the Government and Parliament. The consultation process
built on the recommendations of the HCSP and on previous
programmes. Regional and departmental governments
and associations also took part in the consultation, but their
interests were not fully served as the Act involved a slight
shift from decentralization to centralization. 5
In the summer of 2006 the Minister of Health announced
a general consultation of stakeholders aimed at debating
a new strategy on disease prevention. A Commission on
Prevention was set up and asked to make a thorough analysis
of the strengths and weaknesses of the French disease
prevention system and make recommendations. A report
was published at the end of 2006 providing a general, multisectoral
overview and constructive criticism (7). A regional
consultation process then began and regions were asked to
comment on the report.
2.3. Values and principles
The first report of the HCSP defined a basic set of values,
including equality in health, solidarity with disabled people
and freedom of choice in the lifestyle of individuals and
communities. These values reflect the three core values
of the Republic: liberté, égalité, fraternité. Tackling health
inequalities is a key aim of a number of government documents
and often appears as a horizontal aspect, though
health promotion experts often lack real action and commitment.
The Public Health Act of 2004 (8) incorporates the same
values as the first HCSP report and declares a clear system
of principles. It defines public health policy as a driver for
promoting the health of the population, with special respect
5
The Bill established the Regional Working Groups for Public Health
(GRSP) (see Fig. 1), comprising key actors from governmental and nongovernmental
bodies at regional level that aim to define a regional public
health programme. Compared to the earlier practice, whereby regions
were expected to set their own public health agenda, state representation
in the GRSP is 51%. Thus the state has the strongest voice in the
establishment of regional public health plans.
to social and health inequalities. It stresses the point that
public health policy must tackle the physical, social, economic
and cultural determinants of health. The principles of
the Act are explicitly stated in nine points:
• knowledge and information
• reducing inequalities in health
• specificity
• protecting young people
• priorities and urgency
• economic effectiveness
• intersectorality
• conciliation
• evaluation.
2.4. Setting the agenda
From the beginning, it was proposed that the Act should
be based on solid research and evaluation of epidemiological
studies and routine surveys. For this reason, each of the
100 objectives is linked to expected results and indicators.
To prevent overlap and avoid increasing the already dense
spectrum of various national programmes, the Act refers to
the existing strategies. The Act slightly modified structures
and systems but the principle of decentralization has not
fundamentally changed.
In the field of NCD prevention and health promotion, the
Act deals with the following themes:
• alcohol
• tobacco
• nutrition and physical activity
• health promotion at the workplace
• environmental health
• health inequalities
• disabled people
• child and maternal health
• reproductive health
• mental health
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases