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

Chapter 4
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• cancer
• CVD
• respiratory diseases
• musculoskeletal diseases
• rare diseases
• dental health
• healthy ageing.
2.5. Structures and processes for implementation
The Public Health Act introduced some major changes to
decision-making in public health policy and programme
implementation, with a stronger profile for the HCSP. Thus
the HCSP was modified in March 2007, renamed the High
Council of Public Health (HCSP) and integrated into the
Ministry of Health. Some French public health experts identify
the reasons for this step as the decreasing authority of the
Ministry in recent years owing to the establishment of various
institutions.
The HCSP consisted originally of 20 public health experts
led by the Minister of Health. It has now been enlarged
to 105 members, elected for 3 years with a renewable
mandate. Since the Minister can no longer lead the HCSP,
following its integration into the Ministry, its President will
be elected by the members. The President ensures the
coherence and coordinative function in the work of the
Council. The permanent secretariat and its tasks of providing
support to the Council remain unchanged. Four specialized
commissions have been created, covering respectively
health security; chronic diseases and incapacity; disease
prevention and health determinants; and monitoring and
evaluation.
From March 2007, the Specialized Commission on Disease
Prevention and Health Determinants will take over and
continue the work begun by the Commission on Prevention.
In fact, when the Commission on Prevention was
created, its mandate was similar to that of the HCSP but
restricted to the field of disease prevention. Both bodies
are asked to formulate strategic advice and recommenda
HCSP and it is feared that this will shift the focus of its work
away from the field of health determinants.
The Public Health Act brought some structural changes
at regional level as well. The GRSP were established to
provide a policy-making platform for representatives of the
state (directorates of health and social affairs at regional
and at local level), the health insurance funds, the National
Institute for Health Promotion and Education (INPES) and
various NGOs. In contrast to the Regional Health Conference
(see Box 1), the GRSP includes a narrower circle of
actors and has more decision-making power. The GRSP
defines, in dialogue and in agreement with the Regional
Health Conference, the Regional Public Health Programmes
(PRSP). The new structure may create more transparency
and synergy and reduce overlaps. So far, half of the regions
have developed and approved a PRSP.
In the implementation of NCD prevention and health
promotion activities, the role of NGOs is particularly
important. They carry out important activities in certain
sub-policies, such as those on cancer and CVD, bringing
a sophisticated and differentiated representation of these
policies to the PRSP. The role of public health institutes
is also determined by ensuring trained and experienced
expertise in specific fields.
The relationships among the various bodies and their functions
are illustrated in Fig. 2.
2.6. Monitoring and evaluation
The availability of health data and information has considerably
improved in the last ten years. Now, comprehensive
and reliable information is provided by different institutions
on various health issues and many high-quality studies
have been conducted. Public health institutes such as the
National Institute for Public Health and Medical Research
(INSERM), the Sanitary Surveillance Institute (InVS) and
Case studies: policy development in countries for tackling noncommunicable diseases