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

Chapter 4
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INPES carry out data collection and research and publish
their findings on a regular basis. Three regions of France
took part in the WHO MONICA Project coordinated
by INSERM on behalf of France. The Project aimed at
the surveillance of coronary mortality and morbidity by
working towards the standardization and comparability of
international data (9). Every five years, INPES publishes its
Baromètre santé (Health Barometer) with valuable data on
the health behaviour and attitudes of the population (10).
The nongovernmental Regional Health Observatories (see
Box 1) provide epidemiological data on the health of the
population in the regions. In addition, InVS participates in
data and information collection, although its main mandate
is to carry out health checks, to inform about health alerts
and to contribute to managing health crises. In terms of
NCD policy, the regular reports and information of INPES
and INSERM are crucial and have a considerable policy
impact.
It is expected that the new HCSP Specialized Commission
on Monitoring and Evaluation will bring forward and
strengthen the work that was started by the HCSP in the
1990s. From its outset, the HCSP advocated for a more
systematic collection of data and drew attention to numerous
flaws in the French health information system. In the
HCSP reports, the most striking observations and findings
were identified and presented based on an analysis of the
available information. The Specialized Commission will contribute
to the integration of data from different sources and
the monitoring and evaluation of the 100 objectives defined
in the Public Health Act.
2.7. Policies for tackling NCD
The first comprehensive national public health programme,
on breast cancer screening, was launched in 1992. It was
developed at national, regional and community levels and
coordinated by an interministerial group. This national
programme was followed by many others, focusing on various
areas of health promotion and disease prevention (11).
On the initiative of the ministers, members of the cabinet
and the administration, various national programmes were
created reflecting government current priorities. Between
1995 and 2002, around 40 national health programmes
were launched by the Government, with an overwhelming
focus on disease prevention. The objectives and the
methods of these programmes were generally well-defined,
but none addressed the question of system reorganization.
Concern was raised from time to time that many strategie s
existed in parallel, that programmes were dispersed, and
that there was no coordinating mechanism to ensure a
concentrated, effective distribution of resources.
In 2001, a vain effort was made to create a coordinating
horizontal framework for the various existing national programmes.
The Public Health Act of 2004 aimed to respond
to this need to fill the gap. It proposed to reorganize the
structures between the regional and national levels and to
bring together the strategies under one umbrella. The national
programmes did not become integrated parts of the
Act and only a fraction of their aims and objectives were
included in it.
The timeframes of the national programmes vary from
a couple of months to a few years and are based on the
principles of multidisciplinarity and intersectorality. The
programmes aim to integrate different levels and reach
synergy among various actors, approaches and methods.
INPES has a strong profile in communication at national
level and implements a number of NCD campaigns linked
to the national programmes. Moreover, INPES, jointly with
regional associations dealing with health education, makes a
fundamental contribution to organizing health education in
different settings all over France. Communication and health
education are important pillars of the French NCD policy
(see Box 2).
It is often said that the national programmes are not sufficiently
monitored and evaluated. No systematic measure
Case studies: policy development in countries for tackling noncommunicable diseases