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

• dissemination of examples of good practice and experience
in clinical therapy.
The Programme ended in 2005 and no other heart health
programme has taken its place, although certain measures
and objectives on heart health were replaced by the
National Nutrition Health Programme (PNNS) launched in
2001 and 2006 and the Public Health Act of 2004. PNNS
tackles a significant number of the objectives of heart health
(see section 2.8.2). Furthermore, of the 100 objectives of
the Act, some items cover the major aims of CVD prevention
(such as reducing arterial pressure by 5 mmHg among
people suffering from hypertension and by 3 mmHg among
those with normal blood pressure, and reducing mortality
linked to ischemic cardiopathology by 13% among men and
10% among women).
The Public Health Act intended to compile and collate the
objectives under one framework and to reduce overlap
with other strategies. Overlaps among different strategies
are justified by the presence of common risk factors and
the view that joint actions could strengthen NCD policy. In
reality, these strategies do not have many links with each
other, and at the implementation level actions are often
not the same. The reason for this fragmented approach
is the strong advocacy of influential NGOs in the fields of
heart health, cancer and diabetes, which act separately with
little coordination. The contribution of these organizations
is essential for continuous, well-established projects, but
these bottom-up initiatives should be coupled with strong
government coordination to reduce these overlaps.
The most important, renowned and long-standing organization
is the French Federation of Cardiology (FFC). To reach
a wide population and to reduce overlaps, FFC coordinates
its activities with those of INPES, the national agency on
health promotion. INPES takes care of population-based,
mass media campaigns on healthy nutrition and physical
activities, while FFC focuses on community-based programmes
and specific, targeted campaigns.
FFC organizes a “heart club” in regions and communities
under the leadership of local cardiologists. Within the
framework of the annual campaign of the FFC, “Never the
first cigarette”, some 100 000 young people are reached
annually in schools. For more than 30 years, an annual
two-day “Heart Competition” has been organized countrywide
with various events and programmes to promote and
advocate the fight against CVD.
FFC also coordinates its work with the French Society of
Cardiology (SCF), another prestigious organization known
for its scientific research and secondary and tertiary preven
tion. Both organizations are financed exclusively by donations
from private sources and companies. A common
project of FCC and SCF, “Heart without tobacco”, includes
a number of information events about the harm caused by
smoking and the wide distribution of a brochure to GPs’
waiting rooms on the prevention of CVD.
2.8. Policies related to risk factors
2.8.1. Tobacco
France shows a serious commitment towards a tobaccofree
society and has undertaken significant steps to reduce
smoking. Cigarette advertising is prohibited, the price of
cigarettes is relatively high and continuously increasing, and
the selling of tobacco products has been made difficult by
the appointment of special tobacco points of sale. Smoking
in public places has been banned since February 2007 and
smoking in bars and restaurants since January 2008. A number
of other anti-smoking interventions are taking place but,
despite of the ambitious activities and regulations, the epidemiological
situation is still not satisfactory. The last comprehensive
health survey, the Health Barometer in 2005,
identified a decreasing prevalence of smoking among the
general population aged 15–75 years but a slight increase
among those aged 18–25 years. In a ministerial document
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases