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Exploring Health Policy Development in Europe WHO Library Cataloguing in Publication Data The World Health Organization is a specialized agency of the United Nations with primary responsibility for international health matters and public health. Through this Organization, which was created in 1948, the health professions of over 190 countries exchange their knowledge and experience with the aim of making possible the attainment by all citizens of the world of a level of health that will permit them to lead a socially and economically productive life. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health problems of the countries it serves. The European Region embraces some 870 million people living in an area stretching from Greenland in the north and the Mediterranean in the south to the Pacific shores of the Russian Federation. The European programme of WHO therefore concentrates both on the problems associated with industrial and post-industrial society and on those faced by the emerging democracies of central and eastern Europe and the former USSR. In its strategy for attaining the goal of health for all the Regional Office is arranging its activities in three main areas: lifestyles conducive to health, a healthy environment, and appropriate services for preven- tion, treatment and care. The European Region is characterized by the large number of languages spoken by its peoples, and the resulting difficulties in disseminating information to all who may need it. Applications for rights of translation of Regional Office books are therefore most welcome. Exploring health policy development in Europe WHO Library Cataloguing in Publication Data Exploring health policy development in Europe / edited by Anna Ritsatakis ... [et al.] (WHO regional publications. European series ; No. 86) 1.Health policy – trends 2.Policy making 3.Health for all 4.Evaluation studies 5. Europe I.Ritsatakis, Anna II.Series ISBN 92 890 1352 4 (NLM Classification: WA 540) ISSN 0378-2255 Text editing: Frank Theakston Cover design: Sven Lund World Health Organization Regional Office for Europe Copenhagen Exploring health policy development in Europe Edited by: Anna Ritsatakis Ruth Barnes Evert Dekker Patsy Harrington Simo Kokko Peter Makara WHO Regional Publications, European Series, No. 86 ISBN 92 890 1352 4 ISSN 0378-2255 The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and enquiries should be addressed to the Publications unit, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark, which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. ©World Health Organization 2000 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The names of countries or areas used in this publication are those that obtained at the time the original language edition of the book was prepared. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distin- guished by initial capital letters. The views expressed in this publication are those of the authors and do not necessarily represent the decisions or the stated policy of the World Health Organization. PRINTED IN FINLAND Contents Page Foreword ................................................................................................................................................... ix Prologue ..................................................................................................................................................... xi Contributors .............................................................................................................................................. xv 1. Using the health for all framework to explore the development of health policy in the European Region of WHO ........................................................................................................ 1 2. Case studies ........................................................................................................................................ 25 The process of developing health for all policy in Finland, 1981–1995 ........................................ 27 Simo Kokko Health policy in North Rhine-Westphalia, Germany Birgit Weihrauch ................................................................................................................................ 41 Four variations on one topic: changes in health policy in Hungary (1980–1994) ......................... 64 Peter Makara Health policy development in Lithuania........................................................................................... 82 Vilius Grabauskas Health policy development in Malta ................................................................................................. 94 Ray G. Xerri Health policy in the Netherlands: description and analysis of ten years of national health policy development emphasizing the health for all strategy ........................... 110 Evert Dekker Development of a policy for health for all in Catalonia ................................................................ 130 Ricard Tresserras, Conxa Castell & Lluís Salleras Health policy development in Sweden: action at three levels ....................................................... 147 Bosse Pettersson Comparative analysis of development of health policy in Östergötland County, Sweden .......... 161 Lena Rydin Hansson Healthy City Gothenburg: the work of the Public Health Advisory Committee in evaluating the European regional targets as they relate to Gothenburg ................................... 185 Per Haglind & Willy Nilsson The development of national health policy in Turkey ................................................................... 194 Gül Ergör & Zafer Öztek England: a healthier nation .............................................................................................................. 209 Diana McInnes & Ruth Barnes Health gain investment for the 21st century: developments in health for all in Wales ......................................................................................... 236 Morton Warner 3. An overview of experience in the European Region ..................................................................... 271 Anna Ritsatakis, Ruth Barnes & Patsy Harrington 4. Learning from the past, looking to the future ................................................................................ 347 Anna Ritsatakis Annex. Country profiles ........................................................................................................................ 389 Foreword This book provides a detailed and comprehensive review of health for all policy development in the WHO European Region until 1996. It covers all of the Member States in the Region, bringing together information from a wide range of sources. The study on which the book is based draws together some of the main policy lessons from over 20 years of experience in Europe. Particular attention is paid to health for all as a value-driven policy framework and, more specifically, to the types of policies and programmes that have been adopted to bring those values to life in a variety of policy contexts. Exploring health policy development in Europe identifies some of the future challenges for policy-makers throughout the Region, such as increasing inequities in health, social exclusion, demographic changes, rising expectations and the rapidly expanding developments in information and technology. Despite rather different economic, political and social environments, more than half of the European Member States have developed health policies in accordance with the health for all framework, and a broad basis of support for this approach has been created. This was evident at the forty-eighth session of the WHO Regional Committee for Europe, in Copenhagen in September 1998, when all 50 active Member States passed a resolution approving the revised regional health for all policy for the 21st century as a “guiding framework for health policy development in Member States”, and commended this framework to both the Member States and to other international bodies as a framework for health policy development. I am convinced that this book will provide a strong basis for the further development of target-setting for the promotion of equity in health in Europe. WHO’s newly established European Centre for Health Policy in Brussels is already taking this work further. I should like to express my continued support for this type of health policy analysis, and look forward to seeing in future publications the development of many of the issues raised here. J.E. Asvall WHO Regional Director for
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