Transfer of Health for All policy – What, how and in which direction? A two-case study

BACKGROUND: This article explores the transfer of World Health Organization's (WHO) policy initiative Health for All by the Year 2000 (HFA2000) into national contexts by using the changes in the public health policies of Finland and Portugal from the 1970's onward and the relationship of these changes to WHO policy development as test cases. Finland and Portugal were chosen to be compared as they represent different welfare state types and as the paradigmatic transition from the old to new public health is assumed to be related to the wider welfare state development. METHODS: The policy transfer approach is used as a conceptual tool to analyze the possible policy changes related to the adaptation of HFA into the national context. To be able to analyze not only the content but also the contextual conditions of policy transfer Kingdon's analytical framework of policy analysis is applied. CONCLUSIONS: Our analysis suggests that no significant change of health promotion policy resulted from the launch of HFA program neither in Finland nor in Portugal. Instead the changes that occurred in both countries were of incremental nature, in accordance with the earlier policy choices, and the adaptation of HFA program was mainly applied to the areas where there were national traditions

Gezonde en ongezonde levensverwachting van de Nederlandse bevolking

Gezonde levensverwachting is een relatief nieuwe indicator voor de volksgezondheid, die zowel mortaliteit als morbiditeit en/of beperkingen in de beschouwing opneemt. Deze integrale maat is door Sullivan in de jaren zeventig ontworpen en gebaseerd op het eenvoudige idee om de levensverwachting te verminderen met het aantal jaren doorgebracht in ongezondheid. In dit rapport wordt de gezonde levensverwachting voor Nederland op twee manieren berekend: ten eerste de levensverwachting zonder beperkingen, en ten tweede de levensverwachting op basis van (zeer) goede ervaren gezondheid. In de eerste benadering zijn lange termijn beperkingen berekend op basis van leeftijdsspecifieke antwoorden op 10 vragen behorende bij de OECD vragenlijst in de CBS-gezondheidsenquete, terwijl korte termijn beperkingen ontleend zijn aan enkele andere vragen in de CBS-gezondheidsenquete over beperkingen in de veertien dagen voorafgaande aan het interview. In de tweede benadering is gezondheid gemeten met behulp van de vraag naar ervaren gezondheid. Het blijkt dat ofschoon de levensverwachting bij de geboorte van vrouwen die van mannen met ruim zes jaar overtreft, dit verschil bijna geheel wegvalt als het aantal jaren dat vrouwen in ongezondheid of met beperkingen doorbrengt, in de beschouwing wordt opgenomen. De trend studie 1983-1990 geeft een aanwijzing voor een toename in het gezonde levenspercentage bij mannen, hoewel deze toename alleen voor de leeftijdsklasse van 45-64 jaar significant was. Voor vrouwen blijkt het gezonde levenspercentage af te nemen. Dit is in overeenstemming met trend studies uit andere landen. Het geeft meer steun aan een theorie over expansie van morbiditeit dan aan een theorie over compressie van morbiditeit. De analyse van gezonde levensverwachting naar sociaal-economische status onthulde dat er in Nederland een verschil is van meer dan 10% in gezonde levensverwachting tussen hoge en lage sociaal-economische status, hetgeen overeenkomt met de bevindingen in het Verenigd Koninkrijk.Health expectancy is a relatively new indicator for population health, taking account of both mortality and morbidity and/or disability. This integral measure, introduced by Sullivan in the seventies, is based on the simple idea of subtracting from life expectancy the number of years that may be expected to be spent in poor health. This report presents results of calculations from the Netherlands based on two approaches, firstly disability-free life expectancy and secondly healthy life expectancy. In the first approach long-term disabilities have been calculated on the basis of the age-specific answers to 10 items from the OECD questionnaire in the CBS Health Interview Survey, while short-term disabilities have been derived from other questions in the CBS Health Interview Survey concerning limitations of activities during the fortnight preceding the interview. In the latter, health is based on a health interview question about self perceived health. It appears that, although the life expectancy at birth of females exceeds that of males by rather more than six years, this lead is almost entirely cancelled out by the greater number of years which females spend in poor health or with long/short term disablities. The trend study 1983-1990 revealed some indication for a rise in the healthy life percentage of males, albeit that this development was only statistically significant for the age 45. For females the healthy life percentage appears to decline. This is in concordance with the results of some trend studies from other countries. They give support to the expansion of morbidity theory rather than to the theory of compression of morbidity. The analysis of health expectancies by socioeconomic class revealed that also in the Netherlands impressive difference of more than 10 percent between high and low socioeconomic status exists, which tallies with findings in Great Britain.VW

[A survey of prognostic research in medical examinations.]

Abstract niet beschikbaarThe progress in medical technology causes an increasing availability of diagnostic tests for early detection of serious, incurable diseases and for making predictions about the occurrence of clinical signs. With reference to the political discussion about prognostic medical research, the National Institute of Public Health and Environmental Protection has on assignment investigated what kind of questions and types of medical-diagnostic tests are being used during pre-employment examinations, life-insurance examinations and disability insurance examinations at this moment and in the near future. Furthermore, the prognostic value of the questions/tests with respect to the purpose of the examinations is reviewed and conclusions are drawn about which questions/tests can, from a scientific point of view, be used meaningful in these examinations. The study is done by means of literature-search and consultation of experts. In the examinations, a multitude of questions and tests is being used, of which a selection has been discussed. A distinction has been made between the validity/predictive value of a question/test and the prognostic value of information about a risk factor/disease towards the purpose of the examinations. The prognostic value of questions and tests, used in the examinations, is strongly dependent on the predicted endpoint ; suitability for a job, risk of industrial disability or mortality-risk. The prognostic value is therefore depending on both the specific question or test and the type of examination. In the last chapter of this report, conclusions have been drawn separately for each type of examination. Subsequently, some draw-backs of the study are discussed.DGVGZ/PEP MJ/directoraat Generaal Wetgevin