SUCCESSES AND FAILURES OF HEALTH POLICY IN EUROPE

1. Johan Mackenbach SUCCESSES AND FAILURES OF HEALTH POLICY IN EUROPE

2. WHY? • Europe is an underutilized ‘natural laboratory’ for policy evaluation • Over the past 40 years, there were enormous variations in population health trends • While health care and social policies have often been studied, health policy has not

3. OUTLINE • Successes and failures of health policy in Europe: performance indicators • The Netherlands: strengths and weaknesses of health policy • Determinants of health policy performance: economic, social, political

4. 11 AREAS OF HEALTH POLICY • Tobacco control • Alcohol control • Food and nutrition • Fertility, pregnancy, childbirth • Child health • Infectious disease • Hypertension • Cancer screening • Mental health • Road traffic injury • Air pollution Mackenbach & McKee 2013

5. MAIN SUCCESSES • Tobacco control • Alcohol control • Food and nutrition • Fertility, pregnancy, childbirth • Child health • Infectious disease • Hypertension • Cancer screening • Mental health • Road traffic injury • Air pollution Mackenbach & McKee 2013

6. MAIN FAILURES • Tobacco control • Alcohol control • Food and nutrition • Fertility, pregnancy, childbirth • Child health • Infectious disease • Hypertension • Cancer screening • Mental health • Road traffic injury • Air pollution Mackenbach & McKee 2013

7. APPROACH • Literature reviews to identify effective interventions • Relate implementation to intermediate and final health outcomes • Select performance indicators and create summary score • Rank countries, identify determinants of health policy performance Mackenbach & McKee 2013

8. LESS SMOKING WITH MORE TOBACCO CONTROL Mackenbach & McKee 2013

9. LESS IODINE DEFICIENCY WITH MORE SALT IODIZATION Mackenbach & McKee 2013

10. LESS MEASLESWITH MORE MEASLES IMMUNISATION Mackenbach & McKee 2013

11. LESS CAR OCCUPANT DEATHS WITH MORE SEAT BELT WEARING Mackenbach & McKee 2013

12. HEALTH POLICY PERFORMANCE INDICATORS Mackenbach & McKee 2013

13. THE NETHERLANDS Mackenbach & McKee 2013

14. THE NETHERLANDS Mackenbach & McKee 2013

15. HEALTH POLICY PERFORMANCE IN 43 EUROPEAN COUNTRIES, 2008 Mackenbach & McKee 2013

16. UNFINISHED BUSINESS • Enormous gaps in implementation of effective health policies in Europe, particularly in Central and Eastern Europe • Substantial part of gap in life expectancy with Western Europe is due to higher mortality from causes of death amenable to health policy • Even in Western Europe, countries could typically reduce years of life lost by 30-50% by adopting policies in countries with best practices

17. EXCESS MORTALITY AS COMPARED TO SWEDEN, 2008 Mackenbach & McKee 2013

18. EXCESS MORTALITY IN THE NETHERLANDS, 2008 Mackenbach & McKee, submitted for publication

19. EXCESS MORTALITY IN THE NETHERLANDS, 2008 Mackenbach & McKee, submitted for publication

20. Background:Economic conditions Political conditions Social conditions Will:Political commitmentBusiness support Professional engagementPopulation support Means:Knowledge and information Institutional arrangementsOrganizational effectivenessFinancial resources Delivery:Initiation or redesignPopulation coverage Programmatic designMonitoring and evaluation Mackenbach & McKee 2013

21. WHAT DETERMINES HEALTH POLICY? Mackenbach & McKee 2013

22. WHAT DETERMINES HEALTH POLICY? Nether-lands Mackenbach & McKee 2013

23. WORLD VALUES SURVEY • Traditional values emphasize: • God is very important • Obedience and religious faith more important than independence • Abortion never justified • Strong sense of national pride • Respect for authority • Survival values emphasize: • Economic & physical security more important than self-expression and quality of life • Would not sign a petition • Have to be careful about trusting people

24. BACKGROUND FACTORS VS. SPECIFIC POLICY INDICATORS +: p<.05 ++: p<.01 +++: p<.001 Mackenbach & McKee 2013

25. BACKGROUND FACTORS: THE NETHERLANDS Mackenbach & McKee 2013

26. ROLE OF PARTY POLITICS? • Political science literature: social-democratic government reduces income inequality • No association between social-democratic government 1990-2008 and health policy • Weak association between social-democratic government 1960-2008 and health policy Mackenbach & McKee, submitted for publication

27. NO EFFECT OF RECENT LEFT GOVERNMENT Univariate beta=1.671 (n.s.), multivariate beta = -0.103 (n.s.) Mackenbach & McKee, submitted for publication

28. SOME EFFECT OF LONG-TERM LEFT GOVERNMENT? Univariate beta=1.381 (p=0.04), multivariate beta = 0.812 (n.s.) Mackenbach & McKee, submitted for publication

29. TOBACCO AND ALCOHOL Mackenbach & McKee, submitted for publication

30. IN CONCLUSION • Over the past decades, there have been large differences between European countries in the implementation of effective health policies • Seen from a European perspective, the Netherlands is part of a “sub-top”, with excellent performance in some areas and modest performance in some others • Tobacco control and alcohol control are among the areas in which the Netherlands can do better – but this will require more political will

31. THANK YOU!