Published: 15/08/2002, Volume III, No. 5818 Page 30 31
Health Targets in Europe Polity, progress and promise Edited by Marshall Marinker Publisher: BMJ Books. ISBN 0727916424. 248 pages.£19.95.
Reviewer Dr Geof Rayner Chair, Public Health Association
Public sector organisations in Britain are engulfed by a 'blizzard of targets', according to Professor David Hunter, one contributor to this book.This might not be the sort of statement its editor, or publishers, wanted to hear.
However, the targets discussed in the 14 chapters of this commissioned compilation have less to do with harrying managers and more to do with a rising European-wide aspiration - better health - which requires more than managerialism to achieve.
The common targets under consideration are from the World Health Organisation's 'Health For All by the year 2000'programme.
By 1984, all 51 countries in the region had adopted the 38 HFA targets.Additional targets have been set by some countries, such as England's health inequality targets.
The proponents of targets - to coin a term, 'targeteers'- are those people and organisations who want to shift the health debate away from the usual medicine=health equation to broader social, physical or lifestyle determinants.As all the contributors relate, this is a big and difficult job.
The identified gulf to be bridged is between wonderful intentions - as transmitted by WHO - and the national means to carry them out.To put it another way: how do you square aspirations for a healthier society with the reality of 'business as usual'?
This book looks at seven countries in detail, along with two pan-European chapters and an exchange-of-letters debate.
What emerges from the separate country accounts is how different things can be, and also how similar.
Things that get in the way range from politics and devolution to lassitude and ineptitude.
In Spain, the impetus for action came from its devolved governments, not the national government.But the coming to power of national governments of a more conservative hue has dampened interest.
In Germany,15 years'experience within a non-receptive climate produced very little, though recently enthusiasm has been growing on the back of a resurgent public health movement.
In Lithuania, government targets to reduce health inequalities by 25 per cent by 2010 make the English health inequalities target look either measly or realistic.
Other chapters look to the common characteristics of Europeans - such as the place accorded to the state, the role of WHO and the potential for growth in the significance of EU health policy.But it is inter-esting that, for several contributors, the source of 'target-type thinking' is not European, but US management guru Peter Drucker.
One benefit of the programme may be the fashioning of a European common symbolism around progressive health policy.What this book reveals are the pitfalls of trying to achieve good things without the proper tools, and in circumstances not of one's making.
For those interested in rising to the challenge of improving population health, this book deserves to be read for this message alone.