Health policy-making in central and eastern Europe: lessons from the inaction on injuries?

The burden of disease due to injuries has elicited virtually no public heal th response in the countries of central and eastern Europe, even though inj uries have long been a much greater problem in the east of Europe than in t he west, with children especially affected. This paper seeks to identify fa ctors that have inhibited policy development on this topic and to draw less ons for health policy development in this region more generally. Several factors emerge. Deaths from injuries have had low visibility. Data have not been assembled in a way that would facilitate identification of th e burden of disease that they constitute. Those organizations responsible f or public health, whether within government or at local level, were typical ly very weak with little capacity either to identify the nature and scale o f threats to the health of their populations or to develop strategies to ad dress them. There was uncertainty about ownership, with fragmentation of re sponsibility but no tradition of intersectoral working. Non-governmental or ganizations, which have placed injuries on the health policy agenda in the west, are weak or non-existent. International donors, who could have had a role, have focused on issues such as health care reform. This analysis provides a potential framework for examining policy responses , or lack thereof, to other health challenges in this region. It highlights the need for a better understanding of the potential for using available d ata, which, in turn, requires a major strengthening of capacity. However, i n many countries, there is a need for new ways of working, involving a broa dening of the sense of ownership, with clearly designated responsibilities but designed in ways that encourage rather than inhibit intersectoral actio n. There is also a need to develop non-governmental organizations that have sufficient capacity to undertake their own analyses and to place issues on the agenda.