By the mid-1980s, the experts and socialist politicians really dedicated to health care recognized that the policy that had been followed could not handle the challenge of health care in crisis, and that current health policy was helpless against the deteriorating health status of the population. In 1988, the Minister of Health and Social Affairs established a health care reform secretariat in the Ministry, under the leadership of Dr András Jávor. He later became the Permanent Secretary of State in the Ministry of Welfare, the highest-ranking civil servant (the current name for the former Ministry of Health and Social
Affairs and Ministry of Social Affairs and Health). In the working groups of the reform secretariat, experts who had been sidelined until then developed their ideas about the changes required. The most important reform of this period was the separation of the health insurance fund from the state budget and the transition to an insurance-based system for health care financing.
In December 1987, the Hungarian Government announced by decree a long-term programme for health promotion. This was a unique experiment under socialist conditions in Europe. The programme was to be implemented at the time that basic political reforms took place. Changes that culminated in the collapse of the regime marginalized this initiative, which disappeared along with the old system. Hence this programme cannot be evaluated properly.
The planning and initiation of the long-term health promotion programme in Hungary was made possible by a number of unique circumstances within a regime that was considered “soft” among the other socialist countries. Although Hungary’s epidemiological figures were tragic, even by eastern European standards, the health care system developed a good and active relationship with the WHO Regional Office for Europe. The European targets for health for all and the Ottawa Charter for Health Promotion inspired health policy in Hungary. A team of interdisciplinary experts was on hand to plan and implement the programme, and the personal interests of Dr Judith Csehák, the Deputy Prime Minister at that time, were closely tied to the health promotion programme.
Hungary’s long-term strategy for health for all was based on a well meant but sometimes naive adaptation of the WHO targets for health for all. The Prime Minister issued a government decree creating the National Council for Health Promotion and the National Health Promotion Fund, which was in charge of securing financing for health promotion. The Council set eight priorities:
• AIDS
• tobacco or health
• drug abuse
• alcohol abuse
• hypertension
• mental health
• the mass media
• accidents.
Action programmes addressed these priorities in 1988–1990.
Next, institutional frameworks were installed: the National Institute for Health Promotion was estab-lished and a number of local programmes were developed. The activities of the AIDS and hypertension programmes had positive quantifiable results.
There were, however, signs of difficulty, and only some were linked to the political system. The programme lacked legitimacy. The National Assembly did not debate the population’s health and the health for all policy. The medical profession and most other health personnel were hostile to health promotion. The programme failed to implement action that would serve the population’s interest directly and obviously: offering services that could have made it popular with and well known to the public in the long term. In the absence of a comprehensive system of societal policy objectives and means, the programme lacked support. Both its supporters and opponents blamed it for problems (ranging from the insensitivity of the taxation system to the issue of commercial supply) that could only be regulated in the framework of a comprehensive policy for health for all.
Even the Ministry of Social Affairs and Health made hardly any effort to harmonize prevention and welfare policy. Health promotion cannot replace the whole of health for all policy. It was a mistake to take responsibility (or to seem to do so) for problems that the programme could not influence, ease or overcome. This led to accusations and scorching criticism and aroused a sense of failure among the programme’s supporters. Trapped in the contradiction between the targets set and the real possibilities, the programme was increasingly pushed back within the boundaries of the traditional health care sector.
Despite several positive examples at the local level, no countrywide movement to promote health emerged.
Movements and public institutions for health promotion did not cooperate. The National Council for Health Promotion failed to lay the groundwork for a long-term relationship based on common interests with important social movements that had similar objectives, such as the green party and the association of nature lovers.
The programme failed to identify the economic activities and goods with financial interests in health and healthy lifestyles. In addition, the programme did not have sufficient resources to induce comprehensive social effects. During the three years following its formulation, there was no real programme planning or management at an appropriate level to determine targets, strategies, methods, organizational require-ments, financing, evaluation and adjustment mechanisms in a coherent system. The whole programme was heuristically regulated and manually controlled.
In the absence of appropriate annual and medium-term programme formulation, there were excessive planning and poor selection processes. Since financial, personnel and organizational resources were hopelessly scarce, plans were over-ambitious and complete subjectivity flourished. In the lack of appropriate programme planning, the National Council for Health Promotion was not accountable for its work. Instead, it swam with the tide and compromised its own conscience by stating that needs were so great that any action taken would have some benefits somewhere. The lack of conditions for fair evaluation made feedback and professionally sound adjustment impossible. Further, there was no research infrastructure to assist the health promotion programme in a comprehensive way.
Although it was considered politically incorrect to admit that one was inheriting policies from one’s predecessor from the 1980s, the fact that the major strategies and guidelines for health for all continued into this period permitted substantial elements of continuity in health policy; even in a crisis, this
eventually made possible more organic change.