The parliamentary political agenda: a tool for policy analysis of diabetes priorities in Spain.

OBJECTIVE: To analyze the political agenda on diabetes in Spain under democracy by considering the frequency and content of initiatives in the Spanish parliament. METHODS: A systematic search of parliamentary interventions (1979-2010) reported on the Spanish Congress of Deputies' web page was carried out using the key word "diabetes". A descriptive study of the frequency of interventions was performed, followed by a content analysis, according to the priorities of the World Health Organization (WHO), the International Diabetes Federation and the Spanish Diabetes Federation. Other study variables were the year of presentation, legislature, type of initiative and whether a political decision was taken (yes/no). RESULTS: There were 59 interventions: 22% were related to the first international initiatives and 44.1% took place in the last two legislatures in response to the WHO's program Diabetes Action Now. A total of 32.2% of the initiatives addressed educational and social programs, while 23.7% addressed access to resources and health services. Most initiatives (74.6%) consisted of parliamentary questions to the government, which only required a response. Of the 15 initiatives requiring a decision to be taken, only eight were approved. CONCLUSIONS: Spanish legislators aim to comply with international standards. Nevertheless, political decision-making has sometimes been slow. Importantly, most of the political responsibilities related to health have been transferred to the autonomous regions. The updated National Diabetes Strategy in Spain will need to strengthen public health policies according to established international priorities. Monitoring parliamentary interventions has proven to be a valid tool for evaluating patterns of political debate and decisions on diabetes.

Policy options for obesity in Europe: a comparison of public health specialists with other stakeholders.

OBJECTIVE: To explore policy options that public health specialists (PHS) consider appropriate for combating obesity in Europe, and compare their preferences with those of other stakeholders (non-PHS). DESIGN: Structured interviews using multicriteria mapping, a computer-based, decision-support tool. SETTING: Nine European countries. SUBJECTS: A total of 189 stakeholders. Twenty-seven interviewees were PHS and non-PHS included food, sports and health sectors. MEASUREMENTS: A four-step approach was taken, i.e. selecting options, defining criteria, scoring options quantitatively and weighting the criteria to provide overall rankings of options. Interviews were recorded and transcribed to yield qualitative data. RESULTS: The PHS concur with other stakeholders interviewed, as all emphasised the importance of educational initiatives in combating obesity, followed by policies to improve community sports facilities, introduce mandatory food labelling and controlling food and drink advertising. Further analyses revealed several significant differences. The non-PHS from the private sector ranked institutional reforms favourably; the PHS from non-Mediterranean countries supported the option of medicines to prevent obesity; and those PHS from Mediterranean countries endorsed the use of activity monitoring devices such as pedometers. As far as appraisal criteria were concerned, PHS considered efficacy and the economic impact on the public sector to be the most important. CONCLUSION: There is clear consensus among PHS and other stakeholders concerning the need for a package of policy options, which suggests that European-wide implementation could be successful. However, it would be advisable to avoid more contentious policy options such as taxation until future changes in public opinion.

[Assessment criteria for public policies on obesity: the view of Spanish stakeholders]. / Criterios de valoración de políticas públicas para la obesidad en España según sus actores principales.

AIM: To explore the criteria used to assess public policy initiatives on obesity in Spain by the main stakeholders. METHODS: Multicriteria mapping was performed within the framework of the European PorGrow Project "Policy options for responding to obesity" through a structured interview with 21 stakeholders, who were leaders in the public and private sectors in Spain in the area of food and physical exercise. Qualitative and quantitative information was included in the analysis. The interviewees justified their positions for or against the various policy options with criteria that were weighted by their relative importance and documented with quotations and nuggets from the interviewees' discourse. RESULTS: We identified 93 criteria for policy selection in the 21 interviewees. The most frequent criteria and those perceived as most important were efficacy (n = 18), social benefits (n = 17) and social acceptability (n = 14). The economic impact on individuals and the public sector was not considered important by the interviewees. The economic impact on the commercial sector was not included by any of the participants. The criterion most highly valued by public sector stakeholders was societal benefits while that most valued by private sector stakeholders was efficacy. CONCLUSIONS: Spain is in the initial stages of developing public policy on obesity and, as yet, there are no winners and losers among those concerned, which may explain why economic costs seem to be relatively unimportant for the stake-holders, opening a window of opportunity for the development of regulatory policies.