Preventing Chronic Disease: September 2010: 10_0041

Learning From the European Experience of Using Targets to Improve Population Health
Peter C. Smith, Reinhard Busse, MD, MPH, FFPH
Suggested citation for this article: Smith PC, Busse R. Learning from the European experience of using targets to improve population health. Prev Chronic Dis 2010;7(5). http://www.cdc.gov/pcd/issues/2010/sep/10_0041.htm. Accessed [date].

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Abstract
Health targets have become a widely used instrument to promote population health. We describe the experience in England, where the use of targets has reached the most advanced stage of development, and other European countries. The experience demonstrates that targets may change the behavior of a health system, probably to a larger extent than many other policy instruments, if incentives are aligned correctly and if measures to deal with unintended effects are put in place.



Introduction
Health targets are a tool designed to improve health and health system performance. They have been widely used in Europe, and governments that use them express a commitment to achieving specified results in a defined time and monitoring progress toward broader goals and objectives. Targets may be quantitative (eg, an increase of the vaccination rate by X%) or qualitative (eg, the introduction of a national screening program), and they may be based on health outcomes (eg, reduction in deaths) or processes (eg, screening activity). The introduction of the concept into the health sector is often traced to the publication of the World Health Organization’s Health for All strategy in 1981 (1).

A large body of literature reflects the growing and sustained interest of governments in health targets and their role in the health system (2). This literature distinguishes aspirational, managerial, and technical targets, ranked in terms of the extent to which they prescribe what should be achieved and how (3). We discuss the experience in Europe with health targets as a means of promoting population health, with a particular focus on England where the use of targets has reached the most advanced stage of development (4).

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Preventing Chronic Disease: September 2010: 10_0041