Only on paper. Where does prevention promotion fail?
Appropriate communication to the public, interministerial cooperation, and long-term concepts focused on prevention are, according to experts, the conditions necessary to improve public health in our country. Unfortunately, however, even the government itself, which has put the approach of harm reduction or risk reduction in its cabinet declaration, is often unable to implement its principles, as was seen in the first draft of the consolidation package. The contradictions between theory and practice were highlighted by experts at the 3rd International Conference of the Healthcare Daily titled Economics of Prevention.
“Linking the topics of economics and prevention is relevant at the moment. People respond to economic arguments and money, some even consider them more than the value we call health. They only realise this when they get sick, and then they re-evaluate their view of these two things,” says Ján Mikas, the Slovak Chief Hygienist.
The biggest problem, he says, is how to transfer the findings to the people for whom they are intended. The plans and strategies themselves are usually not a problem, Mikas says, they are prepared accordingly and just need to be updated with new trends, such as e-cigarettes. But then, of course, it is important that the government gets behind the plans and also allocates funds for the individual goals.
“One thing is the financial support, also in the sense that we have the personnel to see the goals through to the end. The second thing is to find a way of communication within the framework of interministerial cooperation with the ministry of culture and education to bring the objectives of the national programmes closer to those for whom they are intended, in cooperation with the third sector, individual actors and well-known people,” explains Mikas.
According to him and other experts, well-known athletes are a suitable mediator whose voice is also heard by the younger generation (we wrote more here). On the other hand, according to Tomáš Vaclík, goalkeeper of the Czech national football team and the American club New England Revolution, it is necessary to educate the population across the board, because parents ultimately pass on habits to their children. “Parents should be motivated to go out with their children. If I tell my daughter she’s not going to be on her tablet and we’re going to go out, we’re going to go out. So parents should be role models for their children and try to instil prevention and the joy of exercise in them,” Vaclík thinks.
We need to work on primary and secondary prevention
Barbora Macková, the head of the Czech National Institute of Public Health, also stresses the importance of the involvement of the whole spectrum of actors in prevention. “We are beginning to understand that public health is not just a problem of health care, but of all departments, and we need everyone to be involved. However, we should leave the coordination of activities to the Ministry of Health,” emphasises Macková.
According to her, the health literacy of the Czech population is also crucial. The role of the National Institute for Public Health should also be to make the population aware that being healthy does not mean that they do not have to take care of their health.
“It’s too late to take care of my health when I’m sick,” said Macková, who said the role of the National Health Institute should also be to spread the message that a healthy lifestyle is “sexy”. On the other hand, coordination of media outputs should come from the government level, for example from the government council for public health, which is planned to be established. The Health Institute should then play the role of expert consultant in communication and campaigns across ministries, so that the Ministry of Agriculture does not endorse campaigns such as “I Eat Meat”.
Mohlo by vás zajímat
Such coordination would certainly be appropriate, according to Ivan Duškov, General Health Insurance Company of the Czech Republic’s deputy for client services. This was shown in full light during the presentation of the first form of the savings package.
“Although the principle of harm reduction was explicitly stated in the government’s programme declaration, the first version of the consolidation package directly contradicted it. When the government itself releases a policy that contradicts its declaration, we have to admit that coordination is problematic. And when the government would like to see coordination between sub-national municipalities, organisations and actors, it is a big task,” says Ivan Duškov, referring to the fact that the first draft package significantly increased the tax burden on less harmful substitutes for cigarettes, such as e-cigarettes. Fortunately, in the end, the experts managed to explain the discrepancy and it looks like there will be no disproportionate tax increase on less harmful variants.
Každopádně by ale podle Duškova mělo prosazování prevence spočívat v mixu opatření. Samotné osvětové kampaně (pokud je nedělají zkušení influenceři) se totiž ukazují jako jedny z nejméně efektivních intervencí, naopak tou s největším dopadem z hlediska ušetřených let života v nemoci je, pokud si lidé budou dávat poloviční porce jídla.
“Where we, as health insurers, try to go down the path of positive motivation is by engaging within the current legal boundaries by making some benefits conditional on desirable behaviour. So when patients go for secondary prevention, they get a rehabilitation benefit,” Duškov outlines.
Even in secondary prevention, we really need to work harder, because participation in screening programmes is not as high as it should be. “I think this is due to a combination of two factors. It’s blamed on irresponsibility, but I think it’s more due to lack of awareness. So that needs to be improved at all levels. But the way forward is also in personalised screening, where everyone should know their risk and behave accordingly. Today, screening programmes are only based on age, other risk factors are missing. It is also necessary to focus on hereditary risk patients, which we are able to identify – and here we still have a lot of ground to cover,” says Luboš Petruželka, Head of the Oncology Clinic at the 1st Faculty of Medicine of the Charles University in Prague. However, he also believes that it is necessary to ensure that patients have somewhere to go and do not have to wait months for the next examination.
Reward for a healthy lifestyle
On the other hand, the prevention funds of the health insurance companies are only supplementary to their amount and cannot be relied on as the main pillar of prevention in the Czech Republic. Nevertheless, they allow payers to focus on certain issues, such as smoking. Here, General Health Insurance Company wants to define a programme to motivate smokers to quit. But this approach also has its pitfalls.
“The problem is that then someone who breathes fresh mountain air, doesn’t smoke, doesn’t drink and plays sports comes to me and tells me that we are investing public money in someone who is voluntarily destroying his own health, but he himself is given nothing. So we still have to work with that,” Duškov points out.
Deputy Duškov also sees a big problem in the fact that even among politicians, few people know and perceive the difference between the different types of prevention (primordial, primary, secondary and tertiary). Primordial prevention is key, where it is necessary to be anchored in government programmes and strategies, and long-term sustainability is also necessary, regardless of the ruling party of the moment.
“In New Zealand, they started the first anti-smoking policy in 1983, 40 years ago. Then the Zero Tobacco Strategy is plausible because it is a long-term process. In our country, there is always some document that is more or less implemented (usually rather less), and it tends to be problematic,” Duškov said.
Michaela Koubová
Photo by Radek Čepelák
We would like to thank the General Health Insurance Company, National Sports Agency, RBP, Health Insurance Company of the Ministry of Interior of the Czech Republic, Military Health Insurance Company, EUC Medical Group and Sprinx for their support of the conference.
Filip Krumphanzl
