How people behave in terms of their health depends on many factors such as government policy, the media, and friends. The problem is that the state only focuses on what it can influence and ignores other factors. Martin Smatana, the Chairman of the Supervisory Board of the local General Health Insurance Company and a health analyst, pointed out the above at the 2nd Annual International Panel of the Permanent Conference on Healthcare in Prague. So multidisciplinary cooperation is the basis for the success of public health policies, he said.
In their search for an answer to what are some of the key factors in the success or failure of public health policies, Smatana and his colleagues looked at all publications on sugar, tobacco, and alcohol since 1970. „Key determinants of health and demand for care are educational attainment, socioeconomic status, and culture. So the richer and more educated we are, the less health care we need,“ he told at the conference.
However, he added, there are factors that can be influenced earlier than in 20 years. People’s behaviour is also influenced, for example, by government policies, the media, and their friends. „The problem is that the state only focuses on what it can influence and ignores other factors. The state can influence demand, supply, and the market. However, many of these measures are one-off, such as the ban on the sale of alcohol. Once you ban something, you cannot do it twice in a row,“ Smatana explained.
France, for example, increased taxes on tobacco products by leaps and bounds and envisioned that people would stop smoking. But the country has achieved the opposite effect. The consumption of illegally imported cigarettes has increased and the state has lost two billion euros in excise duties. Germany, on the other hand, has increased tobacco tax revenues by around 29 percent over 20 years, but the number of tobacco users has fallen by 40 percent. „The basis of their success was multidisciplinary cooperation,“ he stressed.
Even the analysts made mistakes
Smatana admitted that analysts have made similar mistakes in public health policies. „In 2019, my colleagues and I at the Health Policy Institute set out to reduce childhood obesity in ten years. We wanted to tax all confectionery or sweetened drinks and we backed this up with analysis. But it did not go well and nothing materialised,“ he admitted.
The main reason, he said, was that he and the analysts had solely relied on the power of the state and ignored other institutions or factors that intervene in public health. Their study was criticised, and there was even another publication that negated their work.
„Later, we sponsored other studies that looked at how many lives and money we could save if we reduced the consumption of sugar, fat, salt, tobacco, and alcohol in Slovakia. It also looked at what policies we should apply to achieve this. We have prepared the same for the Czech Republic,“ revealed the health analyst.
Media and industry are also important
Smatana says that countries rely only on the standard media to set strategies in public health policies. The problem is that nowadays, for example, social media or celebrities have a greater impact. „It is also a mistake to ignore the industry. This is supported by studies that say, for example, that companies have played a key role in regulating salt in food. So industry is important, it is just that states need to communicate with it,“ Smatana said. Data that can tell us, for example, why people started smoking are also being neglected, he added.
Thus, according to him, the hallmarks of the best public health policies include a long-term approach through the younger generation, incremental goals instead of step-by-step changes, data and targeted behavioural interventions, as well as the targeting and effectiveness of interventions.
Czech Republic on the right track, New Zealand as a model
About half of all deaths in Slovakia in 2019 can be attributed to behavioural risk factors, i.e., dietary risks, tobacco smoking, alcohol consumption or low physical activity. In the Czech Republic, the situation is similar, but according to Smatana, it is a bit better. „I must commend my colleagues, Mr. Vobořil and the others. You may not even realize it, but in multiple elements, factors, and practices, you are probably the best example in the entire region. I am not just talking about the government’s programme statement, which talks about less risky products, but also, in principle, about the data you collect, how you approach measures,“ the Slovak expert complimented.
What country should we look to if we want to see how public health policies are best implemented? „Take New Zealand, for example, which set realistic goals twenty years ago – to raise a tobacco-free generation. The prevalence of 15-year-old child smokers has fallen to 5 percent in 20 years. They have declared that they are banning sales to everyone born after 1998 and now they will address the others with behavioural intervention, less risky products, working with people,“ said Martin Smatana.
Miroslav Homola
