The greatest killer of the modern age is not Covid-19 but diseases strongly associated with lifestyles, such as cardiovascular diseases, cancer, and mental diseases. Their occurrence in the population has been stagnating or even on the rise, the known methods of prevention are no longer as effective, and their treatment costs are on the rise. Therefore, the participants of the international panel of the Permanent Conference on Czech Healthcare on the Economics of Prevention agreed that it is necessary to search for innovative approaches and to reduce the risks of harmful behaviour. The panel was held at Kaiserstein Palace and attended by prominent representatives of politics, medicine as well as healthcare payers from several countries. Aside from Czech Prime Minister, Andrej Babiš, Ministers of Health of the Czech and Slovak Republics, Adam Vojtěch and Vladimír Lengvarský, also had presentations. Former Vice-Prime Minister of the Slovak Republic and Minister of Health, Richard Raši, today a deputy of the National Council, also contributed to the discussion. President of the Polish Society for Public Health, Professor Andrzej Mariusz Fal, the Head of The Institute for Cardiovascular Research, Sackler Faculty of Medicine, Tel-Aviv University, Professor Reuven Zimlichman, President of the Czech Society for Cardiology, Professor Aleš Linhart, and President of the Czech Society for Oncology, Jana Prausová, also lectured on the economics of prevention. The perspective of clinical specialists was presented by their Head Zorjan Jojko, and the role of general practitioners was described by the founding member of the Association of General Practitioners, Zdeněk Hamouz. Healthcare payers were represented by the director of the largest General Health Insurance Company Zdeněk Kabátek.
Despite the tragic statistics of the Covid-19 pandemic, the greatest killers of the modern age remain to be diseases very strongly associated with our modern lifestyles. That is, cardiovascular, oncological, and mental diseases. Their vast majority can be avoided with suitably targeted prevention. In 2019, the Czech Republic paid out 477 billion Czech crowns for healthcare, of which CZK 382 billion covered the treatment of preventable diseases, that is, a whole 80 percent. “Every crown that is invested into prevention thus saves many crowns paid out for treatment. The support of preventive measures and primary care, which is key for these fields, it absolutely fundamental,” the Minister of Health Adam Vojtěch proclaimed at the international panel of Zdravotnický deník’s conference on the economics of prevention.
As Prime Minister Andrej Babiš also pointed out in his contribution, for more than a year the Covid-19 pandemic has been straining the financial, human, and technical capacities of the healthcare system. These could have otherwise been directed at the prevention and treatment of diseases such as cancer or addictions. On the other hand, it was clear that cardiovascular disease or obesity decidedly increased the risk of serious cases of the illness, as well as of Covid-related deaths. “And here the Czech Republic does not compare well in various international statistics, whether it be smoking or alcohol consumption. It is no wonder that the Czech Republic ranked among the highest mortality statistics in terms of Covid-19. In this sense, the disease mirrored the state of health of the Czech population,” Vojtěch added.
The importance of prevention and of the early detection of diseases, which in turn saves money for the system, is beginning to be perceived by those politicians responsible for allocating public financial resources. For instance, when it comes to oncological diseases, the Czech Republic already conducts three across-the-board screening programmes (breast cancer, colorectal cancer, and cervical cancer), and screening for lung cancer is planned to be launched in January. “We do not want to economize on preventive measures and on the treatment of grave diseases, especially oncological diseases,” stated Babiš. According to him, it was Covid-19 that clearly showed the key importance of preventive measures, in this case, vaccinations. At the same time, experts also point out that the known methods of prevention, for example in the field of tobacco control, are no longer bringing about the desired effect, that is, reducing the number of patients. It is necessary to seek out contemporary trends and approaches, they say.“Covid mirrored the state we are in,” said Czech Minister of Health, Adam Vojtěch.
Missing translation of scientific expertise into policies
Everyone intuitively knows that exercise, healthy diet and well-being contribute to better health and to a higher quality of life. It is another thing to support this knowledge with hard facts and transform it into clear national policies with adequate financial support. Prevention is not an attractive topic for politicians because specific results of adopted measures practically arise no sooner than after one whole generation. Therefore, they are often rather reluctant to deal with the issues fully and to listen to scientific arguments.
It is the translation of scientific expertise into the decision-making processes that the Slovak Minister of Health, Vladimír Lengvarský, believes to be one of the “neuralgic nodes” of prevention. According to him, one of the significant sub-topics is the regulation of tobacco and alcohol consumption, and this is an area where it is “necessary to grasp the issues at hand coherently in an extensive dialogue along the entire spectrum of participants,” added the minister.
For that matter, smoking is one of the main risk factors for developing cardiovascular diseases, which, despite the decrease in recent decades, remains to be the main cause of death in the Czech Republic. And we cannot expect any improvement. “It is time to stop slapping each other on the back. The number of cardiology patients has stopped decreasing,” Aleš Linhart, the President of the Czech Society for Cardiology and the Head of the Cardiology and Angiology Department of the First Faculty of Medicine of Charles University and the General Faculty Hospital, warned. And he added: “Our society began to lead healthier lifestyles, there is perhaps a higher quality of life. But these trends have already been exhausted.”
It is necessary to reduce the impact of harmful behaviour
Just like the Czech Republic, other developed countries noted a significant decrease in the number of circulatory system diseases. However, as Professor Reuven Zimlichman, the Director of The Institute for Cardiovascular Research, Sackler Faculty of Medicine, Tel-Aviv University, pointed out, this trend has been stagnating since 2000. “If we wish to achieve a further decrease in numbers, we must search for innovative approaches to prevention,” professor claimed.
According to him, countries should take the path of harm reduction. People are often reluctant to change their habits, Zimlichman explained, and in such cases, the effort to reduce the harmful consequences of risky behaviour should be exerted. After all, such efforts can already be witnessed in several areas of everyday life, such as diet, tanning, excessive sweetening, or sex. The same can also apply to significant risk factors of cardiovascular disease, such as smoking.
“Alternatives to smoking are recognised in some countries as less harmful types of nicotine consumption and are established as a powerful complementary tool to existing tobacco control measures,” Zimlichman delineated. In terms of this claim, he pointed out countries such as Great Britain, which actively supports electronic cigarettes as a method helping smokers to quit, or the USA, where the Food and Drug Administration has already granted several alternative tobacco products the status of a Modified Risk Tobacco Product based on the available scientific evidence.
Legislation should consider various risk levels
In this respect, Andrzej Mariusz Fal, the President of the Polish Society for Public Health and the Head of the Department of Allergology, Lung Diseases and Internal Medicine, Central Clinical Hospital of Ministry of Interior in Warsaw, claimed that the current three pillars of tobacco consumption control policies, i.e. tax increase, smoking bans in public areas, and supporting to quit, have practically not moved Europe forward at all in the last fifteen years. “Therefore, the strategy of harm reduction could be the novel approach. Otherwise, we will just remain at the same level as in 2007,” Fal agreed with those who spoke before him. He also presented the recommendations of the Polish group of experts that considered heated tobacco products. According to it, when pharmacotherapy fails to help smokers quit, such products, which in comparison to cigarettes reduce the harmful consequences of smoking, could be placed at the end of the spectrum of interventions used to support smokers in quitting.
“Consequences increase with exposure. Therefore, programmes with the greatest benefit are those that focus on reducing the greatest number of risks,” the Director of the National Monitoring Centre for Drugs and Addiction, Viktor Mravčík, confirmed. According to him, it is therefore necessary to create a balanced mix of measures in healthcare policies, which would combine the lowest degree of exposure to risk factors while also having the greatest degree of well-being. This, in turn, should be considered by legislation. “Less harmful products should be subject to less regulation,” Mravčík stated.
According to the Vice Director of the General Health Insurance Company, Ivan Duškov, this is also a rather interesting topic for health insurance companies, who are the payers of healthcare. “The concept of harm reduction in smoking is certainly principal for us,” Duškov said.
Joining experts and politicians
Without exception, the participants of the conference agreed that it is primarily each person, and no one else, who is responsible for their own health. And health insurance companies are beginning to take this fact into account. “If we should be able to influence the behaviour of those participating in public health insurance, and we convince them to responsibly approach their health and to contribute to the costs that their behaviour generates, then we will significantly reduce healthcare costs,” the Director of the General Health Insurance Company, Zdeněk Kabátek, stated. According to him, it is high time to find a model, in which the client of the insurance company is more involved in caring for their own health. “Neither the government nor the insurance company is responsible for the health of the population. We should also project this fact into the manner of financing healthcare,” Kabátek said. Of course, this cannot be achieved without a thorough information campaign and the education of clients on how to better care for their health and reduce risky behaviour.
“It is necessary to find a suitable mix of prohibitions and motivations. The government should penalise less and support more. And to do this, it should utilise to a greater extent the helping hand that science and innovations hold out,” the Deputy of the Healthcare Committee of the Slovak National Council and former Slovak Minister of Health, Richard Raši, believed.
According to him, experts must seek out ways of translating their expertise, gathered evidence, and ideas to politicians. For instance, his parliamentary political party, HLAS, has included the principle of harm reduction in its healthcare programme. Connecting expert recommendations with the political establishment is not always easy. Therefore, Raši alleged that it would be conducive to develop international partnerships, in which experts and politicians could exchange information about which approaches work and have a positive impact on the economy. “This will then help us use better arguments for investing into prevention when creating state budgets,” Raši concluded.Director of the General Health Insurance Company Zdeněk Kabátek: “We must find a model that will induce clients to change their habits.“ ”In the case of smoking, if we remain at the level of primary prevention, we will be stuck,” says Andrzej Mariusz Fal, President of the Polish Society for Public Health and the Head of the Department Allergology, Lung Diseases and Internal Medicine, Central Clinical Hospital of Ministry of Interior in Warsaw. “The number of cardiology patients has stopped decreasing,” warns Aleš Linhart, President of the Czech Society for Cardiology and the Head of the Cardiology and Angiology Department of the First Faculty of Medicine of Charles University and the General Faculty Hospital. Director of the National Monitoring Centre for Drugs and Addiction Viktor Mravčík: “It is desirable to prioritise interventions that have the potential to bring about the greatest gains in terms of health.” President of the Czech Society for Oncology and Head of the Department of Oncology at the Second Faculty of Medicine of Charles University and Motol Faculty Hospital Jana Prausová: “Prevention is primarily the task of primary care, it would be impossible to do without it.“ President of the Czech Society of Atherosclerosis Michal Vráblík: “In this room, all of us have atherosclerosis.“ Director of the National Institute for Mental Health Petr Winkler (on the left): “Violent suicides are the cause of higher death rates than war conflicts.“ Head of the Association of Outpatient Specialists Zorjan Jojko: “I perceive the disinterest of patients as a great problem.” Director of the National Institute of Public Health Barbora Macková: “Every one of us must learn to care for their health.” Vice-Director of the General Health Insurance Company Ivan Duškov: “The concept of harm reduction in smoking is certainly principal, in my opinion.“ The founding member of the Association of General Practitioners Zdeněk Hamouz: “It is always true that anything that takes a long time causes a higher mortality.” From the left: Chairman of the Board of the Institute for Central Europe Martin Fedor, also former Ministry of Defence, who at 31 years of age became the youngest minister ever of Slovakia, just as his neighbour standing next to him, present Minister of Health Adam Vojtěch. Further on in the photograph is the Director of the Institute for Central Europe, Katarína Cséfalvayová, and the publisher of Zdravotnický deník, Ivo Hartmann „Covid exhausts the financial resources needed for prevention,” explains Czech Prime Minister Andrej Babiš. Slovak Minister of Health Vladimír Lengvarský: “We need to translate scientific findings into decision-making processes.” „We must eliminate formal measures of prevention that lead nowhere,” Anna Záborská, Vice Chairwoman of the Healthcare Committee of the Slovak National Council. „The government should penalise less and support more,” the Deputy of the Healthcare Committee of the Slovak National Council and former Slovak Minister of Health, Richard Raši, believes. Director of the Institute for Cardiovascular Research, Sackler Faculty of Medicine, Tel-Aviv University Reuven Zimlichman: “We must look for innovative approaches to prevention. One of them is minimising the risks of harmful behaviour.“
Photo: Radek Čepelák
Příspěvek We Are Facing a Pandemic of Lifestyle Diseases. We Need to Improve Prevention and Reduce the Risks of Harmful Behaviour, was the message of the Zdravotnický deník Conference on The Economics of Prevention pochází z Zdravotnický deník