Prevention is better than cure
Health policy, at a national and pan-European level, is still failing to focus on prevention and promoting healthy living – claims Annika Ahtonen
European citizens value health as the basis for well-being. The European Union and member states want people to be healthy because it can bring significant economic and welfare gains for societies. Healthy workers are likely to be more motivated, productive and innovative than colleagues in ill health. Healthy people contribute to society and can save their own and the public sector's money when it comes to things like social services.
So why do preventable health problems such as chronic illnesses - including heart disease, cancer, respiratory disease and diabetes - continue to cause 86 per cent of deaths and 77 per cent of the disease burden? Most of these illnesses could be prevented by maintaining balanced vitamin, mineral and hormone levels - and by tackling unhealthy lifestyles like smoking, bad diets, harmful use of alcohol and physical inactivity. So what more could be done to fight these costly diseases that lead to early retirement, sick leave and poor educational or work achievement? And what role could the EU have in health promotion?
At the moment, only 3 per cent of member state healthcare spending goes to disease prevention. Therefore, the first step would be to encourage authorities to widen their focus from treating diseases to also promoting good health. Although health systems are a national responsibility, the EU's European Semester - which helps to coordinate member states' macroeconomic, budgetary and structural reform policies - can provide an efficient peer-review mechanism for policies. And the EU Directive on Patient's Rights in cross-border healthcare could also play a role in strengthening cooperation. Member states must share knowledge and experience in - for example - empowering personnel to promote health, reimbursement practices and approving, pricing and tackling barriers to the uptake of new products such as biosimilars.
The initial costs and possible long-term investments frighten decision-makers, who want to see results during their mandate. They need politically-attractive incentives to invest in prevention and health promotion. The EU could support this by using qualitative and quantitative policy evaluation tools such as health-impact assessments and cost-benefit analyses, which help to calculate the direct and indirect costs of preventable diseases and benefits of health promotion to society. It is easily forgotten that health is influenced by various factors from education to urban planning and, in fact, some of the most effective measures are taken outside the health sector. In accordance with the Lisbon Treaty, the EU must ensure that its policies that can influence agriculture, transport, employment, environment, taxation and regional development - do promote healthier lifestyles. The EU has to promote a cross-sectoral policy approach.
Once it does this, the EU will provide a strong incentive to the private sector to join in – including the food industry, retailers, advertising, recreation businesses, insurance groups, pharmaceutical companies and the media. Such promotion could become an important source of income and economic growth, if the policy framework and public procurement encouraged industry to develop products and services for a healthier society. Secondly, more emphasis must be put upon changing people's attitudes and behaviour. Although people value health as a key component of well-being and understand the risks of unhealthy behaviour, there is a conflict between attitudes and action. Knowledge does not automatically lead to behavioural change, such as a lasting change in diet. It is difficult to change learned behaviour and people tend to discount future benefits such as losing weight. The EU should develop policies and an environment that help to support behavioural change, while encouraging member states to do the same.
Much more discussion at EU and national level is needed about effective ways to influence behavior. These can include, for instance, having an influential source of information - like children telling their parents of the risks of smoking, incentives that increase personal benefits, influencing the social network - family and friends - and changing default options such as the meal of the day into a healthier option and ensuring that infrastructures support healthier lifestyles. In addition, the EU should use its legislative tools including advertising restrictions on unhealthy products, regulating salt and fat content and food labeling to help consumers make healthier choices. Unhealthy diets worsen obesity, diabetes and heart diseases and it is important that marketing does not mislead consumers. Europeans need accurate, standardised and comprehensible nutritional information - and a holistic understanding of a healthy, balanced diet.
The importance of prevention and health promotion is recognised at EU-level, in the Lisbon Treaty, health strategy and the European innovation partnership on active and healthy ageing. The framework for action exists, and the EU must develop and make a full use of the means at its disposal in order to create an environment - which supports healthier choices, making them more accessible, affordable and attractive. Health promotion could be an investment with significant economic and welfare gains for Europe and its citizens.
Annika Ahtonen is a policy analyst at the European Policy Centre think-tank