Healthcare is not just about making sick people healthy, but also about not making the healthy sick for as long as possible. Petr Fifka, deputy chairman of the Health Committee in the Czech Parliament’s Chamber of Deputies, said this at the opening of the 3rd annual international conference of the Healthcare Daily „Economics of Prevention“. It is necessary to prolong people’s lives in full health, not only physical but also mental, Marek Krajčí, chairman of the Slovak parliamentary health committee and former minister of health, stressed in his lecture on the prevention of health risks in Slovakia.
He added that economics is clearly linked to prevention. „Although the Czech Republic is at the top of Europe on many issues related to the prevention of health risks, we are not nearly as good on many others. We have a high prevalence of diabetes, cardiovascular diseases and the rate of morbidity is far higher compared to developed Western European countries,“ Fifka said, adding that this leads to economic losses, both because of the state expenditure needed to treat sick people, but also because the disease affects people of working age, preventing them from working and making a profit.
Marek Krajčí, chairman of the parliamentary health committee and former Slovak health minister, who joined the conference remotely from Bratislava, agrees with these points. He added that the Czech Republic is slightly better off than Slovakia in terms of statistics on avoidable deaths, but the numbers in both countries are above the average of the European 27.
Habits matter more than healthcare
Many people still die from preventable causes – mainly from coronary heart disease, lung cancer, the effects of alcohol, vascular disease and accidents, including road traffic accidents. Marek Krajčí pointed out that, according to a study by Globsec, up to 40% of premature deaths in European countries are due to lifestyle-related factors. The health care provided contributes only 10% to the overall health of the population.
Krajčí also expanded on Fifka’s claim about the economic losses in the absence of prevention: „People in Slovakia live to the age of 56 in full health. The growing proportion of the population that is too old and the increasing life expectancy make our health systems unsustainable in the long term.“ He believes that people need to live longer in full health, not only physically but also mentally. „This will come back in higher labour productivity, saved resources for health care, and higher citizen satisfaction,“ the MP summarised.
He added that up to 58 percent of the morbidity and mortality rates in Slovakia are influenced by factors that are not directly related to the health system. These are mainly unhealthy diet, smoking, air pollution, alcohol and low physical activity. Krajčí thus confirmed what many other participants of the conference also outlined – the state has a role in disease prevention, but the crucial thing is people’s attitude to their own health.
Inefficient public investments
Prevention is, or should be, handled by many actors at different levels. „In the European Union, there is the EU4HEALTH programme, which was adopted in response to the covid-19 pandemic. This highlighted the fragility of national health care systems,“ said ex-minister Krajčí. The programme focuses on health promotion and protection, international campaigns, prevention of diseases, especially cancer, and improving the quality of medicines. The European Union has earmarked a budget of €5.3 billion for it.
„At national level, it is often said by politicians and other public officials that the prevention of health risks must be a priority. However, in relation to total health spending, we invest less than 1 percent of our finances in it. The rest of the money is spent on treating people who are already sick,“ Krajčí said. According to him, the financing of prevention should be reflected in the health budget as well as in the budget of education and social affairs, which are involved in prevention. According to calculations, 1 euro invested in prevention will save the state 4 to 10 euros later.
The Slovak Republic collects more than €1 billion a year in taxes on alcohol and tobacco, equivalent to about one percent of gross domestic product. Yet very little of this money is spent by the government on prevention of alcoholism, smoking and other negative phenomena. There are several national prevention programmes, but Krajčí said it is crucial that they do not just remain on paper.
Checkups, screening, vaccination, media
Different actors in prevention have their own roles. In Slovakia, interest in preventive check-ups has increased significantly in recent years. Krajčí thinks that one of the reasons for this is the bonuses given to health insurance companies‘ clients who undergo all the prescribed preventive examinations. Speakers at the conference agreed that the best way to motivate people is financially – i.e. by waiving fees, the possibility to undergo some examinations and therapies free of charge, gifts and other benefits.
Krajčí agrees that insurance companies need to have legislative powers to target primary and secondary prevention based on data on the health status of their insured people. Secondary prevention consists mainly of early detection of diseases, and screening is an important tool for this. These are a collaborative effort between promoters, insurers and care providers. In Slovakia, invitations to citizens in the at-risk age group to participate in screening are in place.
Another important part of prevention is vaccination. A few months ago, the National Council of the Slovak Republic succeeded in pushing through the possibility of vaccination in pharmacies, for the time being it is adult vaccination against influenza. „I believe that shorter patient journeys and increased access to vaccines will increase influenza vaccination rates among the at-risk population in Slovakia in the coming years. The network of vaccination pharmacies can also help in the event of a new pandemic,“ the MP noted.
Disease prevention is also influenced by the media and social networks. „Examples attract,“ Krajčí said. This can be seen, for example, in a TV show in Slovakia called Extreme Makeovers. In it, they help morbidly obese people lose weight and show a year of their journey to a healthier life.
Is physical education the solution?
However, this brings us back to the role of the individual – it is up to the individual to change their lifestyle and work on improving their own health. „Politicians often convince people that the government will take care of them, even in the area of health. However, the government should not take responsibility for the irresponsible actions of an individual,“ the MEP argues. Similar slogans about a helping state in Slovakia can also be seen on billboards ahead of the parliamentary elections on 30 September. However, Krajčí said that every individual should take responsibility for his or her diet, exercise and lifestyle. This is where educating children about healthy habits is already important.
On the physical activity of children Krajčí says: „It is a shame that although Slovak MPs, after long and serious discussions, approved a mandatory third hour of physical education in schools, the Ministry of Education has abolished this obligation for schools by internal regulations.“ The topic of physical education in schools was addressed by several speakers at the conference, but it is a more complex issue.
The problem of sports infrastructure in Slovakia does not only lie in the lack of playgrounds, but many schools do not even have a gym. Organised sport in sports clubs is unaffordable for many families. Schools are given a certain pool of teaching hours in each year group, and they do not want to give pupils more hours of PE at the expense of languages, mathematics or science.
Another problem, also highlighted by conference participants, is that in recent years sometimes more than half of the pupils in a class are purposely exempted from PE. Children are not used to moving around and it is a problem of lack of motivation of both children and teachers, as physical education is not a priority in schools. In many cases it is taught in such a way that the teacher lets children play a ball game for a whole lesson, which may not be fun for all children, and those who are not good at it can easily become demotivated.
Lucia Hakszer
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.
