Professor Helmut Brand, president of the European Health Forum Gastein (EHFG), Jean Monnet Professor of European Public Health and head of the Department of International Health at Maastricht University, The Netherlands. He serves on the European Advisory Committee on Health Research (EACHR) of WHO Europe and on the Expert Panel on “Investing in Health” (EXPH) for the European Commission.
Europe is undergoing a period of profound demographic change. Populations are ageing, fertility patterns are changing, modern living has impacted our habits, and consequently, there is an increasing prevalence of people living with one or more chronic disease. Cases of diabetes, for example, are expected to rise from 58.9 million cases in 2015 to 71.1 million by 2040. Today over 10 million people are living with dementia in Europe and it is set to double by 2050. All the while, governments struggle to manage health care spending as much of the continent recovers from the damaging global recession and faces a rising cost of treatments.
With so many potential stumbling blocks for European health systems, can we all truly access quality care?
I say we can. Demographics do not define Europe’s destiny. By proactively considering the challenges and seizing opportunities for new approaches to health care, we can influence our health outcomes for the better. A key lesson for individuals and governments alike: we stand to learn a lot from our neighbours. Working together, we can avoid reinventing the wheel, and promote a better understanding of health care at individual and community level to support health systems as a whole.
Mind the gap: measuring health system performance
Though each country starts from its own context and its health system serves a unique population, most have a similar end goal: well-equipped, efficient and sustainable health system to meet the needs of all citizens. As such, there is value to be derived from measuring how well countries are doing against comparable health indicators.
This is already well underway. In the recent report “So What?”, prepared by the European Commission Expert Group on Health System Performance Assessment (HSPA), the OECD, the World Health Organisation Regional Office for Europe and the European Observatory on Health Systems and Policies, the authors state: “Countries often benchmark with other countries. Whilst the challenges involved in these comparisons are well known, it is also evident that information deriving from international comparisons can provide the basis of further scrutiny and a deeper comprehension of the policies required to improve the status quo.”
Platforms such as the European Union and the OECD offer an excellent means by which governments can share where they are succeeding and where there are gaps. Which prevention tactics are effective in reducing childhood obesity? How can we improve outpatient care for the elderly? Particularly pertinent as government resources are challenged in keeping up with demographic change, this exchange of best practices can facilitate sound strategies for quality health interventions.
Such cross-border collaboration is also the objective of the annual European Health Forum Gastein (EHFG), taking place on 28-30 September. This year’s conference theme, Demographics and Diversity in Europe, places the focus on what new solutions for health one country can learn from the other, to better respond to demographic trends.
Close the gap: accelerating health literacy in Europe
Health literacy, the competence to understand and apply information to make decisions for health care, disease prevention and health promotion, remains a public health challenge in Europe. In the most recent publication of Health Promotion International, I discuss together with colleagues research that demonstrates health literacy on this continent is still at its infancy.
The ability for an individual and their community to be fully informed and engaged in their own care is a necessary step in tackling the burden of chronic diseases in Europe. Take diabetes for example. The HSPA report examines the incidences of hospital admissions for diabetes patients across Europe. Such acute deterioration in the health– such as cardiovascular, renal and neurological complications – is traumatic for patients, expensive for health systems, and often, avoidable.
An effective primary health care system should be capable of implementing a baseline of access to quality health care that prevents the emergence and progression of many major chronic diseases. But to respond to rising populations and limited health system resources, we must also strengthen what is below primary care – community level care. The more each patient, carer, and member of a community is empowered and involved in their own health care delivery and the greater the health literacy amongst the population, the better.
As highlighted by the European Patient’s Forum, empowered patients are part of the healthcare team, crucial for the performance of health care systems. This concept was explored in depth at last year’s EHFG, and is a discussion that will continue to be of pertinence to the Forum for the foreseeable future. A key recommendations of HSPA’s reports states: “In future, greater attention should be given to the assessment of patient experiences, such as patient reported experiences and patient reported outcomes. Health care in most countries is still not sufficiently patient-centred, despite the patients’ participation being increasingly emphasised in recent decades.”
Learning from our neighbours, whether they be neighbouring countries or neighbouring members of the community, will help us keep up with the health care demands of demographic change.
If you’ve ever seen the inside of a doctor’s office, never mind an operating room, you’re probably interested in healthcare. But how much do you actually know? Take this test based on the latest edition of the OECD’s Health at a Glance.
You’ll find all the answers here:
Today’s post is from Kate Lancaster, editor in charge of publications on social and financial issues and employment at the OECD.
Babylonians, Romans, Puritans did it,
Teens and queens and epicenes do it,
Let’s do it, let’s be resolved…
(apologies to Cole Porter)
For millennia, people have rung in the New Year with resolutions for self-improvement. Ancient Babylonians made promises to their gods, in particular that they would return borrowed objects and repay loans; Romans made vows to Janus, the deity whose two faces simultaneously looked back to the past and forward to the future. Puritans fasted, prayed and resolved to be free of sin in the year to come.
In the 21st century, the habit of making New Year’s resolutions is still going strong. The perennial favorites are saving money and losing weight, though the US government also includes drinking less, eating more healthily getting a better education or better job, improving fitness, managing stress, quitting smoking, recycling, taking a trip and volunteering on its list of popular resolutions.
If these are the areas in which we feel we need to improve, does this mean we are all overweight, in debt, under-educated, poorly employed, unfit, stressed-out smokers, without the time to take a vacation, do our part for the environment, or help others? What’s the real picture in OECD countries?
Health data reveal that we’re smoking less, with rates dropping about 20% during the last 10 years, in most countries. When it comes to alcohol, however, the picture is less positive. We may be smoking less, but we’re not necessarily drinking less too. The average rate of alcohol consumption in the OECD has gradually fallen during the past 30 years, but by how much varies widely from country to country, and drinking has even increased in places. We’re getting fatter too. Data show that more than 50% of adults are overweight or obese in 19 out of the 34 OECD countries and this is projected to rise to 65% or more in some OECD countries by 2020.
While our bodies might not be faring so well, our minds are. More adults than ever have at least a high school education in the OECD and the same is true for higher education. The rate of graduates has been steadily rising as well and today nearly 210 million people in OECD countries have completed a degree. For those finishing their education today, however, the job market is tough, as it is for those with lower levels of skills or long periods of unemployment. With 15 million more people unemployed today than five years ago, it’s clear that finding or changing jobs in today’s economic climate is challenging.
What about managing our money? If the crisis has showed us anything, it was that many of us need some financial education. The OECD is working on measuring what we know: the Programme for International Student Assessment (PISA), for example, is including financial literacy in its 2012 testing of 15-year-olds’ competencies. And the OECD and the International Network on Financial Education are collaborating on a portal for financial education information and resources.
So the picture is mixed as we start 2013… perhaps we need those resolutions after all. The real question is, perhaps, where is the data on keeping resolutions?
Gateway for Financial Education
This week the Insights blog will be focusing on health care issues. In this second post, we introduce evidence-based care.
My grandmother believed that tar fumes stopped kids catching colds, so if she saw road menders at work, she’d march me, my sisters and brothers and our friends over to breathe in the vapours.
We’d then have to huddle around a steaming dollop of bitumen, arms flapping to help the lungs pump the goodness into our ventricles, like a flock of baby seagulls stuck in an oil slick.
A woman who thought that pigs could see the wind probably wasn’t the best source of advice on health (or anything else), and a carcinogenic mixture of 10,000 chemicals, half of them unidentified, probably not the best prophylactic around, but the wisdom of the ancients is not the only knowledge that seems bonkers in retrospect. Mainstream medicine has had its share of dubious treatments too.
Not just dubious. The aptly named To Err is Human report from the US Institute of Medicine in 2000 estimated that medical errors killed more people than traffic accidents in the US.
Of course, with millions going to see the doctor every day, even a tiny fraction of mistakes soon adds up to a startling sum, but the problem isn’t just a slip of the scalpel or an illegible prescription. Another report estimated that up to a third of treatments had no real clinical effectiveness.
To the layperson, this is astonishing. How on Earth were the doctors deciding on treatments? Rolling dice? In fact, they were applying what they’d learned at medical school and best practice as it evolved. (more…)