(reporting from Barcelona) 

Is prevention a better cure ?

 Across all European nations and in the teeth of a global financial storm, governments are promising their electorates that health services ‘remain a top priority’.

It is not just in England that the words ‘ring-fenced’ and ‘protected’ are regularly repeated by legislators and policy developers across the political spectrum.

Such is citizens’ high regard for ‘their’ tax-funded health services that ‘the art of the possible’ meets the brick wall of voting power.

The words ‘reform’ or ‘transformation’ or ‘productivity’ are instantly howled down by the vast majority (and tabloid headline writers) who will tolerate no economic surgery at the surgery.

To protest that reform is required in the interests of those at present too young to vote is a short cut to politically-assisted suicide.

To proclaim that, as health budgets have grown by 4% per annum for a decade, that a reduction of 5% per annum for 5 years might now be justified, reaping the rewards of all that investment, is not a line that will earn applause at town meetings or televised debates.

But, even if changes are gradual and phased to align with economic recovery, the health services of Europe will still need transformation.

They will still need to adapt to the pressures of changing demographics, to the explosion of life-style-induced long-term health conditions, to the increasing shortage of wealth producers to support the armies of retired gentle-folk, and to maintain their world-class market-leading position in a technological race where the USA has at least twice the challenge but vastly greater resources for get-well plans.

So, instead of just trying to cope with an increasing burden it is timely to consider what can be done to take away much of the lower-level demands on the expert services of our health-care professionals.

We are already seeing a growth in health anxieties and hypochondria.  The balance between educating people to make a better job of their own well-being might too easily tip over into scares that simply make matters worse.  But this shift in the balance of effort, this recognition that we are all, to a greater or lesser extent, co-producers of our own well-being, is an area where we are likely to see a surge in technological resources and education.

On its own the trend towards better knowledge and increased personal responsibilities will still not be enough to save the budgetary bacon, but, in combination with a wider framework of ideas, fresh thinking and policy changes in many areas previously beyond the boundaries of health ministries, the policy makers of Europe can just catch a faint glimmer of hope.

So it was, I suggest, significant that the latest EC eHealth Ministerial Declaration was announced by Commissioner Neelie Kroes, vice president of the EC and with a wide-ranging portfolio for Europe’s digital agenda.

Just like the fragmented attempts of members states struggling to grasp the wider benefits of fibre access infrastructures (and bolstered in their ignorance by incumbents with most to lose) so the need for radical surgery of health services requires a multi-dimensional appreciation of the wider societal and economic impacts, and is equally up against those who would prefer that, if change must happen, it should happen very slowly.

“Time is not our friend” said Commissioner Kroes speaking in Barcelona earlier this week.

After 20 years of talking, the opportunities for further debate are nigh on exhausted.  This is why European projects such as Preve (for the prevention of disease) deserve not only the attention of European citizens but should also be a focus for technologists the world over.  There has never been a better (or more urgent) time to share ideas and consider health from viewpoints outside of the conventional agenda.

There is no shortage of evidence for wider action.  Different states and different cultures may have diverse health priorities but some fundamentals are clear.

The unhealthy disparities in income inequalities within states has been very clearly matched to health outcomes.   The scope for inducing new types of exercise-encouragement has come from the computer games and sports industries.  The wealth of on-line access to health information for young people that has now reached 40% of 13-25 year-olds in Sweden may perhaps reflect their enhanced local access infrastructures, but it’s a wake-up call to others to stop dithering about digital investment.

The determinants of healthier living are rooted un umpteen things that are well beyond the conventional responsibilities of health-care professionals and their immediate legislators.  The quality of food, community cohesion, transport, safety, education, research and economic drivers all need to be pulled together.   If not, the healthcare professionals will, for example, be stuck with dealing with Type II Diabetes simply because it was someone else’s job to stop selling junk food outside the school gates.

Even with this wider policy perspective there is no doubt that the complexities of an individual’s multiple long-term conditions – the balance of treatments and their varying impacts - will always call for a professional approach.  This does not however mean that General Practitioners must hang on to mundane tasks that are tackled more-effectively by other people and/or with technological support.

In the UK the real results of the Whole System Demonstrator programmes will (if not cut prematurely) begin to flow in 2011 and reveal both the direct and indirect benefits of more astute developments.   Just the reduction in anxiety levels (and economic deprivations) amongst family carers could be valued and used to partly offset the costs of better care for the elderly.

And, if during this transition some hospital wards have to close because they are no longer needed then, please, it should be cause for celebration.

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The author attended the World of Health IT conference 2010 in Barcelona and the 1st workshop for the PREVE project on the prevention of diseases.

The health impacts of income inequalities are discussed in 'The Spirit Level' by Wilkinson and Pickett (2009) and is available (now in paperback) via www.equalitytrust.org.uk

Further details of the PREVE project can be viewed at http://www.preve-eu.org/ 

The UK's Whole System Demonstrator projects are large-scale trial of telemonitoring systems for both health care and social care for the elderly.  Further details and reports can be found at the WSD Action Network

See also:  'Living Beyond our Means'