All this week, Debating Europe will be publishing a themed series of posts looking at the issue of health and wellness in Europe. With healthcare budgets increasingly coming under pressure, it’s important to look at ways to maintain public health without breaking the bank. Our previous post in this series looked at the problem of obesity in Europe, and today we’ll be looking at ways to encourage a greater focus on prevention instead of crisis-management.

In one of our earlier debates on the future of healthcare in Europe, we had a comment sent in from David that painted a particularly bleak picture:

I am pessimistic about the future of EU healthcare. Doctors’ offices will overflow as populations age, with less time for proper diagnoses, while writing prescriptions for pharmaceuticals will be the easiest solution to ease the backlogs. So we will have more pharmaceuticals covering up early diagnoses until crises turn individuals into patients in the medical system.

We took this comment to Michèle Rivasi, an MEP from France who sits in the Greens–European Free Alliance group in the European Parliament, for her to responsd.

Is it too late to avoid the rather bleak scenario that David paints in his comment? Or could better public health be achieved for cheaper if there was more of a focus on healthy living, regular excerise and balanced diets? We had a comment along these lines sent in from Peter, arguing that:

We all by now see the benefit of moving from a focus on disease care to maintaining health and wellness. Now we have to design a new model with a new role for the health care sector, one that moves beyond saving lives in a crisis…

But if everybody already accepts the benefits of such an approach, why hasn’t it happened yet? To get a response to this question, we spoke to Walter Ricciardi, President of the European Public Health Association (EUPHA), an umbrella organisation for public health associations and institutes in Europe.

Peter is absolutely right, and this is happening because the care in health services is doctor-centred rather than patient-centered. This means that doctors have been trained to wait until patients are sick, and wait until they come to hospitals to seek treatment. And this model is, with the increase in life-expectancy, not affordable anymore; now that we regularly have patients who are 80 or 90 years old with multitple diseases, this is unsustainable. Even the richest countries in the world cannot afford this.

To get another perspective, we also put Peter’s comment to Andrzej Jan Rys, the Director of Health Systems and Products at the European Commission. Why haven’t European countries moved towards a focus on prevention yet?

I think we are still in a transition period. On the one hand, we know already that prevention works. On the other hand, we also know that it’s very difficult to introduce this concept into daily life and into health systems without appearing to interfere in people’s private lives. There is a difficult public debate about the role that the state and local government can play here; there is, of course, the famous idea of the ‘nanny state’ telling its citizens how to live their lives.

There are some parallels with public health debates in the past. In the 18th and 19th centuries, when doctors started promoting the importance of public hygiene, including clean water, sanitation and sewage systems, it was a revolution. In the 21st century, we are in a similar situation, except instead of hygiene and sanitation we are talking about alcohol consumption, smoking, diet, physical exercise, etc.

At the moment, less than 3% of total healthcare budgets in Europe are being spent on prevention, and the big question is how and where we should be spending money in order to encourage a greater focus on prevention, which would ultimately save us money in the long-run.

We also had a response to Peter’s comment from John F. Ryan, acting Director of Public Health at the European Commission, who warned that governments shouldn’t automatically go for the ‘low-hanging fruit’ of health promotion campaigns if they are cutting healthcare budgets.

If countries are undergoing financial difficulties, prevention activities can seem like a very low-hanging fruit. It might be tempting to cut back on health promotion campaigns rather than, for example, closing an emergency ward in a hospital. These are tough choices, but from the perspective of the Commission, we think this approach is likely to lead to a much greater long-term burden on the population.

Finally, we spoke to Richard Seeber, an Austrian MEP with the centre-right European People’s Party group and a member of the Committee on the Environment, Public Health and Food Safety in the European Parliament. He made the important point that healthcare is largely a national competence, though there are still areas where the EU can play an important role.

What do YOU think? Is it possible to promote better diets, regular exercise and healthy living without ‘nannying’ people and intruding into their personal lives? At the moment, less than 3% of total healthcare budgets in Europe are being spent on promoting healthier lifestyles. Is this enough, or would healthier living save us money in the long-term? Let us know your thoughts and comments in the form below, and we’ll take them to policy-makers and experts for their response.