01.05.2013 Health2020: a health-policy agenda with potential
The Swiss government's "Health2020" agenda is a comprehensive overview of current health-policy challenges and short and medium term priorities for action. Its implementation offers far-reaching opportunities for further developing healthcare delivery and also for moving forward on other important public-health concerns.
In spring 2012, Swiss government minister Alain Berset decided to have a health-policy agenda drawn up that would identify the key priority areas requiring action by 2020. It was intended to function as both a map and a compass, highlighting in equal measure the principal challenges and the government's responses to them in the form of concrete measures.
For this purpose, a group of experts – seven men and one woman – from a range of sectors concerned with health policy were asked for their assessments of the situation. They submitted their views on the main challenges facing health policy, the most important priority areas requiring action and the necessary short, medium and long-term measures. These inputs were then supplemented and prioritised in the course of three workshops, held within the federal administration, in which government minister Alain Berset and members of the management team of the Federal Office of Public Health (FOPH) also took part.
Four priority areas, 36 measures
Approved and published by the Swiss government in January 2013, the resulting document, "The Federal Council's health-policy priorities" (Health2020), reflects the diversity of topics, objectives and stakeholders involved. But the focus is always on people and their well-being – the needs of the population with regard to health and quality of life constitute the key, binding feature of "Health2020".
As the principal challenges facing the system, the document identifies the increase in chronic diseases, the need for change in healthcare delivery, the need to secure funding and the lack of manageability and transparency. These challenges are to be addressed in four priority areas: "Ensure quality of life", "Reinforce equality of opportunity and individual responsibility", "Safeguard and increase the quality of healthcare provision" and "Create transparency, better control and coordination". Three objectives will be pursued in each priority area, and each of these objectives will be achieved by means of three measures. Thus a total of 36 measures, with different time frames depending on their priority, are to be implemented by 2020.
Chronic disease, psychiatric disorders and addiction
The first two priority areas address issues that are of particular importance to public health. They include active support for health protection, health promotion and prevention, active bolstering of the position of patients in the healthcare system, promotion of health skills and the complex but important issue of social justice, which requires close collaboration between health policy makers and other political sectors.
Three measures have been assigned to objective 1.3: "Intensify health promotion and disease prevention". Firstly, activities focusing on prevention and early identification are to be improved in order to prevent non-communicable diseases. Thus "Health2020" supports the new viewpoint that the actual goal of prevention is not to bring about behavioural change per se, but to reduce the burden of disease. This measure follows on from the healthcare delivery objectives of "Health2020", i.e. that prevention services are to be integrated more closely into healthcare provision. Accordingly, the measure set out at the very beginning of "Health2020" to improve integrated provision will also include early identification and is explicitly justified by the increase in non-communicable diseases. The second measure listed under the goal of "Intensify health promotion and disease prevention" is the promotion of mental health and the prevention and early diagnosis of psychiatric disorders. This measure takes account of the fact that the increase in the burden of disease resulting from chronic conditions is partly attributable to the prevalence of mental illnesses, particularly depression. The third measure assigned to this objective is concerned with the prevention of addiction, of which it also highlights new forms, for instance to the Internet.
All three prevention objectives refer explicitly to the workplace or enterprises as settings, either in general terms in connection with promoting health at the workplace or more specifically to prevent people with mental problems from being removed from the employment process. With regard to addiction, the aim is to reduce the harmful consequences not only for the addicts themselves and the people closest to them but also for the workplace.
Equal opportunities and health skills
In the priority area of "Reinforce equality of opportunity and individual responsibility", the first measure, i.e. "Reinforce fair funding and access", is concerned particularly with strengthening vulnerable sectors of the population within the healthcare system. It will be achieved on the one hand by stepping up programmes such as those being implemented in the field of migration & health. On the other hand, in the medical and accident insurance system, greater account is to be taken of the individual's financial situation. The priority area of "Reinforce equality of opportunity and individual responsibility" comprises not only the objective of ensuring fair funding and access, but also those of "Keep health affordable by increasing efficiency" and "Empower insurees and patients". These objectives represent the view that not only a reasonable policy on costs that is predicated on improving efficiency, but also, for instance, the promotion of health skills are elements that together are essential for guaranteeing sustainable and fair access to the healthcare system.
Topics such as health promotion, prevention, early identification and social health determinants have also been accorded a place in the wide-ranging "Health2020" strategy. This represents a great opportunity to move forward in a large number of important health-policy issues.
Margreet Duetz Schmucki,Head of the National Health Policy Section, firstname.lastname@example.org