01.11.2012 "In the end, the Act foundered because of the government spending 'brake' mechanism, even though the bill itself enjoyed majority support."

Five questions for Felix Gutzwiller. The planned Prevention Act was definitively rejected by a small majority of votes at the end of September when the Council of States refused to loosen the spending "brake" mechanism (to allow redistribution of federal funds). The opponents of the Prevention Act feared new regulations, growing state interventionism and loss of cantonal power. We asked Felix Gutzwiller – professor of medicine, expert on prevention and FDP (Free Democratic Party) representative for Zurich on the Council of States – for his views on the background to this development.

Pictures "In the end, the Act foundered because of the government spending 'brake' mechanism, even though the bill itself enjoyed majority support."

TODO CHRISTIAN

State Councillor Gutzwiller, what does the outcome of this vote mean for you?

It is extremely unfortunate that the bill came so close to becoming law yet foundered in the end. After a first unsuccessful attempt in the 1970s/1980s, this is now the second time that efforts to create a more effective legal framework for health promotion and prevention have failed.

What enabled a majority opposed to the Act to win through in the end?

There were two main reservations about this Act in the eight years it took to develop it. One of them had to do with federalist anxieties ("the smaller cantons have always been against it despite a positive vote by the Swiss Conference of Cantonal Health Ministers"), while the other related to vague fears that this Act would lead to "growing state regulation and prohibition", even to standardisation of individual lifestyles, creating a kind of "menu fédéral". In addition, people – and the media too – did not look closely enough at the opposition's alliance "for a moderate  prevention". This alliance cleverly concealed the fact that the main opposition came from the cigarette trade, the catering sector and the SME association (the SGV), all of which represent clear special interests. And, unusual for the Council of States, no further fact-based arguments were presented in the final phase. In the end, the Act foundered because of the government spending "brake" mechanism, even though the bill itself enjoyed majority support. Paradoxically, the opponents thus ensured that the Federal Office of Public Health would retain approximately seven million francs that had actually been earmarked for transfer to the Health Promotion Switzerland foundation. So if the opponents had been ser­ious when they argued that certain campaigns should be taken away from the federal government, then there would have been all the more reason for transferring responsibility for them to Health Promotion Switzerland, as envisaged.

Why did the promotion of health equity meet with so little sympathy in the conservative camp?

Even in the conciliation committee convened to iron out differences, a member argued that the Act was basically about "social redistribution". This is a grotesque misunderstanding. Given that clear differences in life expectancy between the better and the less well educated sections of the population have been demonstrated in Switzerland too, one of the key tasks of the public sector – also from an ethical viewpoint – is to help promote health equity.

What effects will the outcome of the vote have on future prevention work in Switzerland?

We prevention specialists will certainly have to ask ourselves whether we created grounds for criticism and opposition and, if so, in what respect. Basically, however, we will continue to pursue a number of important goals of the rejected Act. I'm sure, for instance, that we can make further progress in coordinating various prevention activities involving the federal government, cantons, municipalities and private-sector health organisations. In addition, drawing up joint health goals for the country continues to be an important task.

What can prevention professionals and health politicians do better in future?

In the final analysis, the underlying reason for the defeat of the Prevention Act is probably the fact that, in Switzerland, health continues to be regarded as something best left almost exclusively to the individual citizen, and therefore the public sector is denied any legitimate right to play an active role in this area. So there will have to be a particular focus on making people understand the interaction between behavioural and structural prevention. This will perhaps help them see that contributing to the promotion of health equity is a legitimate and important function of the state.

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