01.07.2012 "Prevention measures always require careful weighing up of the demands of health protection and economic freedom."
Ursula Koch answers five questions. The Swiss government has prolonged the national prevention programmes on diet & physical activity, alcohol and tobacco until 2016. What does Ursula Koch, joint head of the National Prevention Programmes Division of the Federal Office of Public Health, think of this decision and of the role of prevention in our society?
The Swiss government has decided to prolong the national prevention programmes on alcohol, tobacco and diet & physical activity. Do you see this as a clear signal of the importance our government attaches to prevention?
Prevention is of great importance to health policy and the economy. The occurrence of cancer, diabetes, chronic respiratory diseases and cardiovascular diseases is on the rise. Combined with the growing ageing of the population, these diseases are huge challenges to the healthcare system. Non-communicable diseases are to a large extent due to lifestyle choices, i.e. they can be avoided if we take more exercise, follow a balanced diet, refrain from smoking and enjoy alcohol in moderation. This is precisely where the national prevention programmes come in: by reducing these risk factors, they help promote public health. They are therefore of great importance when it comes to ageing healthily. They meet international standards and have established themselves throughout Switzerland as an umbrella for a wide range of different prevention activities and players. The Swiss government has acknowledged the importance of prevention and, by prolonging the programmes, has opted for a sustainable prevention policy.
What are the most important goals to be reached in the next four years?
Prevention is always a long-term process. In order to ensure the necessary continuity, the structures and activities developed over the last few years will be continued. Our federalist system and its multiplicity of players mean that coordinating prevention activities is a major challenge. Prevention affects all areas of public life and requires a multi- and cross-sectoral approach (spatial development, business, education, sport, transport, safety, etc.). The particular focus of the next few years will therefore be on coordinating the different activities and players, implementing youth protection regulations and promoting projects in the different settings involved (schools, businesses, etc.). And informing and raising the awareness of the general public and the quality of counselling and treatment services will continue to be important focuses.
Proposals for various improvements have resulted from the evaluations of the national prevention programmes. What are the main improvements from your point of view?
Several months have passed since the programmes were evaluated, and many of the recommendations have already been implemented. For instance, the Tobacco Prevention Fund has been put under the strategic control of the tobacco programme, operational targets have been brought into line with the measures undertaken by the programmes on alcohol and diet & physical activity, and cooperation with the partners of the programmes has been stepped up. This means that in the last few years, all activities, campaigns and studies have been implemented on a basis of much broader support and in cooperation with our partners. We'll continue to work on steadily improving cooperation and promoting innovative approaches.
Prevention activities are often at odds with very real business interests – the tobacco and alcohol industries, for instance, but also food producers and retailers. How do the national prevention programmes handle this problem?
The FOPH's mandate is to promote, and where necessary protect, public health. Obviously, conflicts between the interests of health and commerce can arise. Prevention measures therefore always require careful weighing up of the demands of health protection and economic freedom. But we have to draw a distinction between the interests of the tobacco, alcohol and food industries and those of the economy as a whole. Because good health is absolutely essential for growth and productivity, the economy as a whole ultimately has an interest in a healthy population. This is why, in the field of addiction disorders for instance, we work very closely with businesses. Via the "actionsanté" platform in the framework of the diet & and physical activity programme, food producers and retailers voluntarily undertake measures to reduce salt, sugar and fat levels in foodstuffs. Moreover, we engage in regular discussions with industry federations.
A criticism we often hear is that of the "nanny state" issuing too many health warnings to the general public. How can prevention targets be reached without citizens feeling excessively controlled and hemmed in by commands and prohibitions?
Prevention aims to strengthen the health skills of the general public and to influence general conditions in such a way that healthy behaviour is possible. Genuine choice is an option only for those who are well informed. And I can genuinely engage in my choice of behaviour only if the conditions around me are right. Suppose you want to lose weight but you can't find healthy food in the supermarket or your canteen and you don't have access to parks or bicycle routes? Preventive measures are therefore multisectoral, i.e. they come into play at various levels such as spatial development, food product ranges (community catering) and road safety, and in various settings such as schools or businesses. They also promote early identification and early intervention services in the field of addictive disorders. Restrictions on the availability of harmful products or bans exist only in the area of youth protection or for the protection of other people, for instance the law on protection against passive smoking. All other measures aim to empower informed behaviour, enabling people to decide for themselves which products they want to consume or how they want to treat their own health.