Prioritization in Health – How Can We Lift Prevention?

On January 25, 2023, the IANPHI European Network hosted a webinar on the prioritization of health promotion and prevention.

Limited resources and priority settings often result in treatment being prioritized over preventive interventions within healthcare services. Given the long-term benefits of health promotion and prevention, many National Public Health Institutes (NPHIs) are faced with a need – and a challenge – to strengthen such services.

In this webinar, NPHI leaders from Estonia, Sweden, Finland, Germany and the Netherlands shared the experiences of their institutes in steering systems to better take into account or reinforce health promotion and prevention on a national level, including securing resources within the budget process rather than prioritization on a lower scale.

An open discussion followed to share experiences and strategies related to specific challenges and opportunities to develop prevention system. Dr. Trygve Ottersen, executive director at the Norwegian Institute of Public Health and chair of the IANPHI European Network, moderated the event. 

Cross-Sectoral Prevention in Estonia: Prevention Council and Prevention Sciences Council

By Annika Veimer, Director, National Institute for Health Development, Estonia

See the slides

In Estonia, experts from different ministries and institutes as well as the private sector created the concept of cross-sectoral prevention in 2020. It is based on a 2016 analysis that confirmed that the country's prevention system was lacking in terms of coordination. It also found that prevention efforts were fragmented and that there was a lack of common understanding of prevention and agreement on standards for prevention intervention. In 2021, the Ministers of the Interior, Justice, Education and Science, Culture, and Social Protection met and decided to merge several entities to create a "Prevention Council", which would be tasked to adopt common principles and allow funding to be more easily directed to prevention efforts. 

Annika Veimer pointed out that prevention is more successful and effective when addressed with a similar perspective and common objectives. Therefore, in Estonia, the work of the Prevention Council is complemented by a Cross-Sectoral Prevention Task Force, which implements and evaluates interventions, and the Prevention Science Council, which supports evidence-based decision making. 

How Can We Lift Prevention? The Case of Sweden

By Dr. Anders Tegnell, Senior Advisor, Public Health Agency of Sweden, Sweden

See the slides

In Sweden, as in Estonia, many actors are involved in prevention practices, which represents a challenge for the coordination of policies and actions of prioritization and prevention in public health. Sweden has three levels of governance: the national, regional (21 regions) and municipal levels (more than 300 municipalities). Each of these levels has its own budget and prevention is managed by these three levels independently. 

The creation of the Public Health Agency, which took place just over 10 years ago by merging a number of different agencies, aimed to improve coordination in the areas of surveillance and disease prevention as well as prevention and health promotion, especially in the fields of mental health, substance abuse, and sexual and reproductive health. 

In Sweden, a model has been implemented in order to determine and identify which prevention measures should be implemented based on data collection and data analysis. Building models to measure impact data is important in convincing policymakers of the need for preventive interventions. According to Dr. Anders Tegnell, it is necessary to move away from the duality and comparison between preventive and curative measures, which are easier and quicker to show their effects, in order to be able to truly evaluate the effectiveness of prevention.

Prioritization in Health – How Can We Enhance Prevention? The Case of Finland

By Dr. Eeva Nykänen, Chief Specialist and Head of Team, National Institute for Health and Welfare, Finland

See the slides

Article 19.3 of the Finnish Constitution states that social rights are granted to all and public authorities shall guarantee adequate social and health services and promote the health of the population. It gives the Finnish Government a strong mandate to be active; however, the legislation emphasis has historically been primarily on the right to adequate services and not on health promotion. 

At the beginning of 2023, a major social and health care reform started to change the situation. It shifted the responsibility for organizing care from the municipalities to the counties’ wellbeing services to enhance prevention and strengthen the primary services. It also allowed the central government more control over the social and health care system, as it has the responsibility of funding the counties. Financial incentives will be provided to counties to implement prevention practices; the majority of grants will be allocated as needed; nevertheless, 1% of the total funding, what is called the Health and Wellbeing Promotion Coefficient, will be based on indicators that measure actual health promotion activities.  

Prioritization in Health Promotion and Disease Prevention: an Implementation Perspective

By Prof. Dr. Martin Dietrich, Acting Director, Federal Centre for Health Education (BZgA), Germany

See the slides

Health promotion is a multi-stakeholder effort and responsibility – and an ongoing challenge, not only during times of crisis but also in normal times. There are several aspects to the implementation of the responses of federal agencies and departmental research institutions: technical needs assessment, policy prioritization, legal feasibility within the federal government, administrative laws, and the budgetary framework.

Prof. Dietrich stated that the process needs to be transparent and take into account stakeholders’ views to ensure that the prioritization of prevention is accepted by all. Prioritization and the use of scare resources are closely linked.  From an economic perspective, cost effectiveness might be a good approach. To prioritize health promotion and disease prevention, greater effectiveness of interventions is essential. The use of a model to identify a causal link between an intervention and the improvement of health could be a way to show how interventions actually work. 

Intervention and Reaction of RIVM Representatives: What Works in the Netherland

By Marith Volp, Director of Public Health and Health Services, and Sten Zelle, Advisor on International Affairs for Public Health, National Institute for Public Health and the Environment (RIVM), Netherlands

In the Netherlands, a National Prevention Agreement has been in place for several years. The agreement covers three priority themes: smoking, alcohol and obesity. More than 70 national stakeholders signed the agreement, including the industry. Municipalities are responsible for most of the prevention work. The budget for prevention is determined nationally, and the implementation is done at the local level with local authorities and programs. 

Three strategies are used in the country:

  • Authorities use a health protection angle when creating prevention narratives – a way to remain sensitive to the government’s concerns of being accused of paternalism  
  • Prevention interventions are included in insurance schemes of the health care system. 
  • Integrated approaches and budgets are implemented at the local level, rather than disease-specific programs 

Discussion moderated by Dr. Trygve Ottersen

Panelists answered a question about the integration of environmental concerns in the implementation and evaluation of health promotion measures. They discussed the issue of the equity of prevention interventions and their proper distribution among populations in need. Webinar participants were also interested in learning more about the collection of the primary evidence for the effectiveness of health promotion and disease prevention interventions and the indicators that must be included in studies.  The need to focus on research and observation methods from an economics perspective was also discussed by the panelists. 

Dr. Ottersen announced that a follow-up webinar, organized by the network in March 2023, would take a closer look at the knowledge gap regarding public health and social measures. 

Writer: Philipine Colle. Editor: Marie Deveaux

Share This Story