Newsletter Prevention and Health Promotion May 2013 spectra 98

Health policy

2 Interview with Alain Berset Federal Councillor Alain Berset regrets the rejection of the Prevention Act by Parliament. But he views it as an opportunity to think about new, integrated models that enjoy the support of all major stakeholders within and beyond the healthcare system. The Swiss health minister talks to spectra about the "Health2020" strategy, prevention, the division of responsibilities between the federal government and the cantons, and transparency and manageability within the healthcare system.

3 Health2020 The Swiss healthcare system is in relatively good shape. But it faces major challenges in the coming decades, for instance the growing number of elderly people and the increase in chronic diseases, or the continual rise in healthcare costs due to demographic change and advances in medical technology. The "Health2020" strategy approved in January is designed to gear the Swiss health­care system optimally to these challenges.

4 Break the chains Gays and other men who have sex with men (MSM) protect themselves against HIV to a better than average extent and have themselves tested regularly. Nevertheless, there is a disproportionately high number of infections in this group. In the gay community, HIV is often transmitted within supposedly safe sexual-partner networks by individuals who have themselves just contracted the virus. The viral load in this first phase of infection is extremely high. The devastating consequence is that the virus spreads rapidly. In order to sever the links in this chain of infection, the "Break the chains" campaign is being run this spring for the second year in succession. Health minister Alain Berset: "We have to create an environment that makes healthy behaviour easy."

Interview with Federal Councillor health of people living in Alain Berset. In January, the Swiss much more effectively. government approved the "Health 2020" strategy – a health-policy At the press conference held to agenda focusing on four action launch "Health2020", you areas and 36 measures to be described our healthcare system implemented in stages. Health as lacking transparency. One minister Alain Berset talked to way of improving transparency spectra about the role of preven- is to collect statistical data. Are tion in this comprehensive over- you prepared to create the view of health policy, about state statutory and financial frame- responsibility and self-responsibili- work for such action? ty, the federal nature of the health- The OECD and the WHO rate our health- care system and the importance of care system as being of very high qual- cooperation within and between ity, but see a need for action in the areas the main departments of govern- of manageability and transparency. This ment in promoting and safeguard- is also our view, and we've therefore in- ing public health. cluded these two concerns in the com- work at both these levels, people will be "Health2020" is a comprehensive strat- prehensive "Health2020" overview. One spectra: The "Health2020" able to choose and implement the egy that enables us to gear our health- of the measures envisaged will expand strategy paper demonstrates the healthy option. But in the end, of course, care system to the challenges facing it and improve the basic data available great importance you attach to it's up to them to do so. And that's in the next few years and to further im- and its analysis. Another measure will prevention. Prevention could where self-responsibility is needed. prove it. The strategy is based on a total introduce new steering instruments, for also be the key to achieving the of 36 measures affecting all sectors, instance in the field of outpatient care, target of a 20 percent saving in Health is a cantonal responsibil- and we aim to implement them gradu- enabling the cantons to avoid any sur- healthcare costs. How do you ity. This historical tradition of ally. We shall, of course, communicate plus or shortage of services in this area. intend to strengthen prevention federalism is creating a Swiss all important steps and decisions in de- To obtain greater transparency and efforts in the future, particularly health maze. In what areas tail, while also placing each of them in more efficient control of the healthcare after the rejection of the Preven- would you, as Swiss health the context of "Health2020". In this system, there is a need for even better tion Act? minister, like to have more way we can highlight the effect they will data and for simplification, but also for Federal Councillor Alain Berset: The control? Where should the have on the healthcare system as a new statutory steering instruments. new Prevention Act came to grief in Par- federal government be given whole. The individual measures are liament because there wasn't a majority additional powers? coordinated and complement one an- The use of modern electronic in favour of the funding arrangements. Generally speaking, the division of re- other. In addition, the FOPH will also media is intended to improve Though regrettable, this creates an op- sponsibilities between the federal gov- report regularly on the progress being the quality of healthcare delivery portunity for us to think about new, inte- ernment and the cantons makes good made in the implementation of "Health and reduce costs. The statutory grated models. We can work with our sense in many areas of activity. Our task 2020". framework for e-health is in the partners to draw up a long-term strategy is to develop national strategies and to preparation phase. What bene- that enjoys wide support. But we need to support and coordinate the activities of On page 7 of the document, the fits do you hope to gain from have all players in the healthcare system the cantons in the different areas. As be- Swiss government admits that these innovations? on board. Last autumn, the Swiss gov- fore, the cantons will be able to develop 60 percent of the factors that The use of electronic tools, particularly ernment (Federal Council) prolonged the solutions that are tailored to their spe- influence public health are the electronic patient record, will im- three national prevention programmes cific needs. In many areas at the present beyond the remit of the health- prove the quality of treatment. It means on "Tobacco", "Alcohol" and "Diet and time, the powers of control and enforce- care system. The goals and that all the players involved in the treat- Physical Activity" until 2016. These pro- ment are divided between the federal measures are disease-oriented ment of a patient are more fully in- grammes ensure continuity in our pre- government and the cantons. But we al- and designed for the sole formed and can coordinate it more ef- vention policy. But we need to gear our so have joint powers and responsibili- purpose of improving the actual fectively. healthcare system even more effectively ties in areas such as healthcare provi- healthcare system. Why hasn't to the steady increase in non-communi- sion funding and education. In some of the Federal Council made cable diseases. We're currently drawing these areas we still lack shared health- cooperation within and between up a strategy to meet this need. policy steering instruments, an exact the main departments of govern- definition of the respective tasks, and ment a priority in efforts to Prevention has to seek a balance coordination bodies with which we can improve equality of opportunity between the responsibility of shape our cooperation more efficiently. and quality of life? the individual and the state's We're working together here to find so- Such cooperation is key, so we're also Talking to spectra: mandate to protect public health. lutions. giving it more attention. Unlike other Federal Councillor Alain Berset, Head of What role do you see for the countries, Switzerland possesses a large the Federal Department of Home Affairs Federal Office of Public Health The public basically appreciates number of harmonisation and coordina- (DHA) and also Switzerland's Minister of (FOPH) between these two poles? our healthcare system. However, tion instruments within the Federal Ad- Health. The 41-year-old -born, The FOPH has always focused on two there's a need for improvement ministration – for instance interdepart- Social Democrat politician was elected approaches in its prevention activities. in all areas, and the Swiss mental working groups, the General as a member of the Swiss government in On the one hand, it aims to provide peo- government is tackling them in Secretaries Conference, or the office December 2011, succeeding Micheline ple with specific information on how the "Health2020" reform project. consultation or joint reporting proce- Calmy-Rey. He sat in the Council of they can protect their health. This ap- The four defined priority areas dures which, prior to decisions being States (upper chamber of the Swiss proach covers a wide range of concerns concern the very core of the taken by the Federal Council, enable parliament) from 2003 to 2011, serving such as diet and physical activity, but public health sector. But they are other government departments to ex- as its president in 2008/2009. Alain also protection against infectious dis- abstract and therefore require press their views on specific proposals. Berset studied political sciences at the eases or how to deal with addictive sub- easy-to-understand background Here we must and will be more pro­ University of Neuchâtel and was stances. On the other hand, we have to information and convincing active, but we can also build on what is awarded a doctorate in economics in create an environment that makes advocacy. Is a communication already in place. Obviously, if we gain 2005. Before being elected to the Federal healthy behaviour easy. If somebody concept envisaged for the the support of other sectors such as Council, he worked as an independent wants to eat healthily, what's the point implementation of the new spatial development, transport, sport or consultant on strategy and communica- if they are unaware of, or cannot obtain, priorities of the Swiss govern- mobility for measures that promote tion. He is married with three children. the appropriate products? If we do good ment's health policy? public health, then we can protect the

2 spectra 98 May 2013 Health policy Health2020: a health-policy agenda with potential At first hand In January 2013, the Swiss government The Swiss government's approved a health-policy agenda not "Health2020" agenda is a compre- previously seen in this form in Switzerland. hensive overview of current health- "Health2020" presents the first-ever com- policy challenges and short and prehensive strategy for the Swiss health- medium term priorities for action. care system. It identifies the challenges Its implementation offers far-reach- facing the healthcare system and defines ing opportunities for further the health-policy goals resulting from these developing healthcare delivery and challenges, and the measures that will also for moving forward on other have to be adopted between now and important public-health concerns. 2020. The aim is to enhance quality of life and equality of opportunity for the popula- In spring 2012, Swiss government min- tion as a whole, promote standards of ister Alain Berset decided to have a healthcare delivery and further improve the health-policy agenda drawn up that transparency and manageability of the would identify the key priority areas re- system. quiring action by 2020. It was intended to function as both a map and a com- "Health2020" provides direction for all pass, highlighting in equal measure the those involved in shaping the healthcare principal challenges and the govern- system. It confers a level of commitment ment's responses to them in the form of that will be very important for health policy concrete measures. in the next few years. Though fleshing-out For this purpose, a group of experts – of the individual measures is still at differ- seven men and one woman – from a ent stages, the strategy now lays down in range of sectors concerned with health clear terms where the journey is headed policy were asked for their assessments and what action has to be taken. of the situation. They submitted their port for health protection, health pro- aim is to reduce the harmful conse- views on the main challenges facing motion and prevention, active bolster- quences not only for the addicts them- If we succeed in implementing all the health policy, the most important prior- ing of the position of patients in the selves and the people closest to them measures set out in "Health2020", we will ity areas requiring action and the neces- healthcare system, promotion of health but also for the workplace. have realised many of our health-policy sary short, medium and long-term skills and the complex but important visions by 2020. Switzerland will then have measures. These inputs were then sup- issue of social justice, which requires Equal opportunities a tangibly better healthcare system. plemented and prioritised in the course close collaboration between health poli- and health skills of three workshops, held within the fed- cy makers and other political sectors. In the priority area of "Reinforce equal- But this is going to take a great deal of eral administration, in which govern- Three measures have been assigned to ity of opportunity and individual re- work and dedication. There will have to be ment minister Alain Berset and mem- objective 1.3: "Intensify health promo- sponsibility", the first measure, i.e. "Re- close cooperation with all stakeholders, bers of the management team of the tion and disease prevention". Firstly, ac- inforce fair funding and access", is first and foremost the cantons.There will Federal Office of Public Health (FOPH) tivities focusing on prevention and early concerned particularly with strengthen- be a greater need to share and cooperate also took part. identification are to be improved in or- ing vulnerable sectors of the population with other sectors. As a comprehensive der to prevent non-communicable dis- within the healthcare system. It will be strategy, the agenda attaches great impor- Four priority areas, 36 measures eases. Thus "Health2020" supports the achieved on the one hand by stepping tance to areas such as social issues, Approved and published by the Swiss new viewpoint that the actual goal of up programmes such as those being im- education, work, the environment, re- government in January 2013, the result- prevention is not to bring about behav- plemented in the field of migration & search, innovation and also exchanges at ing document, "The Federal Council's ioural change per se, but to reduce the health. On the other hand, in the medi- the international level. health-policy priorities" (Health2020), burden of disease. This measure follows cal and accident insurance system, reflects the diversity of topics, objectives on from the healthcare delivery objec- greater account is to be taken of the in- The population as a whole – or, depending and stakeholders involved. But the focus tives of "Health2020", i.e. that preven- dividual's financial situation. The prior- on the context, insured persons or patients is always on people and their well-being tion services are to be integrated more ity area of "Reinforce equality of oppor- – will also be key partners in the task of – the needs of the population with regard closely into healthcare provision. Ac- tunity and individual responsibility" implementing "Health2020". to health and quality of life constitute cordingly, the measure set out at the comprises not only the objective of en- the key, binding feature of "Health2020". very beginning of "Health2020" to im- suring fair funding and access, but also The publication of this first comprehensive As the principal challenges facing the prove integrated provision will also those of "Keep health affordable by in- strategy for the Swiss healthcare system is system, the document identifies the in- include early identification and is ex- creasing efficiency" and "Empower in- a significant milestone. But there is a lot of crease in chronic diseases, the need for plicitly justified by the increase in non- surees and patients". These objectives work to be done and it is only just begin- change in healthcare delivery, the need communicable diseases. The second represent the view that not only a rea- ning – the 36 measures have to be imple- to secure funding and the lack of man- measure listed under the goal of "Inten- sonable policy on costs that is predicat- mented. The objectives of "Health2020" ageability and transparency. These sify health promotion and disease pre- ed on improving efficiency, but also, for can be achieved only if the strategy is challenges are to be addressed in four vention" is the promotion of mental instance, the promotion of health skills shaped and carried by all the partners priority areas: "Ensure quality of life", health and the prevention and early di- are elements that together are essential involved. "Reinforce equality of opportunity and agnosis of psychiatric disorders. This for guaranteeing sustainable and fair individual responsibility", "Safeguard measure takes account of the fact that access to the healthcare system. and increase the quality of healthcare the increase in the burden of disease re- Topics such as health promotion, pre- provision" and "Create transparency, sulting from chronic conditions is partly vention, early identification and social better control and coordination". Three attributable to the prevalence of mental health determinants have also been ac- objectives will be pursued in each prior- illnesses, particularly depression. The corded a place in the wide-ranging ity area, and each of these objectives third measure assigned to this objective "Health2020" strategy. This represents a will be achieved by means of three is concerned with the prevention of ad- great opportunity to move forward in a measures. Thus a total of 36 measures, diction, of which it also highlights new large number of important health-policy with different time frames depending on forms, for instance to the Internet. issues. Stefan Spycher their priority, are to be implemented by All three prevention objectives refer ex- Vice-Director 2020. plicitly to the workplace or enterprises Link: Federal Office of Public Health as settings, either in general terms in www.bag.admin.ch/gesundheit2020 Chronic disease, psychiatric connection with promoting health at the disorders and addiction workplace or more specifically to pre- Contact: Margreet Duetz Schmucki, The first two priority areas address is- vent people with mental problems from Head of the National Health Policy Section, sues that are of particular importance to being removed from the employment [email protected] public health. They include active sup- process. With regard to addiction, the

spectra 98 May 2013 Health policy 3 "Break the chains" to reduce HIV infection

Gay community. Avoid all risk of tive findings: the campaign was well un- the later stages of the infection. Many to get tested and counselled at a Check- infection in April and then take an derstood, and 17 per cent of interview- MSM belong to informal networks of point in May, together with any sexual HIV test in May with the partners ees stated that, on account of "Break the parallel sex partners. Trustful relation- partners with whom they subsequently with whom you usually have Chains", they wanted to take an HIV test ships develop within these networks, want to resume unprotected sexual rela- unprotected sex: this is the mes- or had already done so. But what is i.e. the conviction that all members are tions. If there are no fresh cases of HIV sage of the "Break the Chains" "Break the Chains" all about? HIV-negative or are being successfully infection during the period of one campaign, which is being run this treated. But if one member of such a month, infections that have occurred spring for the second time. The High viral load among MSM network contracts HIV, the virus spreads previously can generally be detected aim of the campaign is to break the Gay men and other men who have sex rapidly throughout the entire group dur- and chains of infection broken. This also chains of infection among men with men (MSM) protect themselves ing the primary HIV infection phase. means that the community viral load is who have sex with men. against HIV to a better extent than the This threat is aggravated by the fact reduced, which lowers the likelihood of general population, and have them- that, according to Gay Survey, there has encountering anyone who, without "Break the Chains" was already a suc- selves tested regularly. Nevertheless, in recent years been an increase in the knowing it, is in the primary infection cess last year. 85 per cent of gay busi- there is a disproportionately high num- sexual practice associated with the phase. nesses in the main regions Zurich, Laus- ber of infections in this group. Several highest risk of infection, i.e. anal inter- anne and Geneva took part, and the factors are responsible for this situa- course. Link: www.breakthechains.ch campaign app and its instructions were tion. The main problem is the first post- downloaded 6,000 times. Debriefing in- infection phase, the "primary HIV infec- Breaking the chain of infection Contact: Steven Derendinger, terviews with members of the gay com- tion phase", during which many people "Break the Chains" aims to break the Prevention and Promotion Section, munity showed that HIV had not been are still unaware of their recent HIV in- chains of infection within the sexual [email protected] discussed in the gay scene so openly and fection. At this stage, their viral load is partner networks. The campaign urges so often for a long time. The evaluation so high that they are 20–100 times more MSM to avoid all risk of infection of the campaign also pointed out posi- likely to transmit the virus than during throughout the month of April and then

Credits • No. 98, May 2013

Infograph «spectra – Prevention and Health Promotion» is a newsletter of the Federal Office of Public Health published six times a year in German, French and Growth of health costs in Switzerland English. Some of the views expressed in it may diverge from the official stance of the Federal 17% Office of Public Health. Published by: Federal Office of Public Health, CH-3003 Berne, tel. +41 31 323 87 79, 16% fax +41 31 324 90 33

Produced by: Pressebüro Christoph Hoigné 15% Allmendstrasse 24, CH-3014 Berne [email protected] Head of Editorial Board: Adrian Kammer, 14% [email protected] Contributors: FOPH, Christoph Hoigné Translation: BMP Translations AG, Basel Photos: FOPH, Christoph Hoigné, iStockphoto 13% Layout: Lebrecht typ-o-grafik, 3006 Bern Printed by: Büetiger AG, 4562 Biberist Print-run: German: 6 400, French: 3 400, 12% English: 1050

Individual issues and free subscriptions to «spectra» can be ordered from: GEWA, Alpenstrasse 58,

Percentage of gross domestic product (GDP) 11% Postfach, 3052 Zollikofen, tel. +41 31 919 13 13, 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050 fax +41 31 919 13 14, [email protected] Worst Case (pure aging) Reference Best Case (healthy aging, with investments in prevention and health promotion) Next issue: July 2013 Source: «Development scenarios in healthcare», Legislature Financial Plan 2009–2011 of the Swiss Confederation www.spectra.bag.admin.ch dated 23 January 2008

4 spectra 98 May 2013 Health policy