Family Medicine

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World Book of Family Medicine – European Edition 2015 better education and financial incentives for family doctors. The first concrete achievement occurred in October 2014, with the provision of around 150 Million Euros from specialists’ budget allocated to family doctors. Such an example proves that the mobilization of citizens can influence a national health strategy. Could the Swiss example inspire other countries? Every situation is different… In England in 1996, randomly selected groups of citizens were questioned about their views on the current state of their country’s health strategy and on their ideas for its development compared with the government’s 1995 plan. In conclusion, citizens «should contribute to but not determine health strategy». Citizens may produce fresh ideas but perceive as inadequate the existing arrangements to screen certain types of cancer, although such screening is evidence based (3). This proves that individual points of view without a global perspective do not define a strategy. The increasing complexity of health care organizations combined with the pressure of costs seems to anaesthetize individual initiatives. Or are the health care systems still comfortable enough not to mobilize the population? In Canada in 2002 (4), dialogue sessions with members of the public were used to help define a new health policy. Twelve sessions of a full day of dialogue were held across the country, each with about 40 citizen participants aged 18 years and over, randomly selected to provide a representative cross section of the Canadian population. People working in the healthcare system were excluded. Combining their roles as patients, taxpayers and members of the community, participants reframed the healthcare contract, redefining both individual and collective responsibilities. This had an important impact on the ensuing debate, giving for example a stronger direction for primary care. In conclusion, such engagement of the public may be costly but an essential requirement when opinions are unstable and difficult decisions must be made. An article published in 2004 by De Vos and colleagues (5) analyses the evolution of the European health systems. The authors demonstrate how, since the 1990s, the European Union has built a strict financial and political straitjacket, forcing these systems to carry out privatization and cutbacks. Reform measures can be divided into three interdependent categories: 1) the increasing influence of governments on health care organization, to enable restructuring; 2) measures aimed at reducing public expenses, including higher financial contributions by patients and restrictions on the range of services provided; and, 3) measures that establish competition and hide or open privatization of services and insurance systems. The De Vos et al publication is already 10 years old, during which time the economical crisis of 2008 has taken place , with no change whatsoever to this trend. Is this not a contradiction with the growing collective needs? Is it not a threat to health and social security? The defence of the European welfare state is one of today’s most important challenges. Are citizens aware of the dangers and able to mobilize? Finally as voters, we all have a responsibility to elect or change our authorities if we do not agree with their strategies. Future involvement In a time when social media is creating new ground, can we imagine someone inventing an even more direct democracy than the Swiss model? Groups like Avaaz (6) gather clicks but also voices to get their opinion heard. All forms are probably necessary bearing in mind that humanity has always used both the pioneers and the conservative power brokers in order to maintain the equilibrium in society. Take home messages Individual changes of lifestyle improve health outcomes and can thus indirectly weigh on health policies. A direct democracy system or randomly selected groups of citizens can contribute to health strategy when difficult decisions need to be made. In a moving and increasingly connected world, new ways of mobilization are appearing, from citizen to netizen. For a better humanity? Original abstract http://www.woncaeurope.org/content/6-s-health-their-nation-how-would-citizens-develop-englands-health-strategy References 232
World Book of Family Medicine – European Edition 2015 1. Summerbell CD1, Waters E, Edmunds LD, Kelly S, Brown T, Campbell KJ. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2005 Jul 20;(3):CD001871. http://www.ncbi.nlm.nih.gov/pubmed/16034868 2. IPCC - Intergovernmental Panel on Climate Change www.ipcc.ch 3. Bradley N, Sweeney K, Waterfield M. The health of their nation: how would citizens develop England's health strategy? Br J Gen Pract. 1999 Oct;49(447):801-5. http://www.ncbi.nlm.nih.gov/pubmed/10885084 4. Maxwell J, Rosell S, Forest PG. Giving citizens a voice in healthcare policy in Canada. BMJ. 2003 May 10;326(7397):1031-3. http://www.ncbi.nlm.nih.gov/pubmed/12742930 5. De Vos P1, Dewitte H, Van der Stuyft P. Unhealthy European health policy. Int J Health Serv. 2004;34(2):255-69. http://www.ncbi.nlm.nih.gov/pubmed/15242158 6. The Avaaz community http://www.avaaz.org/en/ 233
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Family Medicine

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