Table 2 Themes of workshop discussions – direct quotations
From: Perceived challenges to public health in Central and Eastern Europe: a qualitative analysis
Key | Direct quotation | Session |
|---|---|---|
1. Clinical medicine and public health | ||
1a | “(…) it is widely assumed that stroke prevention is the domain of neurologists. Neurologists, unlike cardiologists, do not have a strong tradition of involvement with epidemiology and prevention. I think that if you have a situation where stroke is seen as the domain of neurologists this can create major problems in terms of lack of professional leadership for prevention programmes in relation to stroke.” | Stroke |
1b | “In our health care law there is one sentence that says about 30% of all day work for all health professionals has to be related to prevention. It is a very good sentence but this is not how it is done. One problem is how they’re going to fill in some kind of report and the other problem is how they are going to be paid.” | Prevention |
1c | “Okay, I just want to tell you one very interesting positive aspect. For example we have managed to get prevention into the political agenda quite well I think. For example in the coalition agreement of our government it is said that each year at least a certain amount of money has to go to prevention programmes. And I think it’s good. And the second example we have is a round table which is formed by representatives of the ministry, the hospital association, the physician association, the nursing association etc. and we’re discussing health financing in our country. And for example the representative of the physician association is insisting all the time that you have to raise money for prevention; you can’t cut any budget from prevention.” | Prevention |
1d | “Our health politicians agree that cardiovascular diseases are a priority. But the problem is that curative health is much more powerful than public health. And when we’re discussing allocation of resources curative health wins. And now we’re discussing 2007–2030 and the problem is that cardiovascular disease is agreed on as one of most serious issues, but all this money will be allocated to hospital renovations, to equipment, but not for human capital and it’s very important I think to convince health politicians that public health actions are cost-effective.” | Cardiovascular diseases |
1e | “(…) how can we balance public health policy regarding lifestyle changes vis-á-vis medical intervention? Now medical intervention of course has the industry as a strong driver, whereas in public health policy the drivers are much weaker in a way. You know, it’s not very fashionable to make public health policy even as a politician, it’s very fashionable to make policy on say family issues. Maybe defence issues. Maybe security issues, but public health usually doesn’t have a very high reputation even among politicians.” | Cardiovascular diseases |
2. The need for increased public health funding | ||
2a | “I know that capitalism brought us after 1990 very good things but also some problems with food. Because the invasion of new products, very well presented, and also no food control brought us some behaviour not very good for our family and also the children.” | Obesity |
2b | “(…) but after the Second World War we had a good performance, an acceptable level of prevalence [of TB]. Because everything was mandatory at that time, it was maybe better for TB. After 1990 the democracy brought the problem for us. The surveillance for TB after 1990 was non-existent.” | Infectious diseases |
2c | “(…) like the countries that already joined the EU, in our country there is a very favourable political climate to push different solutions, especially if they’re in line with the EU directives (…) and in such a way we could be pushing forward some effective policies.” | Stroke |
3. Effectiveness of prevention | ||
3a | “I wanted to raise the question about the effectiveness of the prevention measures. And I would say that we really don’t have data about whether the preventive activity is working or not.” | Prevention |
3b | “I do agree […] that prevention is important, we should do it, it’s probably cost-effective etcetera etcetera. But I think we haven’t really been able to clearly define or show the effectiveness in studies what is effective and how it is effective.” | Obesity |
3c | “I suggest that we should find ways how to evaluate the effectiveness of the preventive measures we are undertaking. (…) This would be a way to convince politicians and the public and also experts from other professional fields that our proposal is really the best one and that it should be adopted.” | Prevention |
4. Data harmonisation across Europe | ||
4a | “[In some countries] of course the best data regarding stroke are mortality data. But then I recently realised that ‘stroke’ is a difficult diagnosis. There are no international criteria for diagnosing stroke. So it looks like different hospitals diagnose stroke a little bit differently. That’s the weakness of the data. Strokes are not comparable even between hospitals, let alone between regions in the country.” | Stroke |
4b | “(…) I support the view that hospital data will not be terribly useful, certainly not [in some countries]. We found that in the rural area sixty percent of strokes in elderly women were not admitted to hospital. Younger men, yes, strokes in younger men, yes, but older women, no, older rural women, especially no.” | Stroke |