The first panel discussion of the 8th Summit was chaired by Professor Andrzej Fal and held with the participation of three distinguished experts, Mr. Martin Smatana, healthcare analyst from Slovakia, Professor Ranko Stevanovic from Croatia, and Dr. Jiri Votruba from Czech Republic.
Today, total public healthcare expenditure is very high and is rising disproportionately with the economic development of European countries, most of which cannot continue to increase healthcare budgets, Professor Fal stated, and asked the panel how likely it is that their governments (and the European Union) can continue to increase health spending.
In Czech Republic, it depends on the results of our next elections, Dr. Votruba said, but most possibly no government will want to increase further health spending, which is already enormous for our country.
According to Mr. Smatana, this is also true for Slovakia, where increasing health spending is not a priority today. Healthcare expenditure has reached a plateau, and it is rather unlikely to change. The budget for the next year will be just sufficient to cover fixed costs and increase in fixed costs.
In Croatia, where the cost of treating smoking-related diseases is nearly 20% of total health expenditure, it is also not likely that the government will increase health spending further, Professor Stevanovic said.
In Poland, it is also improbable that the government will spend more than it has already been outlined in the budget for 2025 in the coming years, Professor Fal said, because what has been already written in this budget exceeds the amount of funding available from public health insurance.
Emphasizing the significant economic burden of chronic diseases, Professor Fal underlined that treating chronic diseases takes about 70% of the total budget of the National Health Funds in most European countries. The target of saving lives and spending less can be achieved through investing in prevention of non-communicable diseases; and harm reduction is a crucial part of prevention, he added. Prevention of non-communicable diseases includes health literacy, avoiding exposure to risk factors (including behavioral ones), fast diagnosis of the disease, and protection against severe disease and its complications. Lack of social acceptance, public bans, financial pressure, and school and GP educational programs are useful tools to prevent the initiation of smoking, while replacement therapies, clinical therapies of related diseases, and harm reduction tools can support smokers to quit. Therefore, harm reduction and rehabilitation are necessary prevention strategies, since they protect against severe disease and its complications, and have not only medical but also economic effects.
“But to what extent are the tools for preventing and combating cigarette smoking used in Croatia, Czech Republic and Slovakia?”, Professor Fal asked the panellists.
In Croatia, the tools for preventing and reduction of cigarette smoking are not implemented at a systematic level, Professor Stevanovic said. Notably, there is substantial resistance among healthcare professionals and policy makers towards the use of snus products and nicotine pouches. There are still significant misconceptions regarding nicotine and its relation to diseases, and smokeless tobacco or nicotine replacement products are considered as harmful -or even more harmful- than cigarettes. So, tools for preventing and combating cigarette smoking are used little or not at all, Professor Stevanovic concluded.
Unfortunately, Czech Republic is also not doing very well in harm reduction tools implementation, Dr. Votruba said. Although we have successfully implemented well-organized city screening programs, harm reduction strategies do not exist. Czech Republic policy makers are very conservative, and they support the position that since smoking is a poison, people just shouldn’t smoke.
In Slovakia, Mr. Smatana commented, the major problem is that harm reduction sector is over-regulated. We add more and more regulations, he explained, but we do it without actually analyzing the impact of the previous regulations; we hope that the new regulations will make the difference, but in fact over-regulation without proper evaluation doesn’t allow the harm reduction tools to be efficient.
Nevertheless, there are countries, such as Sweden or England, that have successfully implemented tobacco control policies, Professor Fal said. These countries combine tax policies with healthy lifestyle education programs and the existence of subsidies.
Speaking about the situation in Poland, Professor Fal said that today there are 8.5 million smokers in the country, the highest number of smokers since the communist times, because the cigarettes were still getting cheaper and cheaper.
Polish Society of Public Health has suggested to the government to regulate the market by sensibly reducing cigarettes availability, and radically, but progressively, to increase excise duties (and thus prices) of cigarettes as the most harmful products for smokers and their environment.
Polish Society of Public Health, Professor Fal continued, has also sent its suggestions to the European Parliament, making the following suggestions to be included in the EU directive:
- Member States must significantly reduce the financial availability of cigarettes. It may be worth considering introducing a minimum price in relation to the average salary;
- Member States must introduce a uniform, licensing-based sales network for all products covered by the directive;
- In the initial period, price differences should be based on the results of studies and set according to the “less harm, less tax” principle;
- If the experts consider that the evidence is insufficient, public funds should be invested in research assessing the effectiveness, safety and degree of harm reduction.
It is clear that we will not get any data, Prof. Fal explained, if we will not gather them.
Even for those who are severely sick, there is some kind of prevention, Professor Fal said. Harm reduction is prevention; it stops the disease development, improves patients’ condition, and improves their quality of life.
Providing smokers with a choice of cheaper alternatives/subsidies, alongside education and tobacco control measures can have actual results. Sweden, for example, is on track to be “smoke-free” 17 years ahead of the 2040 EU target; smoking rates have fallen from 15% to 5.6% over the past 15 years, while EU average smoking rate is 23%, and in many EU countries, 1 out of 3 people still smoke. Thanks to their country’s policy, Swedish people now have the lowest rate of lung cancer, the lowest rate of cancer in general, and also the lowest rate of tobacco-related diseases like COPD, pulmonary fibrosis and several others.
Many research data show that there are products in the market that are less harmful than the regular cigarette. So, the sooner a smoker switches to an alternative, the sooner his health ameliorates, Professor Fal concluded.