Public health must stress prevention

By Chen Meei-shia 陳美霞  / 

Thu, Jul 17, 2003 - Page 8

Taiwan's society underwent a severe disease-prevention battle during the SARS outbreak. Today, the SARS war is over. People now understand that the nation's public health system needs to be reformed and rebuilt. But this is a cross-ministerial, highly comprehensive job of social reform. Just like the SARS war, this task has to be led professionally by the Department of Health. Most importantly, the Cabinet needs to have new thinking and unmatched resolve.

The public-health system includes two segments -- disease prevention and medical treatment. Priority should be given to the former. However, the government has mainly focused on the latter in recent years. Why has such an unreasonable and unwise method dominated public-health policy for so long? The biggest problem lies in the ideology of "market individualism" -- including viewing health and illness problems as people's own responsibilities, equating health with personal medication, and commercializing and marketing treatment.

Protecting the people's health is society's collective responsi-bility -- not an individual's private concern. Based on the "public-ness" of personal health, an ideal public-health system should work with the public and use society's collective power to prevent disease and protect people's health. Unfortunately, the primary tasks and goals of the nation's health organizations are all designed according to the idea that health is a personal affair.

For example, cancer has been as one of the leading causes of death in this country for the past 21 years. The health authorities blame the illness on personal behavior such as smoking, chewing betel nuts, drinking, lack of exercise and inappropriate eating habits. Therefore, in order to prevent cancer, they spend their limited prevention budget mostly on designing various anti-cancer projects and activities, hoping to change people's "unhealthy behavior."

Nevertheless, the occurrence of cancer is closely related to the nation's politics, economy and social environment as well. Even people's unhealthy habits are deeply influenced by these factors. The effectiveness of any health plan and activity is surely limited if they do not touch on, analyze and criticize these crucial factors that cause cancer.

Each individual's socio-economic environment also affects his or her health behavior. Research shows that most Taiwanese who frequently smoke, drink or chew betel nuts are poorly-educated, with a lower socio-economic status. Obviously, a relatively disadvantageous environment has pushed or lured them to indulge in such unhealthy acts. The effectiveness of health workers' unilateral requests for these people to change their bad habits will be limited if the unfavorable environment facing them remains.

Both the insufficient resources and the ineffective prevention work have formed a vicious cycle today. As a result, all kinds of illnesses occur and people seek medical treatment. Thus, many people equate "health" with "treatment." Most of the nation's NT$500 billion plus medical and health funds are spent on treatment, turning society's responsibility to prevent disease with a collective force into each individual's own responsibility to seek treatment.

The nation's public-health system operates under the principles of commercialization and marketability. The ultimate goal of medical institutions is to make profits. Since people have to seek treatment when they are ill, their need for treatment is more urgent than that for other goods. Such circumstances have created an excellent and infinite market demand.

The fact that our public-health system almost crashed under the pressures brought on it by the SARS epidemic finally highlighted the system's faults. Disease prevention is the collective responsibility of society -- not each individual's own affair. A strong public-health system is absolutely necessary for successful disease prevention and this involves massive workloads.

To reform our public-health system, we first need to change the ideology of "market individualism" that dominates the system. This will be a difficult task and the Cabinet will have to adopt a whole new way of thinking. Of course, we also have to carry out structural reforms on the existing system -- especially on the excessive "medicalization" of the public-health system. Countless obstacles and challenges are all involved in this task -- such as various tangled interests, a rigid personnel system, health professionals' long-accumulated laziness and conflicts and negotiations among Cabinet ministries and agencies.

The Cabinet needs to have incomparable resolve in order to deal with this significant social reform project.

Chen Meei-shia is the director of the department of public health at National Cheng Kung University.