The ACA sees “urgent need for action” in preventive healthcare
The number of healthy life years in Austria dropped by 1.6 years between 2014 and 2019. In the report "Health Promotion and Preventive Healthcare" submitted today, the ACA presents the measures that should be pursued to – as envisaged – increase healthy life years. It furthermore criticizes the fact that the reformed mother-child health passport, which includes, among others, a hearing screening for newborns, has still not been implemented. The National Council had requested the ACA to conduct an audit on 27 topics. To this end, the ACA submitted the three reports "Health Promotion and Preventive Healthcare", "Medical Training" and "Medical Care in the Independent Healthcare Sector".
The audited period for this report essentially spanned the years from 2013 through 2019. Some specific findings also related to the years 2020 and 2021.
Decline in healthy life years
By 2032, every person in Austria should spend two additional years in good health. This was decided by the Council of Ministers in 2012 as one of the ten “Austrian Health Targets”. Despite this objective, however, the health situation has deteriorated. According to Statistics Austria, for example, people aged 65 in 2019 could expect to live an average of 9.75 healthy years. In 2014, this value was at 11.35 healthy life years. The ACA critically notes the following: After about one third of the period of 20 years defined for the attainment of the health targets had passed, the healthy life years have not increased, but even decreased by 1.6 years in the period from 2014 to 2019. National and international analyses attribute this, among others, to the fact that the proportion of the population with chronic, non-communicable diseases – such as obesity or mental illness – is high in Austria. There is still a considerable need for targeted prevention measures.
Urgent need for action
According to a study carried out by the World Health Organization (WHO) on the global burden of disease, the health of the populations of the Member States of the European Region was most threatened by nutritional factors. In 2001, by way of several action plans, the WHO had called on its European Member States to adopt targeted food and nutrition policies. Austria did not produce its first National Nutrition Action Plan until 2011; it has not been updated since 2013.
According to the Austrian Health Survey, the proportion of overweight and obese people aged 15 and over increased by four percentage points to 51 percent from 2014 to 2019. However, this data was based on the self-assessment of respondents who often reported an underweight. The ACA sees an urgent need for action. Health literacy would need to be strengthened in all parts of the population.
Advertising waiver and binding provisions for the food industry
The Federal Ministry of Health aimed to contribute to the improvement of child nutrition. Most of the measures were, however, not mandatory. The ACA recommends to the Federal Ministry of Health to work toward implementing the advertising waiver for certain food categories before, during and after children’s programmes broadcast by audiovisual media services. Furthermore, the impact of the declarations of intent and industry initiatives to reduce sugar and salt content in food would need to be evaluated. If necessary, binding provisions would have to be assessed and initiated.
Reformed mother-child health passport should be implemented swiftly
A key instrument of health promotion and preventive healthcare is the mother-child health passport. The Federal Ministry of Health recognized the need for a change to an up-to-date and evidence-based model. In 2010, it commissioned the Ludwig Boltzmann Institute for Health Technology Assessment to develop a comprehensive set of basic documents for this purpose. It was not until spring 2019 – around ten years after the reform process had been launched – that a plan for implementation was established. The revised mother-child health passport programme would include, for example, a hearing screening for newborns and counselling on topics such as passive smoking, nutrition, oral health and accident prevention.
In 2021, based on the Austrian National Recovery and Resilience Plan 2020–2026, the Council of the European Union approved a project put forward by Austria to develop an electronic mother-child health passport platform by 2026. According to a statement by the Federal Ministry of Health, the legal basis for this should be in place by the second quarter of 2023. The programming is to be put out to tender by the fourth quarter of 2023. Furthermore, by the second quarter of 2026, the proportion of attending physicians and women using the mother-child health passport is to reach 90 per cent.
In November 2022, the Federal Government finally announced that the new, digital parent-child health passport would be ready by 2024. In view of the announced introduction of a new digital parent-child health passport, the ACA points out that the changes to the mother-child health passport that had already been elaborated in 2019 had not yet been implemented by the end of 2022. The financing had also not yet been finally clarified. It therefore reiterates its recommendation to work toward a swift implementation.
Exercise initiative came to a standstill
In September 2018, the then Federal Minister of Health and the then Federal Minister for Sport presented the initiative “Take the first step” (“Mach den ersten Schritt”). This initiative aimed to effect a behavioural change among those who hardly exercise. From early 2019 on, the ministries planned to promote 100 basic exercises. They, however, failed to implement this to the planned extent because the Federal Minister for Sport resigned in mid-May 2019. In end-May 2019, the then federal government was removed from office after a vote of no confidence. The interim government did not pursue the initiative. The website was deactivated, videos were removed from the network.
In May 2019 – by which time the two ministries had already spent EUR 770,000 on the initiative – three companies submitted bids for a motive analysis at the request of the Federal Ministry for Sport. The three companies were, on the one hand, the commissioned company, in which a former federal minister was involved, and, on the other hand, two providers that had been recommended to the Federal Ministry for Sport by the same company. Irrespective of any possible criminal implications, this procedure was not suitable for ensuring transparency and the required competition. Due to the resignation of the Federal Minister for Sport and the subsequent government restructuring, the awarding of the contract was delayed. In September 2019, the Federal Ministry for Sports finally concluded the services contract.
EUR 2,441 billion for health promotion and preventive healthcare
The last time that the Federal Ministry of Health had surveyed public spending in the field of health promotion and preventive healthcare to gain an overall overview was in March 2019 with data from 2016. According to this survey, spending on health promotion and preventive healthcare amounted to EUR 2.441 billion in 2016. Of this amount, social insurance providers spent the most, namely EUR 2.124 billion euros, or 87 per cent of all funds. EUR 1.475 billion went into so-called tertiary prevention. This includes measures designed to prevent or alleviate relapse, chronification or consequential damage.
In 2016, some EUR 69.84 million were spent on health promotion and EUR 296.61 million on primary prevention, i.e. the prevention of disease. In 2014, within the framework of the Federal Target-Based Governance Commission (Bundes-Zielsteuerungskommission), the Federal Government, the provinces and the social insurance providers had decided on a joint health promotion strategy as part of the Federal Target Steering Commission. However, this strategy was only binding for a part of the funds. Furthermore, successful projects had not been sustainably secured until 2021.
The ACA recommends to the Federal Ministry of Health to secure a sustained financing for successful projects related to health promotion and preventive healthcare together with the partners of the Federal Target-Based Governance Commission, to subject the funds to a joint binding strategy, and thereby strengthen the targeted and coordinated use of funds by all partners (Federal Government, provinces, social insurance providers).
Improving the availability of data
In their report, the auditors point to numerous other aspects related to the issue of prevention. In Austria, for example, some 2,400 persons die per year in hospitals after infections with germs. This equals six times more deaths than in road traffic. Appropriate hygiene measures would prevent 20 to 30 per cent of such deaths. The Federal Ministry of Health did not have any data related to the occurrence of infections associated with the healthcare system in the independent healthcare sector. The ACA also finds data lacking in other areas. This concerns, for example, the vaccination coverage as well as up-to-date data on the state of health of children and adolescents throughout Austria. Furthermore, it recommends to improve the quality of data on medical check-ups and the reports thereon in order to be able to make use of the findings deducted therefrom for managing health promotion and preventive healthcare.
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Report: Health Promotion and Preventive Healthcare (in German)
Upon the decision of the National Council, the ACA carried out an audit on health promotion and preventive healthcare. The audit concerned the then Federal Ministry of Labour, Social Affairs, Health and Consumer Protection and, since January 2020, the Federal Ministry of Social Affairs, Health, Care and Consumer Protection.
The audit aimed at assessing the legal, organizational, financial and personnel measures of the Federal Ministry of Health in the field of health promotion and preventive healthcare. The ACA also conducted additional surveys at the Federal Ministry or Arts, Culture, Civil Service and Sport. The audited period essentially spanned the years 2013 through 2019, although, depending on the availability of documents, the ACA also included the years 2009 to 2012. Some specific findings also related to the years 2020 and 2021. Due to the COVID-19 pandemic, the audit had to be suspended temporarily.