Health systems, even the most efficient ones, solve, on average, only 20% of the population’s health problems. The rest, 80% can be solved if we consider essential factors such as lifestyle, environment, education or living conditions. A health reform is needed, with an emphasis on prevention and effective communication, emphasizes Dr. Emilian Popovici, vice-president of the Romanian Society of Epidemiology.
Health systems solve, on average, only 20% of health problems – Photo Shutterstock
The Lalonde model, proposed by Marc Lalonde, a Canadian physician, in 1974, highlights the fact that the health of the population is not only influenced by medical services, but also by other essential factors. Specifically, this model suggests that while hospitals and medical interventions are crucial for treating disease, prevention and promotion of healthy lifestyles, along with a clean and safe environment, are equally important for maintaining population health. Thus, hospitals should not only focus on treatment, but also play an active role in educating patients and collaborating with other sectors to address external factors influencing health.
“According to the Lalonde model, adopted by the majority of developed countries, which have set up high-performing health systems, from the total health problems of the population, the health system, starting from the family doctor’s office and ending with the best performing hospitals and polyclinics , solves a maximum of 20% of a population’s health problems”, emphasizes epidemiologist Emilian Popovici.
The vice-president of the Romanian Society of Epidemiology, Dr. Emilian Popovici, gave the example of Japan, a country with “a super-technological medicine” and well-financed, in which the health system solves a maximum of 17% of the population’s health problems.
“It is complicated to specify what percentage of health problems is solved by the health system in Romania, but it is clear that it is a lower percentage than in Japan“, stated Dr. Emilian Popovici.
Education, factor no. 1 determined of health
The remaining 80% of population health problems are influenced by other determinants, including education, environment and workplace.
“Education is the number one determinant of health, because a people with a lower level of education will not correctly understand the messages transmitted on the topic of health and consequently will not follow advice. Without having the people as partners in health programs, they are at least incomplete, if not powerless in some ways”emphasizes the epidemiologist.
That’s not to mention the education needed to live a balanced life and a lifestyle that supports quality of life.
“According to the latest Eurostat surveys, from 2022, it appears that Romania is in last place, both in the number of books read and in the general level of education. And if we said these two things, we realize how big the impact is also on the health of the population“, stated Dr. Popovici.
Concretely, according to Eurostat, in Romania 17.4% of adults between the ages of 25 and 74 had higher education, just over 60% had secondary education, and almost 22% did not even have high school education.
Thus, the lack of education “it also seriously affects health“.
The environment directly influences health
The second major factor that directly influences the health status of patients is the environment.
“Massive deforestation and climate change affects not only human health, but also agriculture and quality of life. We have a problem, for example, related to the environment in Romania, because 50% of the forests have been cut down. And as a result of these massive deforestation, climate change is also occurring. One serious thing that is happening is this massive deforestation, which unfortunately continues. From here we go to a series of troubles that are linked to each other, the environment directly influences health, air quality, water quality, climate.“, explained Dr. Popovici.
Although it may seem surprising, the third important factor is work.
“Perhaps the state, in the market economy, does not create jobs, but it creates the legislative framework that allows the private entrepreneur to create stable and well-paid jobs that allow man to follow, for example, the health advice that he we give them to the other side. Because in vain we educate him, we give him good advice, but he does not have the financial possibility to follow this advice. All these things are connected“, adds the epidemiologist.
Emilian Popovici suggests that the government should develop a serious and integrated program on five essential areas: education, health, environment, work and development. At the same time, he emphasizes that there is a need for “goodwill and good faith” to achieve this.
Of course, the Government should “modernize the health system, build hospitals, equip them with state-of-the-art equipment, to solve problems related to medicines”.
“But don’t neglect the other parts. Unfortunately, it is clear that they were neglected, from the Eurostat data, so we are not assuming, but talking about reality“, points out the doctor.
What needs to change in the doctor-patient relationship
The Pantelimon Hospital case, where two anesthesiologists are accused of causing the death of a patient at St. Pantelimon Hospital by intentionally decreasing the doses of noradrenaline, has sparked a lot of controversy in society.
Epidemiologist Emilian Popovici says, in this context, that communication between doctors and patients must be improved.
“Communication in the healthcare system is vital. You cannot have a medical system that is truly performing and that is perceived in the most correct way possible by the population, that becomes that partner of the system, so that the system can show its level of performance, if you don’t you have correct communication with patients.“, said Dr. Emilian Popovici.
At the same time, the doctor emphasizes the importance of continuous improvement of the existing infrastructure in the field of health, in parallel with the development of new facilities. The representative of the Romanian Society of Epidemiology states that all resources useful for public health must be supported and improved, and new constructions should complement what already exists.
“Heroic medicine, in which the doctor is put in a position to take extraordinary measures, has saved many lives. When the doctor is fearful, stressed and no longer has the courage to make such decisions, the evil goes to the patient. Therefore, we must be very careful at these extremely sensitive moments, when things are communicated without having any final decisions from bodies entitled to make such decisions“, concludes Dr. Emilian Popovici.
