How Austrians can become healthier
In Austria, life expectancy is relatively high at around 84 years for women and 79 years for men, but the number of years of life spent in good health at 58 and 57 years is significantly below the European average of 65 and 64 years respectively. The Austrian Institute for Health Technology Assessment (AIHTA) has now analysed national strategies and programmes for the prevention and management of non-communicable diseases in several countries in order to derive health policy recommendations for Austria. National strategies and programmes should create conditions for a health-promoting living and working environment for the population.
For years, the biggest health policy challenge has been so-called "non-communicable diseases" (NCDs) such as type II diabetes, cardiovascular diseases, chronic respiratory diseases (e.g. COPD) or depression. This fact has taken a back seat, especially during the Covid 19 pandemic. According to the World Health Organisation (WHO), NCDs account for 86 percent of deaths in Europe.
Now the AIHTA has analysed national strategies and programmes for the prevention and management of NCDs in a study. A total of 18 strategies from Germany, Switzerland, the Netherlands, Finland, Ireland, Great Britain, Canada and Australia were considered. Furthermore, the evaluation results of a total of 11 programmes were analysed on the basis of 21 scientific articles. Most of the studies showed positive effects on mortality, burden of disease, quality of life, self-management or health literacy, but due to the heterogeneity of the included studies and the partly low level of evidence, no conclusive evaluations on the effectiveness of the examined programmes can be derived. The analysis nevertheless provided several insights into how national prevention and management programmes on NCDs can be effectively implemented, emphasise the two study authors Lucia Gassner and Inanna Reinsperger from AIHTA.
Multiple factors influencing health
Health promotion measures should start in early childhood and take into account the social factors influencing health with a "Health in All Policies" approach. Accordingly, successful national strategies on NCDs refer, for example, to the so-called determinant model of the two public health scientists Göran Dahlgren and Margaret Whitehead. This approach assumes that health depends not only on individual biological factors and the behaviour of the individual (for example, by not smoking, exercise, balanced diet), but also to a large extent on social networks, living and working conditions, as well as environmental factors and general socio-economic and cultural conditions.
The authors of the study cite the Swiss model as a positive example, that is organised from an overarching macro level to concrete measures at the micro level. "The Health2030 strategy sets an overall goal that is to be achieved with a wide variety of sub-programmes. This ranges from measures for health-promoting workplaces to the development of healthy living spaces and the improvement of health literacy in the population," explains Inanna Reinsperger. According to the AIHTA report, it is also important for successful NCD strategies to plan evaluation before programmes and measures are implemented. "Germany, for example, has enshrined the obligation to evaluate disease management programmes in law," says Lucia Gassner. However, Germany has the problem that the studies on the effectiveness of these programmes are often not very meaningful. "This is due to the fact that the disease management programmes were introduced nationwide. As a result, it is no longer possible to implement meaningful randomised controlled trials, as regions where the programmes have been implemented can no longer be compared with those where they have not," explains research leader Inanna Reinsperger.
Breaking new ground
In contrast, Finland, for instance, implements some programmes on a regional level first: "For example, prevention measures for type II diabetes or cardiovascular diseases were scientifically monitored for several years to check whether there was sufficient evidence before the programme was rolled out nationwide," Lucia Gassner emphasises. The programmes examined in the AIHTA study mainly comprise prevention or disease management programmes, which usually focus on the interaction between the patient and the health professional (e.g. family doctor). However, some countries, such as Australia, sometimes take unconventional approaches to improve health literacy and population awareness, e.g. of mental illness. The „Mental Health First Aid“ programme, in addition to training for educators and health workers, also provides standardised training courses for the entire population - for example in universities or at the workplace. The declared goal is to generally increase knowledge about mental illness so that relatives, friends, neighbours and acquaintances can also help people with mental health problems.
Contact for content-related questions and interviews:
Austrian Institute for Health Technology Assessment:
Mag.a Inanna Reinsperger, MPH
p +43 / 1 / 2368119-18
Mag.a Lucia Gassner, Bakk.
p +43 / 1 / 2368119-11
Contact for questions about the release:
Mag. Günther Brandstetter;
p +43 / 660 / 3126348
Gassner L, Reinsperger I. National strategies and programmes for preventing and managing non-communicable diseases in selected countries. AIHTA Project Report No.: 139; 2021. Vienna: HTA Austria – Austrian Institute for Health Technology Assessment GmbH. https://eprints.aihta.at/1349/