5 Apr, 12 | by BMJ
On 23 March the Spanish cabinet passed a new draft bill on transparency in public administration, which in other countries is called the Freedom of Information Act. So far Spain remains the only European country with more than one million inhabitants that doesn’t have this law.
The healthcare sector lacks information on how healthcare budgets or waiting lists are managed, or on the number of readmissions of a certain hospital, or the mortality rates of any specific surgical team, intervention, or healthcare centre.
Although this initiative is happening thanks to the current People’s Party government—the last socialist government of Jose Luis Rodriguez Zapatero didn’t dare to introduce it—our prime minister, Mariano Rajoy, has not yet realised that transparency begins somewhere else.
Let me explain. Many of you may consider it normal to have politicians who answer direct questions from journalists, but in Spain this is becoming rather extraordinary. Although the government is enacting the deepest cuts in our democratic history, more than three months after coming to power, Mr. Rajoy still hasn’t held a press conference to talk about domestic affairs. As astonishing as it may seem, he won the last general election without giving a single press conference during his whole campaign.
Our new minister of health, social services, and equality, Ms Ana Mato, is taking a similar approach and hasn’t given a single press conference since she came to office on 22 December 2011.
That is why I was so surprised when I attended the EU health prize for journalists awards ceremony earlier this year in Brussels which was hosted by the directorate of health and consumers of the European Commission. At dinner, the journalists present could choose places to sit and talk freely with the different members of the directorate including the European Commissioner, John Dalli.
This would have been unbelievable in Spain. It gave Dalli the opportunity to voice his concerns regarding healthcare budget cuts across the EU during the “biggest financial economic and social crisis since the second world war,” and for us to clarify what measures the commission will take to face it.
Thus, the commissioner said his current main duty is convincing member states to maintain healthcare budgets because healthcare is the largest employer and a healthy workforce is “a vital ingredient for growth.” “How can we grow with a population that is absent from work, and that doesn’t have the capability to perform at his highest level?” he wondered.
According to Dalli, the impact of the cuts is already here. “We are talking about the next five years.” And Greece was used as an example. “We are already noticing an increase in HIV and AIDS because of reductions in programmes that were working on HIV prevention,” he pointed out.
Strikingly to me, Dalli didn’t consider progressive privatization—like what is happening in the UK or Spain—a big deal. In fact, he considers it part of the solution and “utopic” to think that private systems could enforce good practices while being administered by the state. Whilst accepting that putting our healthcare systems in the hands of a company looking for profit may entail certain risks, Dalli thinks that establishing strict regulation would prevent abuses.
The commissioner also pointed out some specific healthcare challenges. The number of European citizens aged 65 and over will double over the next 50 years—from 87 million in 2010 to 148 million in 2060—which will place further challenges on healthcare systems. He recalled the Active and Healthy Ageing initiative and the overarching target to increase the average healthy life span by 2 years by 2020.” “Let’s get people out of hospitals, and let’s concentrate on combating tobacco and alcohol consumption and obesity.” he said.
This led to one of my favorite issues: the new European Tobacco Products Directive. Let’s remember that 13 million Europeans suffer from diseases related to smoking. Under the new legislation, tobacco cessation therapies will be regulated, and they “must prove effective.” Dalli wants to focus on the “availability and attractiveness” of tobacco, so certain limitations will be established for vending machines, and plain packaging will, at last, be a reality. Some substances that are not necessary from a technical standpoint but which enhance its addictive power—like certain flavours—will be banned, he said.
You can agree or disagree with Dalli, and I certainly disagree in a few things, but, unlike Rajoy, Dalli knows transparency is not just a law, but an attitude and a priority. The EU is always concerned that national politicians take the credit for any successes and blame Brussels for any failures, but from this meeting it is clear to me that the EU has much to teach our national leaders.
Aser García Rada is a paediatrician at the Hospital Infantil Universitario Niño Jesús in Madrid, Spain, and a freelance journalist.