Sunday, March 20, 2011

The successes of prevention in the Netherlands.

On March 11, the department of Public Health of Erasmus University Medical Center celebrated its 40 anniversary with a symposium on the success of prevention in the Netherlands, in the period of 1970-2010. The symposium was well attended by almost all experts in the field, as well as representatives of policy and practice organisations.

The head of the department, Prof Johan Mackenbach provided an overview of the success of prevention. This overview is more extensively documented and described in the book that he edited on the topic (see the picture), and illustrated in a short documentary.

Mackenbach argued in his presentation that the successes of prevention are often rather unnoticed, because, indeed successful prevention prevents ill health or mortality, i.e. it prevents an event from happening. This relative invisibility of the success of prevention may be one of the important reasons why policy makers have less attention for prevention and are often less willing to invest in prevention (only a few percent of the national health care budget is invested in prevention).

The successes presented by Mackenbach were identified based on the following criteria:

1. The effectiveness of the preventive action, policy or intervention should be scientifically well-documented

2. The effect of the preventive intervention should have clearly caused a reduction in mortality or morbidity because of the disease that the intervention was aiming to prevent

The team that did the analyses came up with 5 fields of prevention, i.e. prevention regarding pregnancy and youth care, prevention regarding work & health, prevention of accidents and injuries, promoting health lifestyles, and medical preventative interventions.

In terms of prevention of deaths, the antismoking efforts were by far the most successful prevention intervention in the last 40 years, with more than 6900 deaths prevented per year. Other important successes are the removal of trans fatty acids from foodstuffs (1500 deaths per year avoided), the screening on and treatment of high blood pressure (3000 per year), and traffic safety measures (2000).