Health Priorities in French-Speaking Swiss Cantons

Philippe Chastonay,Jean Simos,Rudolf Zurkinden,Thomas Mattig,Nicolas Cantoreggi

doi:10.15171/ijhpm.2017.91

Abstract

In Switzerland, the federal authorities, the cantons, and the communes share the responsibility of healthcare, disease prevention and health promotion policies. Yet, the cantons are in most health matters independent in their decisions, thus defining as a matter of fact their own health priorities. We examined and analysed the content of the disease prevention and health promotion plans elaborated during the last decade in six French-speaking cantons with different political contexts and resources, but quite similar population health data, in order to identify the set health priorities. The plans appear significantly inhomogeneous in their structure, scope and priorities. Most of the formal documents are short, in the 16 to 40 pages range. Core values such as equity, solidarity and sustainability are explicitly put forward in 2/6 cantonal plans. Priority health issues shared by all 6 cantons are "physical activity/sedentariness" and "nutrition/food." Mental health is explicitly mentioned in 5 cantonal plans, whereas tobacco and alcohol consumptions are mentioned 4 times. Less attention has been given to topics that appear as major public health challenges at present and in the future in Switzerland, eg, ageing of the population, rise of social inequalities, increase of vulnerable populations. Little attention has also been paid to issues like domestic violence or healthy work environments. Despite some heterogeneity, there is a common base that should make inter-cantonal collaborations possible and coordination with national strategies easily feasible.

Highlights

Defining and implementing health priorities is, at least in a democratic society, a complex process and a difficult one.[1]
Some argue that efficiency comes first because of the limited resources, while others push for more equity and solidarity[3]; some support technical solutions such as the Program Budgeting and Marginal Analysis (PBMA),[4] while others plead for entrusting a group of experts, who take into account the existing empirical evidence[5] when setting priorities; some plead for engaging target populations in the process, in order to make public health services more relevant for them.[6]
In Switzerland, the federal authorities, the cantons, and the communes share the responsibility of healthcare, disease prevention and health promotion policies, yet the cantons are in most health matters independent in their decisions, defining as a matter of fact their own health policies.[7]

Summary

Introduction

Defining and implementing health priorities is, at least in a democratic society, a complex process and a difficult one.[1]. We wondered which were the health priorities set in those plans, how they had been defined, whether those priorities reflected the health problems responsible for most of the burden of disease encountered in Switzerland and whether those plans share common aspects in terms of values, priorities and programs, which could eventually facilitate intercantonal collaborations and possibly would make adhesion to national strategies easier.

Methods

Results

Discussion

Conclusion