01.05.2013 Health minister Alain Berset: "We have to create an environment that makes healthy behaviour easy."

Interview with Federal Councillor Alain Berset. In January, the Swiss government approved the "Health 2020" strategy – a health-policy agenda focusing on four action areas and 36 measures to be implemented in stages. Health minister Alain Berset talked to spectra about the role of prevention in this comprehensive overview of health policy, about state responsibility and self-responsibility, the federal nature of the healthcare system and the importance of cooperation within and between the main departments of government in promoting and safeguarding public health.

Pictures Health minister Alain Berset: "We have to create an environment that makes healthy behaviour easy."


spectra: The "Health2020" strategy paper demonstrates the great importance you attach to prevention. Prevention could also be the key to achieving the target of a 20 percent saving in healthcare costs. How do you intend to strengthen prevention efforts in the future, particularly after the rejection of the Prevention Act?

Federal Councillor Alain Berset: The new Prevention Act came to grief in Parliament because there wasn't a majority in favour of the funding arrangements. Though regrettable, this creates an opportunity for us to think about new, integrated models. We can work with our partners to draw up a long-term strategy that enjoys wide support. But we need to have all players in the healthcare system on board. Last autumn, the Swiss government (Federal Council) prolonged the three national prevention programmes on "Tobacco", "Alcohol" and "Diet and Physical Activity" until 2016. These programmes ensure continuity in our prevention policy. But we need to gear our healthcare system even more effectively to the steady increase in non-communicable diseases. We're currently drawing up a strategy to meet this need.

Prevention has to seek a balance between the responsibility of the individual and the state's mandate to protect public health. What role do you see for the Federal Office of Public Health (FOPH) between these two poles?

The FOPH has always focused on two approaches in its prevention activities. On the one hand, it aims to provide people with specific information on how they can protect their health. This approach covers a wide range of concerns such as diet and physical activity, but also protection against infectious diseases or how to deal with addictive substances. On the other hand, we have to create an environment that makes healthy behaviour easy. If somebody wants to eat healthily, what's the point if they are unaware of, or cannot obtain, the appropriate products? If we do good work at both these levels, people will be able to choose and implement the healthy option. But in the end, of course, it's up to them to do so. And that's where self-responsibility is needed.

Health is a cantonal responsibility. This historical tradition of federalism is creating a Swiss health maze. In what areas would you, as Swiss health minister, like to have more control? Where should the federal government be given additional powers?

Generally speaking, the division of responsibilities between the federal government and the cantons makes good sense in many areas of activity. Our task is to develop national strategies and to support and coordinate the activities of the cantons in the different areas. As before, the cantons will be able to develop solutions that are tailored to their specific needs. In many areas at the present time, the powers of control and enforcement are divided between the federal government and the cantons. But we also have joint powers and responsibilities in areas such as healthcare provision funding and education. In some of these areas we still lack shared health-policy steering instruments, an exact definition of the respective tasks, and coordination bodies with which we can shape our cooperation more efficiently. We're working together here to find solutions.

The public basically appreciates our healthcare system. However, there's a need for improvement in all areas, and the Swiss government is tackling them in the "Health2020" reform project. The four defined priority areas concern the very core of the public health sector. But they are abstract and therefore require easy-to-understand background information and convincing advocacy. Is a communication concept envisaged for the implementation of the new priorities of the Swiss government's health policy?

"Health2020" is a comprehensive strategy that enables us to gear our healthcare system to the challenges facing it in the next few years and to further improve it. The strategy is based on a total of 36 measures affecting all sectors, and we aim to implement them gradually. We shall, of course, communicate all important steps and decisions in detail, while also placing each of them in the context of "Health2020". In this way we can highlight the effect they will have on the healthcare system as a whole. The individual measures are coordinated and complement one another. In addition, the FOPH will also report regularly on the progress being made in the implementation of "Health 2020".

On page 7 of the document, the Swiss government admits that 60 percent of the factors that influence public health are beyond the remit of the healthcare system. The goals and measures are disease-oriented and designed for the sole purpose of improving the actual healthcare system. Why hasn't the Federal Council made cooperation within and between the main departments of government a priority in efforts to improve equality of opportunity and quality of life?

Such cooperation is key, so we're also giving it more attention. Unlike other countries, Switzerland possesses a large number of harmonisation and coordination instruments within the Federal Administration – for instance interdepartmental working groups, the General Secretaries Conference, or the office consultation or joint reporting procedures which, prior to decisions being taken by the Federal Council, enable other government departments to express their views on specific proposals. Here we must and will be more pro­active, but we can also build on what is already in place. Obviously, if we gain the support of other sectors such as spatial development, transport, sport or mobility for measures that promote public health, then we can protect the health of people living in Switzerland much more effectively.

At the press conference held to launch "Health2020", you described our healthcare system as lacking transparency. One way of improving transparency is to collect statistical data. Are you prepared to create the statutory and financial framework for such action?

The OECD and the WHO rate our healthcare system as being of very high quality, but see a need for action in the areas of manageability and transparency. This is also our view, and we've therefore included these two concerns in the comprehensive "Health2020" overview. One of the measures envisaged will expand and improve the basic data available and its analysis. Another measure will introduce new steering instruments, for instance in the field of outpatient care, enabling the cantons to avoid any surplus or shortage of services in this area. To obtain greater transparency and more efficient control of the healthcare system, there is a need for even better data and for simplification, but also for new statutory steering instruments.

The use of modern electronic media is intended to improve the quality of healthcare delivery and reduce costs. The statutory framework for e-health is in the preparation phase. What benefits do you hope to gain from these innovations?

The use of electronic tools, particularly the electronic patient record, will improve the quality of treatment. It means that all the players involved in the treatment of a patient are more fully informed and can coordinate it more effectively.

Talking to spectra:

Federal Councillor Alain Berset, Head of the Federal Department of Home Affairs (DHA) and also Switzerland's Minister of Health. The 41-year-old Fribourg-born, Social Democrat politician was elected as a member of the Swiss government in December 2011, succeeding Micheline Calmy-Rey. He sat in the Council of States (upper chamber of the Swiss parliament) from 2003 to 2011, serving as its president in 2008/2009. Alain Berset studied political sciences at the University of Neuchâtel and was awarded a doctorate in economics in 2005. Before being elected to the Federal Council, he worked as an independent consultant on strategy and communication. He is married with three children.

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