Bulgaria is in the penultimate place in Europe in terms of the readiness of its health system to meet new challenges in the future.

This shows a special report of the international organization GLOBSEC from the evaluation of the Health Systems Readiness Index of 27 countries on the Old Continent. 

The most prepared according to the survey are Norway, Switzerland and Sweden, in the middle of the ranking are Germany and Spain, and Romania and Bulgaria are at the bottom in terms of preparation to meet the health needs of their population in the coming years. 

The unique data has been collected within the framework of the Health Care Readiness Index 2021 on the readiness of the health care systems in Central and Eastern Europe for future challenges, including aging, increasing chronic diseases or new waves of infectious diseases.

Readiness today - Readiness tomorrow

The index examines the readiness of health systems from two perspectives.

The first analyzes the current state of health systems by factors such as the number of health workers, percentage of preventable deaths, life expectancy, access to modern medical treatments and innovative technological solutions.

"Readiness today" reflects the extent to which the health system is meeting the needs of its population at this time.

And there, Bulgaria is in last place together with Romania. 

The second perspective, "Tomorrow Readiness," focuses on future health challenges.

In determining this index, experts use the degree of predictability of the health picture in the given country, the control of risk factors such as harmful nutrition, smoking and alcohol, prevention, the vaccination process, health education, targeted measures and strategies.

This index reflects the readiness of countries to respond to health situations related to diseases with expected trends and to provide the necessary health care and prevention to their population, while at the same time being flexible enough to adapt to unexpected crisis situations, experts say .

According to them, among the most key indicators is the percentage of preventable mortality, which depends on a number of factors, including speed and access to the health service, technology, number of specialists and health facilities, prevalence of chronic diseases.

As a result of the large number of smokers, unhealthy nutrition and a poor health culture, chronic diseases are widespread in our country, which has also led us to the top spot in mortality from COVID-19.

What does excellent Norway do?

The research shows a drastic difference between the first and the last in the ranking of the readiness of the health systems - Norway has 80 out of 100 points accumulated from the evaluations in the various categories, while for Bulgaria and Romania they are only 38. Norway, which today serves as an example for many health systems in Europe, place great emphasis on prevention and risk factors such as unhealthy foods, excessive alcohol use and smoking. 

Norway can be a role model in terms of prevention, curbing people's risky behavior and guiding them to limit alcohol, eat less harmful foods and use reduced-harm nicotine products instead of cigarettes. 

"Good prevention with a focus on avoidable mortality can seriously change the picture where it is not optimistic.

Reduction of salt and sugar consumption, access to innovative medicines and innovative products are part of the successful strategy.

These measures are often underestimated, because they do not lead to an immediate improvement of the picture, and the results come after time"

, says one of the authors of the report, Martin Smatana.

Thus, with an average of 17% of people at risk due to their dietary habits in the EU, in Norway their percentage is 13%.

With an average of 17% of Europeans at risk of smoking, in Norway only 12% smoke and their proportion has decreased by almost 3 times in 20 years thanks to the policies implemented in this direction and the support of smoke-free alternatives.

Excessive use is also twice as low as for the average European - the data shows that only 3% of Novrejs consume more alcohol than is permissible.

Another example of a country with a serious focus on prevention and a strategic approach is the Netherlands.

The comparative analysis shows that there the scope of preventive measures of the health system is nearly 4 times greater than that in Bulgaria. 

The tax logic "More harmful becomes more expensive"

The not very wealthy members of the union from Eastern Europe, which have a smaller health budget, can apply the good examples from Europe and the world, but they themselves must adapt the policies to their reality. 

"Take smoking - one of the good examples of a strategy to reduce the harm to public health from it is New Zealand and Australia, which invested in prevention and managed in 20 years to achieve a remarkable result where their next generation will not smoke at all.

Pricing alone cannot achieve smoking cessation, especially in our region"

, commented Martin Smatana and gave as an example the losses of millions in France, where after the drastic increase in the price of cigarettes in order to reduce smoking, instead of more taxes, the measure generated more contraband. 

Taxes affect the affordability of public health products, commented Cecil Noriega of the EU's Taxation and Billing Office. 

"There are European directives on tobacco and alcohol and we are in the process of revising the rules.

Most countries already impose higher taxes on unhealthy foods.

It is undeniable that taxation can be decisive, but we are dealing with taxes, not health.

Measuring the health impact of new nicotine products will take time, and for now we are looking at the practices of member states from a fiscal perspective rather than a health perspective."

Roland Freudenstein, vice president and head of GLOBSEC's Brussels office, was adamant that people's risky behavior is increasingly affecting the security of healthcare systems. 

"Harm reduction is an increasingly important part of the big picture and we can now talk about behavioral economics." 

Europe should think about a health union that takes into account the differences of the respective countries, but applies good practices with an indisputable effect on public health, the experts were categorical.