A Pan-European Public Health Culture
Though born and raised in Escanaba, Michigan, and educated at the University of Michigan—where he earned a bachelor’s degree in French and a master’s in public health—John-Paul Vader, MD, MPH ’88, has spent much of his life in Switzerland, where he is an associate professor in the University of Lausanne Medical School and a member of the Healthcare Evaluation Unit of the university’s Institute for Social and Preventive Medicine. Next year, Vader will become president of the European Public Health Association (EUPHA), a federation of 40 national associations of public health, with approximately 10,000 members. He spoke to Findings about his future role and about how European public health issues and aims compare to those in America.
Findings: The European Public Health Association was founded fairly recently, in 1991, whereas the American Public Health Association (APHA) dates back to 1872. Why the difference?
John-Paul Vader: Because of the fragmentation of European society. Europe is about the size of the United States in terms of population, but you’ve got over 40 different countries here. So each country had its association, or something similar, but there was no federation at the European level. EUPHA really started out with 10 countries, and now it’s got almost 40.
Findings: Is it a coincidence that EUPHA came into existence at about the same time as the European Union?
Vader: No, it’s not a coincidence. The need to federate and collaborate was evident in the public health field, as it was in the political field. But the EU is such a preponderant part of European politics that sometimes we have to remind members of the EU that it’s not the European Union Public Health Association—it’s really all the European countries, including Switzerland and several eastern European countries which are not part of the union. The EU powerfully supports the EUPHA, because we’re an important part of civil society at the European level.
Findings: What are the EUPHA’s top priorities?
Vader: Fostering collaboration among the public health associations is one of the priorities. And we’re encouraging an EU–financed partnership of fledgling public health associations in eastern Europe, where associations from western Europe partner up with associations in eastern Europe who are just trying to get off the ground, to get a public health culture going.
Findings: What is the public health legacy of the Soviet bloc?
Vader: It was a very strange situation in eastern Europe because the notion of the health status of the populations was such a politically charged issue. Some of the statistics before the fall of the Iron Curtain could not really be trusted, because the Communist countries wanted to show that their system of politics led to much better health among their populations than in capitalist countries. What happened was that after the fall of the Iron Curtain, some of these statistics we saw for the first time, and others became worse as time went on. Mortality due to alcohol-related deaths continued going up in some countries even after the fall of Communism.
Findings: So you’re dealing with huge discrepancies in population health.
Vader: Yes. Another of our priorities is to respond to the needs of addressing inequalities in health, in access to health care throughout the EU. That’s a big problem within countries but also between countries. That’s probably our major public health problem, as well as financing the health care systems.
Findings: Are health care costs as big a problem in Europe as they are in the United States?
Vader: It’s a worldwide phenomenon. We’ve just learned in Switzerland, for example, that insurance premiums will probably go up five to six percent on January 1. They’ve gone up that percentage every year for the past ten years. We spend about 12 to 13 percent of our GDP on health. Other countries spend less—Ireland is seven percent—with very little difference among health indicators, so obviously there are things to be learned.
Findings: Besides the high cost of health care, what challenges do you face?
Vader: Cardiovascular disease is still the number-one cause of death throughout Europe. Traffic accidents are a major concern, but there’s great variability. In France, it’s more than twice the rate in England, just across the channel—that’s the culture of how you view the automobile, how you view speed, how you view the need to get where you’re going as fast as you can. But you can avoid a lot of those accidents if you put in place the right policies. And that is beginning to happen. Another area where Europe is starting to follow suit with the States is in terms of the politics of tobacco control. More and more countries are requiring employers to protect employees from second-hand tobacco smoke. That’s a big change from ten years ago. Obesity is also a growing problem. It’s the future epidemic that we’re all afraid of.
Findings: What’s your association’s relationship to the APHA?
Vader: There are so many people at the APHA, and it’s got so much experience, and the resources—everyone looks up to it. Many of Europe’s public health specialists trained in the U.S., as well, and maintain close working relations with North American colleagues. We still look to North America and the APHA for taking the lead in a lot of areas, though there are areas where I think it should be the other way around, in terms of attitude toward the prevention of HIV spread or the prevention of drug addiction, for example, where the politics of it in the U.S. hinders the effectiveness of public health approaches. The Europeans are much less concerned about what’s politically correct or “morally” correct, but are looking more at what’s effective in terms of the public health impact.
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Like their colleagues in the United States, public health professionals in Europe are worried about rising health care costs, the high incidence of cardiovascular disease, and obesity. But, as the new president of the European Public Health Association points out, Europeans also face uniquely difficult challenges.