Mês: Novembro 2018

Health at a Glance 2018, Saúde Mental [II]

Portugal é o quinto país da União Europeia com maior prevalência de problemas de saúde mental. De acordo com o relatório Health at a Glance 2018, divulgado esta quinta-feira pela Organização para a Cooperação e Desenvolvimento Económico (OCDE), 18,4% da população portuguesa sofre de doença mental, onde se inclui ansiedade, depressão ou problemas com o consumo de álcool e drogas.

As estimativas são referentes a 2016, com base no trabalho feito pelo Instituto de Métricas e Avaliação em Saúde (IHME, sigla em inglês). De acordo com o relatório da OCDE, que analisa dados de 36 países europeus — entre os quais os 28 que fazem parte da União Europeia —, “mais de uma em cada seis pessoas nos países europeus sofre de um problema mental”. A média europeia é de 17,3%, ou seja as estimativas apontam para perto de 84 milhões de pessoas afectadas por este problema.

“Os problemas mais comuns são ansiedade, com uma estimativa de 25 milhões de pessoas a viver com este problema, seguido de depressão, que afecta 21 milhões de pessoas. Estima-se que 11 milhões de indivíduos na Europa tenham problemas de consumo de álcool e/ou drogas. Doenças mentais graves como a doença bipolar afecta quase cinco milhões de pessoas e a esquizofrenia 1,5 milhões”, diz o relatório.

No topo da lista de países com maior prevalência estão a Finlândia, a Holanda, França e Irlanda, com taxas iguais ou superiores a 18,5% da população afectada por estes problemas. Logo a seguir surge Portugal, na quinta posição, com 18,4% de prevalência estimada. Também em Portugal, os problemas mais comuns são a depressão e a ansiedade (cada um afecta 6% da população). Seguem-se os problemas relacionados com o consumo de álcool e drogas (2%) e a doença bipolar e esquizofrenia (2%).

Os países com menos prevalência são a Roménia, Bulgária e Polónia, com taxas inferiores a 15%. “As diferenças podem estar relacionadas com o facto de em alguns países a população estar mais alerta para a saúde mental e à existência de menos estigma associado às doenças, assim como um acesso mais fácil aos cuidados de saúde e com isso haver um diagnóstico mais cedo. Em muitos países ainda há um grande estigma, associado ao facto de que é melhor não falar de doenças mentais”, lê-se no documento.

Na lista de doenças mentais não estão contabilizados problemas com demência, tema que no ano passado mereceu especial destaque da OCDE. Nesse relatório Portugal também estava entre os países com prevalências mais altas de demência, com 20 em cada mil habitantes a sofrer desta doença.

O Health at a Glance 2018 afirma que o custo associado às doenças mentais é muito elevado também a nível económico. O relatório estima que os custos da doença mental representem mais de 4% do PIB dos 28 países da União Europeia em 2015. Ou seja, mais de 600 mil milhões de euros.

Este valor engloba custos directos com saúde (190 mil milhões de euros), com a segurança social (170 mil milhões de euros) e custos indirectos associados à baixa produtividade laboral e desemprego (240 mil milhões de euros). “Apesar dos valores serem consideráveis, são subestimados pois vários custos adicionais não foram tidos em conta”, ressalva o relatório, dando como exemplo as limitações de horas de trabalho dos cuidados informais.

O peso do custo das doenças mentais varia entre países. Na Roménia, Bulgária e República Checa, este peso está entre os 2% e os 2,5% do PIB. Já na Dinamarca, Finlândia, Holanda e Bélgica representa valores acima dos 5% do PIB. Em Portugal, a estimativa do custo total das doenças mentais é de 6,5 milhões de euros (3,6% do PIB).

[artigo do Público]

“Health at a Glance: Europe 2018”, Saúde Mental

Capítulo 1 –Promoting mental health in Europe: Why and how?  [p. 19-40]
Mental illness affects tens of millions of Europeans every year
Mental health problems affect about 84 million people across EU countries
Although there are significant gaps in information about the prevalence of mental health problems across EU countries, all available evidence suggests that mental health problems affect tens of millions of Europeans every year. The data currently available from population-based surveys are often limited to a few specific mental health disorders, or specific age groups. However, the Institute for Health Metrics and Evaluation (IHME) provides estimates of the prevalence of a wide range of mental health disorders across all age groups based on a wide variety of data sources and a set of assumptions.
According to the latest IHME estimates, more than one in six people across EU countries (17.3%) had a mental health problem in 2016 (Figure 1.1) – that is, nearly 84 million people.
The most common mental disorder across EU countries is anxiety disorder, with an estimated 25 million people (or 5.4% of the population) living with anxiety disorders, followed by depressive disorders, which affect over 21 million people (or 4.5% of the population). An estimated 11 million people across EU countries (2.4%) have drug and alcohol use disorders. Severe mental illnesses such as bipolar disorders affect almost 5 million people (1.0% of the population), while schizophrenic disorders affect another estimated 1.5 million people (0.3%).
By country, the estimated prevalence of mental health disorders is highest in Finland, the Netherlands, France and Ireland (with rates of 18.5% or more of the population with at least one disorder), and lowest in Romania, Bulgaria and Poland (with rates of less than 15% of the population).
Portugal é o quinto país da União Europeia com maior prevalência de problemas de saúde mental.
Some of these cross-country differences may be due to the fact that people living in countries with greater awareness and less stigma associated with mental illness, as well as easier access to mental health services, may be diagnosed more easily or may be more likely to self-report mental ill-health. In many countries, there is still strong stigma associated with various mental health problems, and in some countries this stigma sits alongside a still-widespread belief that it is better to simply avoid talking about mental illness (Munizza et al., 2013).
Several mental illnesses are more common amongst women, including anxiety disorders, depressive disorders and bipolar disorders. Some of these gender gaps may be due to a greater propensity of women to report these problems. However, one exception is drug and alcohol use disorders, which are more than two times more likely to occur in men than women on average across EU countries (IHME, 2018).
[p. 21-22]
Mortality related to mental health problems and suicides is substantial
Over 84 000 people died of mental health problems and suicides across EU countries in 2015, and this is an under-estimation as many people with mental health problems also die prematurely because of higher rates of physical health problems and chronic diseases that are not properly treated. “Excess mortality” for mental disorders – the gap between the mortality rate of the general population and the mortality rate for people with a mental disorder – is huge. For example, excess mortality amongst women who have been diagnosed with schizophrenia is above 6 in Finland, Norway and Sweden (OECD, 2018). Persons with severe mental illness die 10-20 years earlier than the general population (Liu et al., 2017; OECD, 2014; Coldefy and Gandré, 2018).
Of the 84 000 deaths directly related to mental health problems and suicides, most of these deaths were among men, mainly because of higher suicide rates among men (Figure 1.4). Some 43 000 men in EU countries died from suicide in 2015, compared with 13 000 women. However, the gender gap in suicide attempts is much smaller or even reversed in some countries, because women often use less fatal methods.
The costs of mental health problems exceed 4% of GDP
The total costs of mental health problems on EU economies are huge, highlighting the need for greater efforts to prevent mental ill-health and to provide timely and effective treatments when it occurs. Besides the costs on health care systems, mental health problems also result in substantial costs in terms of social security benefits as well as
negative labour market impacts in terms of reduced employment and productivity.
(…)
In 2015, the overall costs related to mental ill-health are estimated to have exceeded 4% of GDP across the 28 EU countries.
This equates to more than EUR 600 billion. This total breaks down approximately into the equivalent of 1.3% of GDP (or EUR 190 billion) in direct spending on health systems, 1.2% of GDP (or EUR 170 billion) on social security programmes, and a further 1.6% of GDP (or EUR 240 billion) in indirect costs related to labour market impacts (lower employment and lower productivity).
Despite these costs being considerable, they are still a significant under-estimate, as several additional costs have not been taken into account. These include, in particular, social spending related to mental health problems, such as higher social assistance benefits and higher work-injury benefits, and the higher cost of treating a physical illness if the patient also has a mental illness.
In addition, some of the indirect impacts of mental health problems on labour market participation such as reduced employment rates or working hours for informal caregivers taking care of people with mental health problems or the impact on co-workers, have not been taken into account.
Conclusions [p. 40] [bold nosso]
Many European countries are taking action to prevent mental illness and to promote mental well-being. More than one hundred interventions to promote good mental health and protect populations from the negative impacts of mental illness were found across the EU, targeting all age groups.
Measures are being adopted to promote well-being in schools and nurseries, with new parents, or in workplaces. Reducing stigma and increasing understanding of mental well-being are policy priorities. Furthermore, with improved population-level awareness and understanding of mental health, the stigma around seeking mental health care and talking about mental illness falls. Overcoming stigma and improving diagnosis rates can be expected, in turn, to contribute to more robust data on the true prevalence of mental ill-health.
As this chapter shows, mental ill-health is not distributed evenly across the population, and there are important age, gender and socio-economic differences in the burden of disease. Some groups are also less likely to be the target of promotion or prevention interventions. Supporting vulnerable groups, such as older people or unemployed people, is important to build more inclusive and active societies, but at present far fewer policies reach these groups. The dialectic relationship between distance from social structures and deteriorated mental well-being should also not be underestimated. Just as mental ill-health reduces the likelihood of being in employment, unemployment increases the risk of having poor mental health. Programmes that foster good mental health – reducing loneliness, encouraging social participation, building support structures – and interventions that can identify and respond to signs of mental distress, should be priorities for European countries.
The growing evidence base along with the significant burden of mental illness make clear that there is a societal case for introducing many such promotion and prevention programmes, but there is also a clear economic case for further investment in this area. Actions to prevent mental illness and promote good mental health can bring lifelong benefits to children and their families, workplace interventions can reduce absenteeism and presenteeism, and suicide prevention strategies can prevent tragic losses of life and potential.
The costs of mental illness are extremely high, the potential gains from strengthening mental well-being are significant, and the opportunities for promotion and prevention are far from exhausted. This chapter lays the grounds for a clear case: much more can and must still be done to promote mental well-being and prevent mental ill-health.

“Health at a Glance: Europe 2018” – Sumário Executivo

Health at a Glance: Europe 2018
STATE OF HEALTH IN THE EU CYCLE
Health at a Glance: Europe 2018,  lançado a 22 de novembro, apresenta dados de saúde da União Europeia [28 países].
Sumário Executivo

Health at a Glance: Europe 2018 presents comparative analyses of the health status of EU citizens and the performance of the health systems of the 28 EU Member States, 5 candidate countries and 3 EFTA countries. It is the first step in the State of Health in the EU cycle of knowledge brokering.

This publication has two parts. Part I comprises two thematic chapters, the first focusing on the need for concerted efforts to promote better mental health, the second outlining possible strategies for reducing wasteful spending in health. In Part II, the most recent trends in key indicators of health status, risk factors and health spending are presented, together with a discussion of progress in improving the effectiveness, accessibility and resilience of European health systems.

Ideias-chave destacadas no sumário executivo

Making the case for greater priority to improving mental health

  • Mental health is critical to individual well-being, as well as for social and economic participation. Yet, according to recent estimates, more than one in six people across EU countries had a mental health issue in 2016, equivalent to about 84 million people. Moreover, in 2015 the deaths of more than 84 000 people in EU countries were attributed to mental illness or suicide.

“The total costs of mental ill-health are estimated at more than 4% of GDP – or over EUR 600 billion – across the 28 EU countries”

  • The economic and social costs of mental illness are substantial.The total costs of mental ill-health are estimated at more than 4% of GDP – or over EUR 600 billion – across the 28 EU countries. EUR 190 billion (or 1.3% of GDP) reflects direct spending on health care, another EUR 170 billion (1.2% of GDP) is spent on social security programmes, while a further EUR 240 billion (1.6% of GDP) represents indirect costs to the labour market due to lower employment and productivity.
  • The heavy individual, economic and social burdens of mental illness are not inevitable. Many European countries have in place policies and programmes to address mental illness at different ages. However, much more can be done to manage and promote mental health.

Reducing wasteful spending to make health systems more effective and resilient

“Evidence from various countries suggests that up to one-fifth of health spending is wasteful and could be reallocated to better use”

  • Wasteful spending occurs when patients receive unnecessary tests or treatments or when care could have been provided with fewer and less costly resources. Evidence from various countries suggests that as much as one-fifth of health spending is wasteful and could be reduced or eliminated without undermining quality of care. Reducing wasteful spending not only contributes to health system resilience, but helps achieve and maintain universal access to effective care.
  • When it comes to hospitals, many admissions could be avoided with better management of chronic conditions in the community. Potentially avoidable admissions for conditions such as asthma and diabetes consume over 37 million bed days each year across the EU. Unnecessarily delayed discharges are also costly for hospitals, and many discharge-ready patients occupy beds that could be used for patients with greater needs.
  • When it comes to pharmaceuticals, minimising waste and optimising the value derived from medicine spending are also critical to achieving efficient and sustainable health systems. A mix of policy levers can support this goal, including: 1) ensuring value for money in the selection and coverage, procurement and pricing of pharmaceuticals through Health Technology Assessment; 2) exploiting the potential savings from generics and biosimilars; 3) encouraging rational prescribing; and 4) improving patient adherence.

Gains in life expectancy have slowed in many EU countries, and large  inequalities persist

  • While life expectancy increased by at least 2 to 3 years over the decade from 2001 to 2011 in all EU countries, the gains have slowed down markedly since 2011 in many countries particularly in Western Europe, increasing by less than half a year between 2011 and This slowdown appears to have been driven by a slowdown in the rate of reduction of deaths from circulatory diseases and periodical increases in mortality rates among elderly people due partly to bad flu seasons in some years.

“People with a low level of education can expect to live six years less than those with a high level of education”

  • Large disparities in life expectancy persist not only by gender, but also by socioeconomic status. On average across the EU, 30-year-old men with a low level of education can expect to live about 8 years less than those with a university degree (or the equivalent), while the “education gap” among women is narrower, at about 4 years. These gaps largely reflect differences in exposure to risk factors, but also indicate disparities in access to care.

Putting a greater focus on preventing risk factors

  • While smoking rates in both children and adults have declined in most EU countries, about one-fifth of adults still smoke every day, and as many as one in four in countries with less advanced tobacco control policies.
  • Alcohol control policies have reduced overall alcohol consumption in several countries, but heavy alcohol consumption among adolescents and adults remains an important public health issue. In EU countries, nearly 40% of adolescents report at least one “binge drinking” event in the preceding month, and more than 40% of young men aged 20-29 also report heavy episodic drinking.

“At least one in six adults are obese across EU countries, with wide disparities by socioeconomic status”

  • The prevalence of obesity continues to increase among adults in most EU countries, with at least one in six defined as obese. Inequality in obesity remains marked: 20% of adults with a lower education level are obese compared with 12% of those with a higher education.

Strengthening the effectiveness of health systems can reduce premature mortality

“More than 1.2 million deaths could have been avoided in EU countries in 2015 through better public health policies or more effective and timely health care”

  • More than 1.2 million people in EU countries died in 2015 from diseases and injuries that could have been avoided either through stronger public health policies or more effective and timely health care.
  • Vaccine-preventable diseases have resurged in some parts of Europe in recent years, pointing to the importance of promoting effective vaccination coverage for all children across all EU countries.
  • It is estimated that 790 000 people in EU countries died prematurely in 2016 due to tobacco smoking, harmful consumption of alcohol, unhealthy diets and lack of physical activity.
  • The quality of acute care for life-threatening conditions has improved in most countries over the past decade. Fewer people die following a hospital admission for acute myocardial infarction (a 30% reduction on average between 2005 and 2015) or stroke (a reduction of over 20% during this same period). However, wide disparities in the quality of acute care persist not only between countries but also between hospitals within each country.
  • Remarkable progress has also been achieved in cancer management through the implementation of population-based screening programmes and the provision of more effective and timely care. Survival rates for various cancers have never been higher, yet there is still considerable room for further improvement in cancer management in many countries.

Ensuring universal access to care is critical to reducing health inequalities

“Unmet health care needs are generally low in EU countries, but low-income households are five times more likely to report unmet needs than high-income households”

  • Unmet health care needs are an important measure of accessibility. Recent survey data show that in most EU countries the share of the population reporting unmet care needs is generally low and has declined over the past ten years. Yet, low-income households are still five times more likely to report unmet care needs than high-income households, mainly for financial reasons.
  • In addition to being affordable, health services must also be accessible when and where people need them. While the numbers of doctors and nurses in nearly all EU countries have increased over the past decade, shortages of general practitioners are common, particularly in rural and remote areas.
  • Long waiting times for elective surgery is an important policy issue in many EU countries as it impedes timely access to care. In many of these countries, waiting times have worsened in recent years as the demand for surgery has increased more rapidly than the supply.

Strengthening the resilience of health systems

  • Health systems need to respond more efficiently to changing health care needs driven by demographic changes and exploit more fully the potential of new digital technologies to strengthen prevention and care.
  • In 2017, health spending accounted for 9.6% of GDP in the EU as a whole, up from 8.8% in Population ageing means not only that health care needs will increase in the future, but also that there will be increasing demand for long-term care. Indeed, spending on long-term care is expected to grow faster than spending on health care. “New digital technologies have the potential to promote more healthy ageing and more people-centred care”
  • New digital technologies offer great opportunities to promote healthy ageing and achieve more efficient and people-centred care. The use of Electronic Medical Records and ePrescribing is growing across EU countries, and growing numbers of EU residents use the internet to obtain health information and access health services, although there are disparities by age and socioeconomic groups.
  • Population ageing requires profound transformations in health systems, from a focus on acute care in hospitals to more integrated and people-centred care in the community. Many EU countries began this transformation over a decade ago – for example by reducing hospital capacity and average length of stay, and strengthening community care – but the process still requires ongoing, long-term effort.

Monitoring and improving the State of Health in the EU

Health at a Glance: Europe 2018 is the result of ongoing and close collaboration between the OECD and the European Commission to improve country-specific and EU-wide knowledge on health issues as part of the Commission’s State of Health in the EU cycle.

—————————————-

The State of Health in the EU is a two-year initiative undertaken by the European Commission that provides policy makers, interest groups, and health practitioners with factual, comparative data and insights into health and health systems in EU countries. The cycle is developed in cooperation with the Organisation for Economic Co-operation and Development (OECD) and the European Observatory on Health Systems and Policies.

The two year State of Health in the EU cycle consists of four main stages:

  • The Health at a Glance: Europe, prepared by the OECD, gives a horizontal starting point.
  • 28 Country Health Profiles, adapted to the individual context and specificities of each EU country, assess the strengths and challenges in their respective health systems.
  • A Companion Report published along with the Country Health Profiles draws cross-cutting conclusions, links common policy priorities across EU countries, and explores the scope for mutual learning.
  • At the close of the two-year cycle, health authorities in EU countries can request voluntary exchanges with the experts behind the State of Health in the EU, to discuss findings and potential policy responses.

The research is undertaken by health experts and is designed to inform and support policy making, not to make recommendations. The cycle is aligned to the policy objectives set out in the 2014 Commission Communication on effective, accessible and resilient health systemsSearch for available translations of the preceding link

“A morte da competência. Os perigos da campanha contra o conhecimento estabelecido.” Tom Nichols

Quando o comprei, não estava realmente à espera que me deliciasse e entretivesse. E instruísse, ao mesmo tempo. De tal forma que faço um post sobre ele, ainda não passei do primeiro capítulo – estou na «ascensão do eleitor pouco informado» (p. 45).

Como o autor conta no prólogo, começou por escrever um artigo – que vos convido a ler aqui. “Se escrevo este livro é por estar preocupado.” Deixo uns excertos do artigo e a promessa de voltar aqui quando acabar…

The Death Of Expertise

I fear we are witnessing the “death of expertise”: a Google-fueled, Wikipedia-based, blog-sodden collapse of any division between professionals and laymen, students and teachers, knowers and wonderers – in other words, between those of any achievement in an area and those with none at all. By this, I do not mean the death of actual expertise, the knowledge of specific things that sets some people apart from others in various areas. There will always be doctors, lawyers, engineers, and other specialists in various fields. Rather, what I fear has died is any acknowledgement of expertise as anything that should alter our thoughts or change the way we live.

What has died is any acknowledgement of expertise as anything that should alter our thoughts or change the way we live.

This is a very bad thing. Yes, it’s true that experts can make mistakes, as disasters from thalidomide to the Challenger explosion tragically remind us. But mostly, experts have a pretty good batting average compared to laymen: doctors, whatever their errors, seem to do better with most illnesses than faith healers or your Aunt Ginny and her special chicken gut poultice. To reject the notion of expertise, and to replace it with a sanctimonious insistence that every person has a right to his or her own opinion, is silly.

Worse, it’s dangerous. The death of expertise is a rejection not only of knowledge, but of the ways in which we gain knowledge and learn about things. Fundamentally, it’s a rejection of science and rationality, which are the foundations of Western civilization itself. Yes, I said “Western civilization”: that paternalistic, racist, ethnocentric approach to knowledge that created the nuclear bomb, the Edsel, and New Coke, but which also keeps diabetics alive, lands mammoth airliners in the dark, and writes documents like the Charter of the United Nations.

This isn’t just about politics, which would be bad enough. No, it’s worse than that: the perverse effect of the death of expertise is that without real experts, everyone is an expert on everything. To take but one horrifying example, we live today in an advanced post-industrial country that is now fighting a resurgence of whooping cough — a scourge nearly eliminated a century ago — merely because otherwise intelligent people have been second-guessing their doctors and refusing to vaccinate their kids after reading stuff written by people who know exactly zip about medicine.

In politics, too, the problem has reached ridiculous proportions. People in political debates no longer distinguish the phrase “you’re wrong” from the phrase “you’re stupid.” To disagree is to insult. To correct another is to be a hater. And to refuse to acknowledge alternative views, no matter how fantastic or inane, is to be closed-minded.

How conversation became exhausting

Critics might dismiss all this by saying that everyone has a right to participate in the public sphere. That’s true. But every discussion must take place within limits and above a certain baseline of competence. And competence is sorely lacking in the public arena. People with strong views on going to war in other countries can barely find their own nation on a map; people who want to punish Congress for this or that law can’t name their own member of the House.

People with strong views on going to war in other countries can barely find their own nation on a map.

None of this ignorance stops people from arguing as though they are research scientists. Tackle a complex policy issue with a layman today, and you will get snippy and sophistic demands to show ever increasing amounts of “proof” or “evidence” for your case, even though the ordinary interlocutor in such debates isn’t really equipped to decide what constitutes “evidence” or to know it when it’s presented. The use of evidence is a specialized form of knowledge that takes a long time to learn, which is why articles and books are subjected to “peer review” and not to “everyone review,” but don’t tell that to someone hectoring you about the how things really work in Moscow or Beijing or Washington.

…………………

O populismo contemporâneo aumentou o desdém pelos peritos e elites de todo o género na política externa, na cultura, na economia, e até mesmo na ciência e na saúde. Tom Nichols analisa e desmonta o manancial inesgotável de rumores, mentiras, análise pouco séria, especulação e propaganda – e a tendência para «procurar informações que apenas confirmam aquilo em que acreditamos». Segundo o autor, os ataques ao conhecimento e à cultura levam à convicção irracional de que qualquer um – depois de frequentar os fóruns da Internet – é tão bem preparado como um perito para discutir seja que assunto for. «A Morte da Competência», uma análise da irracionalidade da política e da comunicação de hoje, é um livro refrescante e oportuno sobre como equilibrar o nosso ceticismo. aqui