Hungarian public health - ups and downs in the last 20 years

Before 1990 in the era of ‘building socialism’, public health services in Hungary—similarly to the other Central Eastern European countries—were mostly organized following the Soviet model with a high priority on infectious diseases and carrying out authoritative hygienic and sanitary control measures. The concept of ‘new public health’ as a contemporary application of a broad range of evidence-based scientific, technological and management systems implementing measures to improve the health of individuals and populations became more and more widely accepted only after the regime change in 1989–90. Recognizing that the ‘hygienists’ are not adequately trained to perform high-quality public health services, the Hungarian Government initiated the development of the School of Public Health at the University of Debrecen in the framework of ‘Health Services and Management Program’ (1993–2000). The School served as the basis institute to the establishment of the first Faculty of Public Health in Hungary.1 At present, the Faculty of Public Health offers a rich variety of learning experience in the field of public health (BSc and MSc courses in public health, MSc in Health Psychology, MSc in Health Policy Planning and MSc in Complex Rehabilitation). Public health training is also delivered in two other universities in the country. In addition, the medical specialization training in Preventive Medicine and Public Health was also developed and launched, and it is running at four training sites. As a result of the educational development efforts, more and more well-trained professionals appeared on the labour market. The policy framework of public health has shown a remarkable consistency for the past 20 years in Hungary. The first comprehensive programme, which was developed by Prof. Pál Kertai, the first chief medical officer, was launched as a government resolution in 1994. It was followed by renewed public health strategies in 2001 and 2003 as another government and parliament resolutions, which set priorities and defined actions for 10 years. They represented the values and concepts of ‘new public health’. Besides health protection, they emphasized health promotion, prevention of non-communicable diseases and reduction of health inequalities. These public health programmes preserved the leadership of public health in the health sector, but they extended the range of actors to all sectors and advocated partnership between them. Unfortunately, only a small proportion of the planned actions was implemented because of the lack of long-term political support, inadequate financing, insufficient institutional capacity and the limited intersectoral collaboration. Of the very attractive ‘For a Healthy Nation’ Public Health Program linked to the name of the former Minister of Health, István Mikola, only the breast screening programme was implemented until the governmental change in 2002. In 2003, the Parliament had called on the government to update and expand the public health programme ‘For a Healthy Nation’, and to present the ‘National Programme for the Decade of Health’.2 In the framework of this programme, actions started basically in all areas of public health under the leadership of State Secretary Zsuzsanna Jakab, the later founding director of European Centre for Disease Prevention and Control and the present Regional Director of the World Health Organization Regional Office for Europe. Soon, it was realized that the available institutional, financial and human resources required focusing the interventions. Intersectoral Public Health Committee was established; a population-based cervical screening programme and health promotion programmes for settlements, workplaces and schools were launched. A strategy against AIDS and a National Food Safety Program were developed. In the accession process to the European Union, Hungary has joined the thematic health programmes, like the Health Monitoring Programme. In 2006–10, public health was not on the health policy agenda. The turbulent political debate on the reform of the health care system detracted almost all attention and resources. In 2010, the new government defined priorities and short-term actions in its health plan (Semmelweis Plan for the Rescue of Health Care).3 Public health legislation was effectively used, smoking was banned totally from public and work places and point of sales of tobacco was reduced to a large extent. Hungary was one of the first countries where companies that place certain pre-packed products on the market must pay public health product tax depending on the sugar, salt, methyl-xanthine and taurine content of the product. Recent surveys have shown that it had an effect on the attitude and consumption of the population. Because of financial austerity, only European Union structural and other external funds are being used for development. The projects include capacity building of institutions that actually provide health promotion and disease prevention services—establishment of a National Health Communication Centre within the public health service, health promotion offices in outpatient services, a model project of community-oriented primary care in the framework of the Swiss Contribution Programme,4 colorectal screening programme and involvement of public health nurses in the cervical screening programme. Whether these developments are sustainable and whether the modernization of the Hungarian public health system would continue is still a question. The integration of the local branches of the National Public Health Service to the regional and local governmental offices did not increase professional capacities and reinforced the administrative nature of the Service. The establishment of the planned National Institute of Public Health is delayed; therefore, the coordination and management of the newly developed services is not optimal. Furthermore, a strong political support is needed to provide funding for these activities after the developmental phase. This requires additional work from all stakeholders to increase the visibility of public health and make it an important item on the government agenda. A renewed Hungarian public health strategy and programme based on the values, principles and priorities of the World Health Organization's Health 2020 would be able to give an adequate policy framework to further actions.5