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This he blames on the lack of national cardiovascular disease prevention efforts, which, he says, have been limited to a few media campaigns.“There was a national initiative that started with a pilot programme in the Prahova County focused on the prevention of cardiovascular diseases,” he says, but it did not progress much beyond good intentions “due to a combination of cost and a not very positive evaluation of the pilot.”Professor Dan Gaita, president of the Romanian Heart Foundation, echoes Popescu’s view, noting that poor people are particularly affected.
“Poor people have limited access to information and, consequently, have a low level of awareness,” he says. Poor people also smoke more and suffer more from stress which significantly influences the major cardiovascular disease risk factors.”For Gaita the lack of prevention campaigns is only one part of the problem.
Ioana Gheorghe (not her real name), 75, who lives in the western city of Timisoara went to her general practitioner twice complaining she felt poorly. In his opinion, my condition was perfectly fine for my age.” She had her first stroke shortly thereafter, and then a second following a period of hospitalization.
Gheorghe is one of a growing number of Romanians struggling with the debilitating effects of cardiovascular disease – especially heart disease and stroke – which now accounts for an estimated 60% of all deaths in the country, making it far and away the leading cause of death in this nation of 21 million in south eastern Europe.
“An HPV vaccination programme was abandoned after a controversy over possible side-effects in girls who took the vaccine,” he adds.
From 1949 to 1989, Romania had a centralized state-run health system.Dr Maria Suciu, a general practitioner based in the western city of Arad, says: “The amount of money we receive from the National Health Insurance House is very small and we cannot equip our office.” Suciu says that she is unable to carry out even basic diagnostic procedures such as measuring blood sugar and cholesterol levels.She estimates that it would cost €30 000 to equip her office for such tasks with a minilab, and with that equipment 40% of the noncommunicable diseases she sees could be managed much better over the next 10 years.Broader collaboration can make a difference, according to Dr Kwok-Cho Tang, a health promotion expert at WHO.“To sustain positive behavioural change, media campaigns alone, more often than not, will not work.There must also be interventions for policy and environmental changes.” He adds: “To effectively address noncommunicable diseases, collaboration is required within and beyond the government sectors.”Suciu does her best to alert patients to the dangers of sedentary lifestyles, smoking, and eating foods that are high in salt, sugar and fat content, but such warnings have their limitations: “Most of my patients do not follow my advice regarding prevention,” she says.When it comes to our health, prevention is much better than cure.The focus on treatment, especially tertiary (hospital) care, rather than prevention and early detection at the primary health care level is reflected in the government’s health expenditure too, which focuses narrowly on hospitals at the expense of primary health care.For Dr Liviu Stafie, at the Regional Health Insurance House (Casa Judeteană Iasi de Asigurări de Sănătate or CNAS) in the city of Iasi, this focus on hospitals is one of the biggest problems Romanian health care faces.But after the fall of Communism in 1989, major health system reforms began and by 1998 a decentralized social health insurance system had been established.Health reforms in the 2000s aim to shift the focus to prevention, but this is still a work in progress.