This chapter is about three policy areas that are related to each other not only at a national but also at an international level. It involves the links between social and health policy, development policy and competition policy. Social systems and health systems will in the future be increasingly dominated by the need to change existing conditions to avoid possible future diseases. Instead of “diagnosis and treatment” the emphasis will be on “prediction and prevention”, as the prevention of diseases is the key to a strong economy.
Through prevention, each individual has an improved quality of life and the chance for a long, healthy life. Prevention must be considered by those who are healthy as well as those who are already suffering from a chronic disease with a view to avoiding further complications. When considering the cost of disease prevention clearly ethical reasons come first. As such, it is unethical and thus unjustified to engage in a discussion of who counts or not in terms of the costs of extending lives.
If we start from the premise of an aging population, the working capacity must be extended, and that will only possible through appropriate preventive measures. In this case there is not only a responsibility for providers of health and pension insurance but also the employers, who have a vested interest in seeing a fall in the incidence of ill health amongst an aging workforce.
In the long term, medical costs in an economy can be effectively reduced through efficient health care. For this, it is necessary, however, to identify all the appropriate preventive measures. When appropriate prevention measures are effective, they are able to contribute to an improvement in health care financing. Prevention is to be carried out on three levels.
Primary prevention will focus on healthy people, who do not have symptoms of disease or who are in a position to be able to control their behavior so as to eliminate any symptoms or postpone these to a later date. This health care is aimed at a broad population and is already in use in kindergartens and schools. Secondary prevention primarily includes screening tests for diagnosing diseases which are not yet visible at the symptom level, such as cancer screening. The third level of prevention is to avoid a worsening of symptoms or the occurrence of additional complications in established illnesses.
When it comes to changing the health behavior of individuals, state institutions mainly rely on the information of their citizens. They have the opportunity to take restrictive measures and intervene only on the basis of recommendations via bans, for example, on tobacco and alcohol, and other actions that impact the lives of citizens. Denmark experimented with such measures by instituting a fat tax, while the US is doing so with a ban on artificial transfats in food, to be implemented in 2018. But such interventions for most health officials do not seem to be first choice solutions as this tends to have disruptive effects on the entire economy.
At present it is not yet common in most health systems for physicians to be sufficiently rewarded for increasing the preparedness and responsiveness of their patients. It will therefore be necessary to consider these benefits in the medical fee catalogs accordingly. Since the level of health care is also in direct relation to the level of education of citizens, the education systems will have to strengthen their role in helping health literacy of the population. In addition, the internet provides an increasingly important channel to inform people about these issues.
Today, in most countries, the problem is to adequately target groups for preventive measures, mainly people with a high risk of disease, and, in general, to define and develop optimal approaches for these target populations. There is still uncertainty as to what programs are actually suitable for health care and how the financing is to take place. As such, all political powers will be required to work on solutions. The sooner this happens the better.
The ideal solution of individualized, science-based health care is still far off. Realizing this will require comprehensive scientific and technological developments, the achievement of cost effectiveness, widespread availability and the ability to apply any solutions on a large scale. The road to individualized precision medicine is long. In the first instance, focus will need to be given to improving scientific and technical methods for identifying target populations and addressing them specifically. In this context, we now speak of a stratified medicine, i.e. a medicine that is aimed at certain groups, or strata.
Another important aspect when considering precautionary health systems is the ability to influence risk factors. We still believe that these risk factors are mainly in the domain of each individual’s influence. However, it must be seen whether a “behavioral prevention” is sufficient or not with regard to larger populations or whether changes in peoples’ living conditions (“situational prevention”) is just as or even more necessary. This means, however, that external risk factors, such as emissions from motor vehicle traffic or by urbanization and other environmental factors, such as an increase in UV radiation, must be considered.
Preventive health care systems are an essential element of global health. The global convergence of living and consumption habits is accompanied by the spread of non-communicable chronic diseases, which are not only a problem of developed countries, but also increasingly occur in emerging and developing countries. Today, we are not only seeing the challenge of preventable deaths from infection diseases, but we are seeing non-communicable diseases threaten development opportunities, economic growth and the entire social and political stability of a whole region.
All forms of disease in the emerging and developing countries are a major cause of poverty and inequality as well as associated conflicts. The consequences of climate change in these countries are an additional public health challenge. A permanent challenge is still the fight against hunger and malnutrition. According to the WHO Constitution, health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. In this context, human rights are of particular importance to food.
Overall, it is clear that global health issues are closely related to many other policies, such as development, trade, industry, food, agriculture, research, education and environmental protection. Global health issues are thus no longer treated exclusively by health experts but by a large number of governmental, intergovernmental and non-state actors.
This “international health” has traditionally been focused on developing countries and their health problems, that is, on infectious diseases, water problems, sanitary conditions and malnutrition. Meanwhile, the term “international health” was replaced with the new concept of “global health”. This term includes, alongside existing priorities, an emphasis on prevention and on a common understanding of health as a public good that requires the cooperation of all stakeholders and places the importance of systems and structures in the foreground.
Especially in developing countries, the context of globalization and urbanization created a double burden of classic health risks from communicable diseases and lifestyle diseases. The goal of Global Health is to enable people to gain more control over their health. This requires the joint efforts of international organizations, national government agencies and civil society and the private sector. To establish a workable relationship between government and business, both a national and international competition policy is necessary to keep everyone involved.
With regard to the policies of national governments and international organizations my view, similar to that held by Nestlé, has long been one based on ordoliberalism, a German variety of social liberalism. This thinking implies that states have the task of creating the conditions for free competition in the economic sphere, and keeping it operational, in order to ensure individual freedom. Regulated competition prevents the emergence of private sector market power and establishes a legal framework within which the players can act.
According to theories of ordoliberalism, a State’s objectives can be realized when it recognizes the following principles in its economic system:
securing free market prices and a functioning price mechanism;
ensuring open markets or preventing market entry barriers;
freedom of contract;
equality before the law;
private ownership of means of production and
ensuring that private-sector decision-making power and responsibility correspond to the polluter pays principle.
In addition, the state should be able to make timely interventions in economic activity, while ensuring that these are not detrimental to the market price mechanism. Indeed, globalization needs a frameword.
For its part, Nestlé applies the above approach in all nation states where it has factories and behaves accordingly towards all local consumers, employees and state institutions. Companies are essential parts of the social structure of each country. They mus therefore meet certain obligations in respect to the environment in which they operate and cannot ignore or disregard these.
In addition, a global expert also needs clear and inviolable principles and values on issues such as the quality and safety of products, ways of dealing with the various stakeholders, environmental and ecological conditions and human rights.
With these principles, Nestlé contributes to the increased prosperity of the countries that have given the company a home. And it does this not just by bringing good products to market, or bringing expertise and new technologies, or paying wages and buying raw materials. An international company also ensures above all more competition. It forces suppliers, commercial and financial partners and authorities to improve their own practices.
When people no longer have to fight to avoid hunger, new values are created alongside more prosperity, more education and a higher degree of awareness of these values. That is also a good basis for the development of democracy. And with more democracy, greater attention and respect is secured for human rights. This requires more than the declaration of values; it requires specific actions.
The long-term success of a company is only possible, in my opinion, when its activities, principles and practices, find general agreement among all parties, be they owners, consumers, civil society, employees or authorities. For this reason it is in the long-term interests of each manager, to conscientiously abide by laws, to develop an understanding of social issues and to ensure that the company’s activities and the interests of the society in which it operates go hand in hand. This naturally requires the involvement of stakeholders to strengthen dialogue and deepen understanding of important social issues.