Time out to simply sit and watch the world go by

This week’s blog comes from a small village in the mountains of Portugal. It’s a beautiful place called  Monte Frio. I’m here as a guest of my childhood friend Keith and his lovely wife Ana. Like me, Keith is retired. He has the best of both worlds, an apartment in Matosinhos, Porto, near the sea and a house up here in the mountains. We both love music, and we both have large collections of musical instruments – Keith’s collection is more eclectic than mine. Mine is mainly dominated by famous name guitars (Fender, Martin, Gibson and so on). J doesn’t share my passion for collecting musical instruments (how many guitars does a man need?). 

Their house has a balcony that looks out over the valleys and mountains that surround the village. So, it has been wonderful to spend some quality time, playing music, eating, drinking great wine, and simply sitting and watching the world go by. The realities of the world will still be there when I return, but just for a few days it has been wonderful to step off the merry-go-round and chill.

The last time I was here in Portugal, was December 2019. I presented a keynote paper at a mental health conference. It was a stay that I really enjoyed and I promised I would return the following year. Little did we know what was coming to the world in 2020. Covid-19 reached Portugal in March 2020; in the UK it was February of the same year.

Many readers will know that Portugal is part of the Iberian Peninsula and is famous for its beaches, port and great food. Possibly some people will have heard of their most famous football player, Cristiano Ronaldo. What is probably less well known is that Portugal has a very good healthcare system. In world rankings (supplied by Numbeo) Portugal ranks 24^th – the UK, 15^th. Top country in this index is Taiwan, something I wrote about earlier in the year. Last year’s World Index of Healthcare Innovation, an index based on measuring quality, choice, science and technology and financial sustainability, ranked Portugal 22^nd. The UK was 10^th. Strangely Taiwan is not part of this index.

Actually, I have never been a great fan of league tables. Both the league tables above do little to ensure that different health care systems are comparable. More importantly, such metrics tend to look only at illness services and not at measuring how the social determinates of good health and well being are addressed. And that’s where I’m at in my thinking. It’s possible to have the best acute medical services in the world, and we need them of course, but if we could do more to prevent ill health, then the world would be a better place.

So, as I’m in Portugal, let me provide you with an example or two of what I mean. Here there is a universal and publicly-funded health service. It’s called Servico Nacional de Saúde (SNS) – it is similar to what we think of as our NHS in the UK. As in the UK, most services are completely free to all Portuguese citizens. There are some charges called ‘taxas moderadoras’ which are not there to help pay for the provision of health care, but to stop people accessing services that they don’t need. If you visit your GP, you pay a fee of about £4.50. To go to your local A&E department as a non-emergency presentation, it’s £13.50. Like in the UK, you will need to pay for your prescriptions to be filled (unless like me, you are over the age of 65). Now then, here’s a thought, what about if we introduced these charges to out NHS. I’m sure it would make a difference to the ever increasing urgent and emergency care demands. I know it’s an idea fraught with issues of how to protect the truly vulnerable, but goodness I like it.

Like many countries, cancer, cardiovascular diseases and respiratory conditions are the most concerning issues in Portugal.  Reducing the risk of experiencing one of these conditions revolves around addressing both health inequality factors and life choices. My friend Keith is one of the 17% of people in Portugal who continue to smoke tobacco. He is a health care professional and understands the harm smoking has on an individual health. Internationally, smoking remains the number one preventable cause of death. The World Health Organisation report that it kills more than 8 million people a year, including 1.2 million deaths of people exposed to second-hand smoke. Smoking related deaths and illness are the number one preventable health care problem. Interestingly, last week the renowned Health Foundation, published a survey that observed only 46% of people thought the UK government were doing enough to reduce the harm caused by smoking. There is another health aspect to smoking that is nothing directly do with smoking, but is just as damaging. It is the economic impact. A packet of 20 cigarettes in the UK cost between £10 – £16.50. That is a lot of money to get diverted from household spend and, in many circumstances, it will be an additional contributor to poverty. And so, the circle of social determinants impacting on health and wellbeing turns once more.

It doesn’t have to be like this. I’m saying hats off to the New Zealand government. Two weeks ago, they introduced a new law that sets a steadily rising purchasing age so that today’s young people will never be able to legally buy cigarettes. The age limit will be raised year on year. Additionally, in the future you will only be able to buy cigarettes from specialty tobacco stores. I have seen this approach work well in Finland and parts of Australia with the selling of alcohol. In announcing the new law, the New Zealand Minster for Health, Ayesha Verrall, said: ‘Our priority in bringing this bill is protecting what is precious- our people, our whȃnau (families) and our communities’. As I sit here writing this, waiting to travel back home, I have to say, Ayesha’s words resonate well with me. We do need to keep looking for ways to promote health and wellbeing rather than continuing to just build bigger and more expensive hospital and clinics. Prevention is always going to be better than cure.