Croatia spends 11% more than the EU average on cancer treatment but records the second-highest mortality rate in the bloc, signalling a crisis within the public health system, according to Croatian MEP Romana Jerkovic, who spoke to EURACTIV.hr.

Jerkovic is the SDP representative in the European Parliament, a member of the Club of Deputies for the Progressive Alliance of Socialists and Democrats, and a member of the Special Committee for the Fight Against Cancer in the European Parliament.

“Croatia has very poor cancer treatment outcomes…we spend more, and we achieve worse results,” she told EURACTIV.

Jerković, also a doctor, scientist, and professor at the Faculty of Medicine in Rijeka, praised Croatia’s National Strategic Framework against Cancer but also pointed out that the document remains a dead letter and raised questions about ways of using money to fight the disease.

She recently organised a conference in the European Parliament to discuss the implementation of new recommendations for cancer screening programmes. Asked by EURACTIV whether such events result in changes to the healthcare system, she affirmed that they do.

“I thought it was extremely important to attend the conference “It’s time for a screening! Implementation of new recommendations for cancer screening programs”, which was held in Brussels, hosted representatives of the profession, politics and patient associations from Croatia. They tell me that they learn a lot at events like this and help them to become aware not only of the importance of European health strategies but also of the fact that we have considerable financial resources available for their implementation.”

She said, however, that while EU policies in the field of health offer a number of scientifically based and quality guidelines for improvement, the decision on whether to implement them is made exclusively by the member states.

The MEP continued that Croatia is seriously behind in implementing strategies and plans, with many remaining solely on paper.

“The National Plan to Fight Cancer is, unfortunately, the best proof of that. Croatia has very poor cancer treatment outcomes, patients enter our system at an advanced stage of the disease,” she explained.

Despite this, Croatia is the first EU member state to start a national screening programme for lung cancer, using a low-dose CT method.

“Of course, the introduction of screening is only one important step, but it is not the only one in order to see results and reduce mortality. We also need increased public health campaigns on the importance of quitting smoking,” she added, looking to Belgian and EU bans on smoking indoors.

As for screening for other kinds of cancer, she lamented the low turnout rate of 20% for colon cancer screening which she believes is due to a lack of information.

“There is no research on the reasons for low response, but I believe that in the background there is little or no information. Therefore, investing in increasing health literacy, i.e. in educating the population about the ways in which cancer can be prevented, is of great importance in this case,” she said.

As for the country’s mortality rate where there are some 25,000 cancer diagnoses each year and 14,000 deaths, she said there is no evidence-based answer to the question. However, “using experiential logic, we can conclude that the biggest problem is that patients enter our system too late, that is, their disease is diagnosed at an already advanced stage, when the prognosis is worse and the chances of survival are lower.”

The situation is made worse by the cancellation of some screening programmes such as the cervical cancer programme in 2016. Attempts to revive such a scheme could be hampered by a lack of information about what facilities are available to help people.

“From the media statements of representatives of the Croatian Institute of Public Health, it is evident that they have not yet made an in-depth analysis and that they have no insight into the state of our infrastructure and human resources.”

This can be partly blamed on the COVID-19 pandemic which resulted in around one million cancers being diagnosed late across the bloc, coupled with increased strain on healthcare systems.

“Unfortunately, the pandemic has had a negative impact on all aspects of the health system, including the treatment of malignant diseases. I don’t think our healthcare system is ready for an increased influx of such patients at all,” she said.

But the main obstacle in resolving the problem is political will as there is no shortage of other factors.

“The biggest problem is that there is no political will. There is no other justification given that we have the knowledge, guidelines, and co-financing that is offered to us from EU funds. Our public health workers who design or implement health policy do not have a built-in awareness of the importance of the screening program, so how can we expect citizens to have it,” Jerkovic explains.

She continues that health literacy among the general population is a big issue as citizens need to be responsible for their well-being as well.

“Health literacy is a big problem and it is the responsibility of every individual to be aware of the risks of contracting not only cancer, but also other non-communicable diseases. However, it would be possible to talk about the absolute responsibility of the individual only in a situation where the state, on its part, offered adequate protection from other factors that negatively affect human health.”

As for €4 billion in EU funds, earmarked for fighting cancer across the bloc by 2025, Jerkovic said the strategy is great on paper but has been waiting two years for implementation. Furthermore, she does not know how much money Croatia will gain as the time to apply is running out.

“We have been waiting for its implementation for two and a half years. We have been waiting for an action plan for two and a half years. And while the time for application of projects and withdrawal of EU funds for oncology is running out, Minister of Health Vili Beroš is busy replacing the committee and wasting time,” she said. The MEP also questioned what happened to some EUR 80 million of EU funds that were designated for oncology equipment.

“Maybe we should ask him where millions of these same funds disappeared? With this kind of incompetence, you can only embarrass yourself,” she said.

(Goran Ivanovic | EURACTIV.cr)

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