Covid-19, the “Children without tobacco” initiative, monkey pox: for public health experts, it has been impossible to escape the spotlight since 2019. Essential, this discipline is however not the most popular and even less the best funded from the country. While caregivers from all over the world come to train in Switzerland, only one out of four public health officer positions there is occupied by a person trained in public health at master’s level.
Who we talk to. Jean-François Etter, specialist in issues related to tobacco addiction, directs the program of Master of Advanced Studies in public health at the University of Geneva — a three-year, in-service training program. While training places are still available, Jean-François Etter pleads for strong training and better dialogue between public health specialists and the political world.
Heidi.news — Public health: the term is known, but its meaning may be less. What are its specificities?
Jean-François Etter – It is a discipline that is interested in the health of the population as a whole, beyond care. It brings together disciplines such as epidemiology, social and preventive medicine, health promotion or research on care and health systems. It takes into account the social, economic and legal context, at the local, national and international level, to preserve and improve the health of the population. At a time when most of the money is invested in curative care, public health will also focus on approaches that take into account the person and his environment before he enters the hospital and after she leaves.
The doctor who works in care will respond to a complaint from the patient, at the individual level. In public health, the prism changes and goes to the population level: individuals evolve in a society and the disease is part of an environment.
The relationship with the authorities is important, because public health often involves state intervention and operates within a legal framework. There is therefore also a whole dimension of promoting laws favorable to health.
You talk about the legislative framework. Where are we in Switzerland? What is the health status of public health?
Overall, the situation is not so bad. Switzerland is one of the countries with the best life expectancy in the world and the level of health of the population is very good. On the other hand, we are behind in terms of prevention. We spend less, or even much less, on average than countries comparable to Switzerland.
Why?
Let’s say that the financial incentives are much stronger for curative care, in terms of reimbursement. In my opinion, there is also the notion of urgency which intervenes and which is perhaps less present in prevention and health promotion. While research shows that by investing small amounts in prevention, we save larger amounts later.
There is also an unfavorable political context in a country as liberal as Switzerland, which also hosts the headquarters of many multinationals, particularly in the food and tobacco industry. There is only to see what happened with the tobacco products law. It spent six years in the hands of Parliament, going back and forth between the chambers, only to come out almost empty of its contents. It took a popular initiative to arrive at a constitutional article prohibiting tobacco . Finally, there is a major effort to be made in the training of health professionals.