Getting in shape for the EU
The Czech Republic is almost ready to join the European Union - but are its citizens in equally good form? The Czech Cabinet recently took a closer look at the state of people's health and decided that they need to undergo a radical transformation as well. Czechs drink too much, they smoke too much and an increasing number of them are overweight. Is the government's Health 21 action plan a good idea or is the state meddling in people's lives? Find out what some experts think in this week's Magazine with Daniela Lazarova.
The Czech Republic is almost ready to join the European Union - but are its citizens in equally good form? The Czech Cabinet recently took a closer look at the state of people's health and decided that they need to undergo a radical transformation as well. Czechs drink too much, they smoke too much and an increasing number of them are overweight.
After giving the matter careful consideration, the government unveiled its Health 21 action plan, the aim of which is for Czechs to be transformed into healthy European citizens within 10 to 15 years. Alcohol consumption should be cut by half, the number of fifteen year old smokers should reach 0% and everyone should loose some weight with the aim of reducing the high incidence of diabetes and cardio-vascular disease. Although many journalists regard this ambitious project with skepticism, there is no doubt that Czechs are less healthy than most European citizens and any step towards improving this is a good move. The government's plan has been especially warmly welcomed by doctors working with the young who argue that healthy habits are formed early in life. Dr. Eva Kralikova explains that as far as smoking is concerned teenagers are a high risk group.
"The situation is very bad because teenagers smoke a lot. While smoking has decreased in the population as a whole it has increased significantly among the young. Approximately 50% of 15 to 18 year olds smoke, and it is interesting to note that girls smoke a little bit more than boys, which is new."
Do you have any idea why that is so?
It is mainly peer pressure. And this peer pressure is strongly influenced by the aggressive marketing of tobacco products. For example we did a study in Prague, a survey of three and a half thousand teenagers and we found that- 70% teenage smokers smoked those brands which had massive ad campaigns at the time of the survey, even if they were more expensive than the most sold brand at the time. That shows that young people do not want to smoke just any cigarette. They want to smoke a given brand."
Curbing and eventually banning tobacco ads at sports and other events is one of the goals of this health plan - do you think it is the right way to go?
"Of course, it is one of the most effective measures and it won't cost the government anything. The argument that some jobs will be lost as a result is misleading because those smokers who would like to quit - and that is about 70% of all smokers- have a very good idea as to what they would spend their money on in place of cigarettes. So the money wouldn't be lost."
Many critics view the government's health plan as meddling in people's private lives - telling them to eat healthier, to lose weight and quit smoking. They also don't like the fact that some things -such as alcohol or cigarettes -will no longer be so widely available. Will this "forbidden fruit" policy not be counterproductive with the young?
"Well, smoking is "forbidden fruit" for young people under 18, because officially you have to be 18 to be able to buy a packet of cigarettes. It would probably be wise to withdraw this age limit on the sale of cigarettes because it only makes cigarettes more attractive, implying that smoking is an adult decision. It is also part of the so-called "preventive programme" of the tobacco industry. Philip Morris for instance has a programme called "Adult Decision" which tells children they can smoke when they are 18, not sooner. This is very tempting for teenagers - for fourteen, fifteen year olds who must wait for other things until they come of age but who can have that cigarette right away. So maybe we should change our policy on this. Some years ago I was convinced that the age limit was useful but statistics from around the world show us that the policy is in fact counterproductive."
Another ambitious task the government has set itself is to reduce the amount of alcohol consumed by 40%. A big part of this challenge is to convince Czechs that although their Pilsner beer is good, there can be too much of a good thing. Especially if you start too young in life. Ladislav Csemy works at the Addiction Studies Department at the Prague Psychiatric Clinic in Bohnice.
"We have the results of a recent WHO study and when we compare the behavior of Czech 11 year olds to that of kids their age elsewhere we see that we have the lowest number of children who do not drink at that age in all of Europe."
What do Czech children drink at age eleven?
"Well, usually they start with beer because that is the most popular and widely available alcoholic beverage. Unfortunately people are very tolerant to alcohol misuse. Children can easily consume alcohol and in many cases parents don't tell them that it is inappropriate."
Do you feel that, in general, Czechs drink more than they should?
"Yes, that is not only my opinion but that of many other professionals."
Why do you think that is so?
"I am not sure. There is a strong tradition of beer drinking in our country and alcoholic beverages are very cheap, especially beer. For many Czech men it is inconceivable that they would spend some time in a restaurant or pub and drink coca cola or some other non-alcoholic beverage. So they order a beer and not just one half-pint, but five, six or seven."
You mentioned why Michail Gorbachov's attempt to curb alcoholism in Russia failed. Can you tell me why.
"In general it was because he opted for prohibition. He banned alcohol outright but nothing was done to educate people about why they should not drink. So the public did not accept or support his goals. There was no way it could have worked under those circumstances."
So what do you think would work for us?
"One important thing is to limit the availability of alcoholic beverages, through higher consumer tax, administrative measures and so on, and the second is to get across an important message to the public - that to be healthy is good for you and that part of a healthy lifestyle, a successful lifestyle is to drink in moderation."
Like cigarettes, alcohol will, in future, be less widely available and much more expensive. Doctors who work with alcoholics applaud the government's plan, although most of them feel it is long overdue. Dr. Jaroslav Skala who established the first Czech clinic for alcoholics back in 1948 says that a complex view of the problem is something the country badly needs. He says he is still amazed by how many treatments an alcoholic undergoes for alcohol related problems without being made to undergo a cure for alcoholism itself.
" I consider it a crucial mistake that patients are given a liver transplant without being made to undergo treatment for alcoholism. They leave the hospital with a new liver and drink themselves to death a few years later. I would make people accept more responsibility for their health - in other words - you can have a liver transplant if you make an effort to cure your addiction. People here still live as they like and expect doctors to pick up the pieces when their sins catch up with them."
