Prevention Is Better Than Cure, Say Romanian Doctors: An Epidemic of Noncommunicable Diseases Is Sweeping Romania. an Underfunded Health-Care System Focused on Treatment Rather Than Prevention Is Struggling to Meet the Challenge

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The problems started with a missed diagnosis. Ioana Gheorghe (not her real name), 75, who lives in the western city of Timisoara went to her general practitioner twice complaining she felt poorly. "The GP told me there was nothing wrong. In his opinion, my condition was perfectly fine for my age." She had her first stroke shortly thereafter, and then a second following a period of hospitalization.

Gheorghe is one of a growing number of Romanians struggling with the debilitating effects of cardiovascular disease--especially heart disease and stroke--which now accounts for an estimated 60% of all deaths in the country, making it far and away the leading cause of death in this nation of 21 million in south eastern Europe. This represents one of the highest levels of cardiovascular disease in the 53-country European Region of the World Health Organization (WHO).

For Dr Irinel Popescu, head of the Surgery and Liver Transplantation Centre at Fundeni Hospital, Bucharest, the epidemic of cardiovascular disease is to a large extent driven by lack of awareness among Romanians regarding the importance of diet, exercise and giving up smoking. This he blames on the lack of national cardiovascular disease prevention efforts, which, he says, have been limited to a few media campaigns.

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"There was a national initiative that started with a pilot programme in the Prahova County focused on the prevention of cardiovascular diseases," he says, but it did not progress much beyond good intentions "due to a combination of cost and a not very positive evaluation of the pilot."

Professor Dan Gaita, president of the Romanian Heart Foundation, echoes Popescu's view, noting that poor people are particularly affected. "Poor people have limited access to information and, consequently, have a low level of awareness," he says. "Fruit and vegetables cost more than fat. Poor people also smoke more and suffer more from stress which significantly influences the major cardiovascular disease risk factors."

For Gaita the lack of prevention campaigns is only one part of the problem. He gives equal weight to a health-care tradition that puts too much emphasis on treatment. "As doctors, we were taught to treat a disease, not to prevent it," he says, adding: "That's what we learned at school and for 20 years that is what we have been doing!" The problem with this approach is that it misses important opportunities for risk reduction.

There is a clear need for prevention of a disease developing in the first place and, once it has developed, early diagnosis and treatment. "Earlier diagnoses have the potential to produce better treatment outcomes, especially with regard to cardiovascular diseases and some cancers," says Dr Andreas Ullrich, cancer expert at WHO. Gaita says: "Now it's time to focus on prevention."

Romania has a national cancer programme, but here, too, the vital prevention components are still missing. "All in all, we have stayed at the level of cancer prevention via mass media campaigns and periodical check-ups of women for the early detection of cervical pre-cancer lesions," says Popescu. Romania has the highest mortality rate for cervical cancer in the WHO European Region, despite the fact that the deaths from cervical cancer can be substantially reduced by screening programmes with referral for treatment services. Vaccination against the human papilloma virus (HPV), the main cause of cervical cancer, is an option to further reduce incidence. However, currently due to the inefficiency of the screening programme "detection of cervical cancer is delayed and cervical cancer is diagnosed in advanced stages," Popescu says. "An HPV vaccination programme was abandoned after a controversy over possible side-effects in girls who took the vaccine," he adds.

From 1949 to 1989, Romania had a centralized state-run health system. But after the fall of Communism in 1989, major health system reforms began and by 1998 a decentralized social health insurance system had been established. …