In 2020, Portugal recorded as main causes of death stroke (9.9%), lung and colorectal cancer and ischemic heart disease (6.4%), covid -19 (5.7%) and pneumonia. (5.1%). To increase a risk with health, it will be necessary to act on the factors of poor control by the Portuguese, especially not that cardiovascular diseases are respected, which are the main causes of death in the country. According to a study by the Doctor Ricardo Jorge National Health Institute (INSA), 68% of the population has two or more risk factors for cardiovascular disease and 22% four or more.
If health, as defending Isabel Galriça Neto, should medically be — first and foremost — an individual concern, the truth is that the Portuguese only react a problem arises: “’Now that I’m going to be careful.’ This is the prevailing thought”, says the medical director of the Palliative Care Unit at Hospital da Luz. “Prevention serves to work in the medium and long term, there are no results in immediate terms, or that move away as people, because only value when they are already losing.”
In part, this explains the reason why more than half of the Portuguese are obese or pre-obese and 43% have high blood pressure. Hence the importance of developing strategies to protect the population from risk factors for diseases and promoting health lifestyle and health protection measures. One of them, says the chairman of the Ordem dos Médicos (OM), is sugar: “It destroys everything, it’s like a legal drug”, said Miguel Guimarães. The most relevant risk factors are diabetes, high cholesterol, arterial hypertension, pre-obesity/obesity and smoking (see graph with associated deaths).
When does prevention start? The answer does not offer many doubts to former Health Minister Maria de Belém Roseira: at school. It was during her tenure that she developed a youth smoking prevention program in a school setting. “1 When there is, there are just over 0 schools that adhere. It was an articulated program between the Ministries of Health and Education. At the end of the term, we had more than a thousand. Regrettably, that program is over”, she says, considering that “the Portuguese have little culture of prevention”. “Children are also health workers. They should take home the advice their parents didn’t have and don’t value.”
António Morais, Portuguese Society of Pneuology, recalls that the president’s cancer is today one of the main causes of death in Portugal. “In 2018, tobacco accounted for 524 cancer cases out of 8, having caused four thousand victims. In Portugal, 15% of the population is a smoker, however, as for smoking cessation, they are among those who were left behind during the pandemic — and who accumulate longer waiting lists ”, he says. “A window of opportunity is needed And, although there is less smoking, today there is another problem that has been undervalued: integrated cigarettes. “He mentions that it is less bad for not having been traditional, but as tobacco substances are there, such as nicotine, which causes dependence. It is a tobacco advertising contract, even though advertising has been banned in Portugal.”
Screening only for some
They are called population-based inventories. In February, the Minister of Health guaranteed that the early diagnosis-mayor to the results obtained in the pre-pandemic years. As an example, Marta Temido said, in the case of colon and rectal cancer — one of the most deadly in Portugal — around 57,000 people were screened. The number represents a growth of 44% in 2019. But experts are unanimous: the national coverage of screening is heterogeneous. In urban centers there is a race against time in carrying out diagnostic tests due to the pandemic, but there are areas where there are almost none.
“We have to do what we have already pointed out several times”, begins by saying Miguel Guimarães. “To be able to improve the bad indicators of chronic, which are bad at the European level because we have a burden of disease after 65 years, but we can have in prevention, in the screening of other cancers – in addition to breast, uterine, colon and rectum. With regard to the law of means – financial allocation in the State Budget -, we are 25% less than what is done at European level”, said the chairman of the OM.
The diploma that may be other population-based retinas breast, cervix, colon and rectum and 2016 advanced diabetic pathogenesis, but only now it is predicted that extended to diseases. The program is in the hands of the Council of the European Union and should be published publicly soon in Portugal. “[O problema] It’s not just about control. The 30 deaths are not only avoided by the thousand. But the cancers that kill in Portugal still no longer have an effective population-based model”, says José Dinis, director of the National Program for Oncological Diseases.
Noting that the new European Plan to Combat Cancer is about to enter public discussion in Portugal, the also onc onc IPO in Porto says the reduction in cancer numbers — responsible for the death of 30,000 people a year in the country — it is done “by modernizing the ongoing tracking programs and extending them to the entire national territory”. “It is necessary to draw up membership plans. People have to join, how to convince. The program must also provide the territory in a homogeneous way. There are areas that are well covered by tracking, but others that are not.”
Knowing that every day counts for cancer, the European plan has a target of three million lives by 2030. In its Portuguese version, however, it aims to reduce the mortality figures in our country, where, according to data from the Global Cancer Observatory, in 2018 more of 58 thousand new cases. Knowing that during a pandemic diagnosed through the diagnosis of millions of cancer patients, the numbers are expected to skyrocket in the coming years.
“The experts in which they are unanimous in 2022 and in the years that will say they are more doctors”, Ricardo and PSD deputy Baptista Leite. “Many of the early diagnoses are made in primary health care facilities. With so many people without a family doctor, it means that we are facing a fundamental failure. The key, rather than comparing in terms, is realizing what was lost during the pandemic.”
Why late diagnosis of cancer?
The lack of doctors in primary health care. Most of the illness times are done in these units, specialists in General and Family Medicine. The problem is that there are more than one million Portuguese people without access to a family doctor, which increases the possibility of early diagnosis.
How many General and Family Health doctors work in the SNS?
In 2020, there were 400 doctors of this specialty in Portugal. According to the majority of the National Statistics Institute, these clinicians, close to 310, give service in the private service.
Until what age is it expected to have a healthy life?
It is estimated that men can live disease-free up to age 73. Women, on the other hand, have a healthy life up to 72. According to Pordata, a fifth of deaths in Portugal are premature.
Best of of the working texts on the website
Doctors over 60
Half of the specialist doctors are over 61 years old. The age group above 65 is the one that has increased the most in recent years.
how the elderly live
Aging: poor, dependent and discriminated against at work. How are our seniors? We need to improve access to health care, adapted senior work and increase the financial literature.
Lack of resources
One of the least competitive and aging specialties: obstetrics represents 4% of the total number of doctors in Portugal. The lack of human resources in the SNS is increasingly a concern, especially in obstetrics and gynecology emergencies.
Let’s live longer. What advances in health can mark the next decades? What is the impact of aging on our savings, on cities, on social life? In 2022, Expresso launches a project on this new challenge, with the support of Fidelidade and Novartis.
Texts published in the Express of June 2, 2022