Universal check-up programme in Albania: Is this an effective decision?

At the end of 2014, a health programme with free check-ups for individuals aged 40–65 was launched in Albania, with the aim of early detection of the main non-communicable diseases, as well as depression and mental health issues. This initiative is in line with British policy, but similar programmes have been found to be unsuitable in the Danish population. ¹ The Albanian programme has been criticized by some for its lack of effectiveness and efficiency, but the WHO screening criteria are still contemporary. ²

The mass health screening programmes of the 20th century were widely accepted, but in recent years, they have faced criticism, leading many organizations to revise their screening guidelines.^3–5 The main reasons for the criticism have been the upsurge of false-positive outcomes (creating increased anxiety for patients and increased costs for health care systems), the scarcity of evidence of cost-effectiveness and cost-benefits, the potential harm of screening procedures, failure to improve individuals’ health status and the failure to meet the WHO screening criteria.^4,5 Instead of the WHO criteria, the two main points of focus have been that screening should reduce morbidity and mortality, ² but there is a paucity of evidence on the positive effects of mass health screening on morbidity and mortality. ⁶ Several studies have shown that this kind of mass screening is not suitable.^1,5,6 Krogsbøll et al. ⁶ have suggested that health checks not only fail to improve morbidity and mortality but may also be damaging rather than profitable, and that mass health screening did not make a difference to the number of admissions to hospitals, number of referrals to specialists, absence from work or increased number of visits to physicians. The ‘Inter99’ randomized trial revealed that systematic screening does not affect the development of ischemic heart disease, stroke, or cancer or indeed death. ¹ An Austrian study found no statistically significant impact of mass screening on individuals’ health status. ⁵

In the light of the existing literature and based on the main mortality and morbidity causes in Albania (non-communicable diseases account for 89% of all deaths), we suggest that the current version of the Albanian health check programme should either undergo major revisions or be abolished. However, counselling by Primary Health Care (PHC) providers in fields such as smoking cessation, unhealthy diet, physical activity and alcohol consumption is strongly recommended. Furthermore, Albanian policymakers should raise taxes on tobacco and alcohol, introduce a tax on unhealthy food and drinks and launch health education programmes in schools. The education of the population would lead not only to patient involvement but also to self-care motivation and self-recognition of risk. Providing people with information enables them to make an informed choice about screening. ⁷ It is not recommended that PHC providers should stop preventive activities. We suggest that more attention should be focused on secondary prevention based on individuals’ characteristics (age, gender, personal and family history, lifestyle, preventive medicine, and socioeconomic status).^8,9 For instance, screening for cardiovascular disease based mainly on age is a very cheap and effective method. More than 30% of people aged over 50 would gain eight years of life without a first heart attack or stroke through the use of preventive medication, a cost-effective and safe process.^9,10 Further and continuous flexible education (embedding mental health issues) for PHC providers is also essential with regard to diseases that are given a high priority by the programme. These suggested actions would, in expectation, reduce the health gap in Albania and improve the quality of life in the general population.