Mark Wahba, Emergency Room Physician, Saskatoon Health Region, Saskatoon SK Canada
In 2004 Greece stunned the soccer world by winning the Union of European Football Association quadrennial championship tournament - Euro 2004.
Not Italy. Not Germany. Not England. Not The Netherlands. Not France.
Better known for starting the Olympic Games and feta cheese, Greece had never been a soccer powerhouse. Prior to Euro 2004 the Greeks had participated only twice in the final round of a major tournament: the 1994 FIFA World Cup and the 1980 UEFA European Championship. Entering the tournament bookmakers pegged them as 150-1 long shots to take home the cup. On January 20, 2012, the odds against libertarian Republican Ron Paul becoming the next US President were only 35-1.
So how did this obscure soccer nation steal the championship from the traditional powerhouses of Europe? (The Greek team actually earned the nickname “The Pirate Ship” in the Greek media during this tournament for “stealing” the wins from the established soccer nations.)
The answer: a boring, but exceptionally effective defensive strategy.
I looked at the stats from the official UEFA Euro 2004 website for all of Greece’s games in the final tournament. Here are the results.
Goals scored: Greece: 7 Opponents: 4
Attempts on target: Greece: 21 Opponents: 30
Attempts off target: Greece: 19 Opponents: 50
Corners: Greece: 21 Opponents: 51
The statistics, and anyone who endured watching Greece’s slow boring style (if it could be called that) for 90 minutes confirm that Greece played a very defensive strategy. Their opponents had double the number of scoring attempts and over twice as many corner kicks. (To win a corner kick the ball has to be deep in your opponent’s end.) In the final against Portugal, Greece had ball possession for only 42% of the match, a mere 38 minutes compared to Portugal’s 52!
Sure it was dull to watch and soccer purists abhorred Greece’s tedious style. After all, soccer’s tagline is “The Beautiful Game.” Yet tedium was the key to what BBC Sport called “one of the biggest shocks in football [soccer] history.” So if being dull gets you the end result that you are looking for, maybe we ought to consider whether dull is beautiful after all.
Now, soccer is (supposed to be) entertainment and you can have an honest argument about whether winning ugly is ultimately good for the game. Health care, on the other hand, does not aim to entertain. But it does have to deliver results. Preventive medicine is a lot like Greek soccer in 2004. Sadly, many people find it uninteresting. It doesn’t get a lot of fanfare or respect.
Let’s look at some things that people might consider boring, and at what we could do if we really focused on them.
Hypertension: “It has been estimated that a 5 mm Hg reduction of Systolic Blood Pressure in the population would result in a 14% overall reduction in mortality due to stroke, a 9% reduction in mortality due to Coronary Heart Disease, and a 7% decrease in all-cause mortality.”
Quitting smoking: “Smokers who quit at about age 30 reduce their chance of dying prematurely from smoking-related diseases by more than 90 percent.”
Weight loss: In obese people, “modest weight loss, such as 5 to 10 percent of your total body weight, is likely to produce health benefits, such as improvements in blood pressure, blood cholesterol, and blood sugars.”
Physical activity: Exercise helps to reduce high blood pressure and reduces risk for type 2 diabetes, heart attack, stroke, and several forms of cancer. It helps reduce arthritis pain and associated disability. Physical activity also reduces risk for osteoporosis and falls. Exercise even reduces symptoms of depression and anxiety.
Eradicating poverty: Lower socio-economic status is associated with worse health outcomes. An amazing 3.5 million Canadians live in poverty. That’s 10% of the population.
Improving Literacy: Literacy is a significant health determinant. Incorrect use of medications, failure to comply with medical directions, and errors in administration of infant formula are some of the health risks associated with illiteracy. The Canadian Council on Learning reported about 60% of adult Canadians lack the literacy skills to manage their health adequately.
Unfortunately, none of the above seems very exciting when compared to the sharp end of the medical spear. Prevention and health promotion don’t get the respect they deserve. Not from the medical community nor the media nor the politicians. Perhaps if “winning the game” meant improved health outcomes and better population health, prevention would get a status upgrade. We need to realize that an ounce of prevention truly is worth a pound of cure.
So maybe healthcare could learn from Greece’s Euro 2004 victory. Defense and prevention might lack glamour and the adrenaline rush of an immediate and dramatic payoff. But they can be enormously effective in achieving better outcomes for both individuals and populations.
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