Sanja Šišović, Programme Director, CAZAS
From the Youth Manifesto to systemic reform, CAZAS advocates for prevention, literacy, and inclusive health policies in Montenegro
In Montenegro, public health is at a crossroads. Chronic diseases, mental health challenges, and lifestyle risks collide with social inequalities, digital misinformation, and declining trust in institutions. Sanja Šišović, Programme Director of CAZAS, argues that the country must move from a reactive system to one rooted in prevention, health literacy, and community support. In this interview, she explains why health should be treated as social capital, how young people are redefining its meaning, and why cooperation across institutions, the civil sector, and the economy is essential for building a healthier future.
How would you assess the current challenges in the field of public health in Montenegro?
Public health in Montenegro today faces challenges that are at once medical, social and generational. Alongside chronic non-communicable diseases, mental health, and the use of tobacco, alcohol and other psychoactive substances, we increasingly see that health also depends on the availability of information, living conditions, trust in institutions and the ability of citizens – especially young people – to receive support in good time. On one side, we carry the burden of chronic non-communicable diseases, mental health, and the use of tobacco, alcohol and other psychoactive substances, but also the increasingly pronounced consequences of inequality in access to information, prevention and support. On the other hand, the contemporary way of life, the digital environment, economic pressures, and reduced trust in institutions further complicate the public-health response. What is particularly concerning is that health is often considered only once a problem has already arisen. Yet the essence of public health lies precisely in prevention, early response, education and the creation of an environment in which healthy choices are easier, more accessible and socially supported. In that sense, Montenegro needs a stronger shift towards prevention, intersectoral cooperation, and policies that treat health not merely as a matter for the health system but as a matter of education, social protection, the economy, urban development, and human rights. The World Health Organization and the European Observatory on Health Systems note that chronic non-communicable diseases – particularly cardiovascular disease and cancer – are the leading causes of death in Montenegro, while high blood pressure and tobacco use are among the important risk factors, even as citizens’ private spending on health is rising and places us fairly near the top among countries. This is truly a powerful warning to the entire system – not only the health system – to improve how it works. It is especially important to speak and do more about the health of young people. Through the Youth Manifesto for Health (ProGLAS mladih za zdravlje), which emerged from consultations with more than 500 young people from 22 Montenegrin municipalities, we clearly saw that young people do not view health merely as the absence of illness. They speak of mental health, healthy habits, sexual and reproductive health, the digital environment, the living environment and access to services. Their message is very clear: they need more accessible services, more verified information, less stigma, and greater involvement in decisions that affect their lives and health. That is why I believe one of the key challenges in Montenegro is the transition from a reactive system – one that most often acts only after a problem has arisen – to a system that invests in prevention, early support, and communities in which the healthy choice is really the easier choice.
What role does education play in the prevention and improvement of public health?
Education is one of the most important tools of public health, but only if it is continuous, comprehensible and adapted to the people for whom it is intended. It is not enough merely to convey information. It is necessary to develop health literacy – the ability of people to find, understand, evaluate and apply information important for their health. This is especially important today, when citizens, and young people in particular, are exposed daily to a large amount of content, but not always to accurate, verified, and useful information. In practice, we see that young people often seek answers on the internet, social media, and other digital platforms. Still, they also face disinformation, contradictory advice, and content that is not always grounded in expert sources. That is why health education must be far more than occasional campaigns. It should be part of the school system, youth work, local services, digital platforms, and community work. It is particularly important that education be based not on fear or judgement, but on empowerment, trust and the development of life skills. People change their behaviour more easily when they understand the risks, know whom to turn to, and feel that the system does not judge but helps. Prevention begins with information, but is complete only when that information becomes knowledge, a decision, a habit and part of a culture of living. It is precisely for this reason that investing in health literacy is an investment in more responsible individuals, more resilient communities and a healthier future for society.
How does CAZAS contribute to raising awareness of important health and social issues?
CAZAS has, for many years, worked at the intersection of public health, human rights, education, and community work. Our contribution lies not only in conducting campaigns but also in opening up topics that are often sensitive, suppressed, or insufficiently present in the public space. We work with young people, vulnerable groups, experts, institutions, schools, local communities and international partners. Through the direct provision of preventive health services, education, counselling, fieldwork, public campaigns, digital content, research and advocacy, we strive to bring important health topics closer to citizens in a way that is comprehensible, practical and free of stigma. For us, it is particularly important that public health does not remain an abstract concept. When we speak of health and healthcare, we are, in fact, speaking of quality of life, dignity, safety, and equal opportunities for all people.
How significant is cooperation with institutions and international partners in this field?
Cooperation is crucial because no single sector can respond to complex public-health challenges on its own. Institutions have the mandate, systemic responsibility, and ability to ensure long-term continuity. In contrast, the civil sector often has direct contact with the community, flexibility, and the capacity to recognise needs in the field quickly. International partners bring knowledge, standards, innovation, and opportunities to learn from best practices in other countries. The best results arise when there is trust and when partnerships are not reduced to formality, but rest on joint planning, the exchange of data, the coordination of activities and the shared assumption of responsibility. For Montenegro, a small country with limited resources, international cooperation is especially important. It enables us to learn from others’ experiences, test new models of work, and align public health policies with European and international standards.
What key results would you single out from the organisation’s work to date?
CAZAS’s most important results are continuity, persistence and a focus on health. In the field of public health, continuity is often as important as innovation because community trust does not arise overnight. Over the years, we have developed programmes of prevention, education, support and advocacy, particularly in the areas of HIV, youth health, addiction disorders, mental health, healthy lifestyles and the protection of vulnerable groups. Amid a sea of sustainability challenges and current events that often divert focus from health, we are proud to have, for almost three decades, persisted in our mission of putting health first and ensuring that our community support services are inclusive, accessible and evidence-based. Through our work, we provide preventive health services each year to at least 1,000 unique users, and the range of services is expanding and adapting. I believe it is also a significant result that we have created our own micro-system in which we can tailor our services to our users’ needs. I would also single out the fact that we have managed to connect direct work with citizens and the advocacy of public policy. This means that experiences from the community do not remain merely at the level of individual stories, but become the basis for recommendations, institutional dialogue and systemic change. An important result is also the large number of young people, experts, activists, representatives of institutions and civil society organisations who have gained knowledge and skills through our programmes. For us, success is when people – after education, support or a joint initiative – continue to act in their own community. Over these thirty years of work, we have certainly spoken to thousands of people who have passed through our programmes.
How do you see the role of the civil sector in creating sustainable public policies?
The civil sector has an irreplaceable role in creating sustainable public policies, particularly because it is often the first to recognise problems that the system does not yet see clearly enough. Civil-society organisations are close to citizens, work with communities that are often excluded from formal processes, and can bring real-life experience into policy. In the field of public health, this is somewhat specific because the sector’s role should be, in part, to mediate between what science and evidence say and the needs of citizens and patients – and to turn all of that into an effective public-health programme, that is, policy. However, the civil sector should not be seen merely as a critic of the system. Its more important role is to be a partner that brings data, recommendations, innovative solutions and the voice of the community. Sustainable policies do not arise behind closed doors. They arise through dialogue, evidence, participation and accountability. For public health, this is especially important. If a policy does not understand the needs of young people, those at risk, patients, families, or local communities, it can hardly be effective. That is why I believe the civil sector is a bridge between citizens and institutions, but also a corrective reminder that public policies must serve people.
How present is social responsibility in the business sector when it comes to public health?
The social responsibility of the business sector exists, but in public health, it is still not sufficiently developed strategically. It often comes down to individual donations or one-off campaigns, which is useful but not enough. Without a healthy individual, there is no healthy economy, no productive teams and no sustainable development. People’s health directly affects working capacity, motivation, absenteeism, work quality, and the long-term stability of the community. That is why the business sector must view public health not only through the lens of philanthropy but also as part of a serious development and business strategy. Systems, companies, and corporations around the world are increasingly investing in prevention because they recognise that it is far wiser and more humane to preserve health than to respond later to the consequences. This includes promoting healthy lifestyles, preventing chronic diseases, supporting mental health, protecting the health of young people, and strengthening local services and communities. In particular, we must not forget psychological safety at work, which is still rarely recognised as an important health measure. The workplace is not merely a space for productivity but also one that can either preserve or undermine health. If employees do not have a sense of safety, respect, belonging and the possibility to speak openly without fear of consequences, then we are speaking of a risk that affects both mental health and the quality of work. That is why investing in a healthy work culture, stress prevention, protection from discrimination, employee support, and a psychologically safe environment must become part of a contemporary approach to public health. My message to the business sector is very concrete: public health is not a topic outside the economy – it is its precondition. Companies that invest in the health of their employees, young people, and the community in which they operate are not investing merely in a good image but in a more resilient society, more stable operations, and a future in which development has a human face.
What are the greatest challenges in working with vulnerable groups, and how do you approach them?
The greatest challenges are stigma, mistrust, fear of judgement and the insufficient availability of tailored support. Vulnerable groups often do not seek help, not because they do not need it, but because they have previously experienced rejection, discrimination or a lack of understanding. That is why the first task is to build trust. Our approach is based on respect, confidentiality, non-judgement and working in line with people’s real needs. This means that we do not start from the assumption that we know what someone needs; instead, we listen to the community, involve users and build support that is accessible, practical and dignified. In working with vulnerable groups it is important to understand that a health problem is often not isolated. It is connected with poverty, family relationships, education, employment, violence, discrimination or a lack of information. That is why an integrated approach is needed, in which healthcare, social protection, education, the civil sector and the local community work together.
How do you see the development of public health and education in the period ahead?
I believe that, in the period ahead, public health will have to become much more proactive, more digital and more oriented towards prevention. The health system cannot be sustainable if we deal predominantly with consequences and too little with causes. That is why investment in health literacy, mental health, the prevention of chronic diseases, early intervention and work with young people will be decisive. Education will have to adapt to new generations. This means less formal lecturing and more interactive work, digital tools, peer education, practical knowledge and space for conversation. Young people do not merely want to listen to messages; they want to participate, ask questions, challenge and create solutions. Even so, it will be important to work on intergenerational differences, because for the first time in history, we have such a gulf in technological literacy between the oldest and the youngest patients. I also expect that public health will increasingly depend on cooperation among different sectors. Health is not created only in the doctor’s surgery. It is created in the family, the school, the community, the workplace, the media, on the internet and through public policies. Finally, experts increasingly warn of the importance of targeting the social determinants of health, which are directly linked to other sectors – meaning that the responsibility of the education sector, the economy, and others will increasingly be in the health sector’s focus.
What message would you send to decision-makers and the international community when it comes to investing in public health?
My message is simple: investing in public health is not a cost, but the wisest investment a society can make. Every euro invested in prevention, education, mental health, early support, and reducing inequality returns through healthier citizens, less pressure on the health system, greater productivity, and more stable communities. To decision-makers, I would say that public health must be a political priority, and not merely a sectoral topic for the Ministry of Health. We need data-driven policies, sustainable financing for preventive programmes, the strengthening of local services, and the genuine inclusion of young people and communities in decision-making processes. To the international community, I would say: continue to support Montenegro, but also invest in long-term capacities, and not only in short-term projects. The greatest result arises when international support strengthens local actors, institutions and communities to carry change forward themselves. Health must be a shared responsibility and a shared value. Finally, I would call on every citizen to make their contribution so that, together, we create a society in which the healthy choice is the easy choice. The only system in which an individual can be healthy is one in which the healthy choice is the easy choice.