KAUNAS UNIVERSITY OF MEDICINEFACULTY OF PUBLIC HEALTH

DEPARTMENT OF PREVENTIVE MEDICINE

“HEALTH POLICY DEVELOPMENT IN LITHUANIA”

PROF. Vilius GRABAUSKAS

BISPH TRAINING COURSEPUBLIC HEALTH SCIENCE

LEARNING OBJECTIVES

Vilius GRABAUSKAS

TO PRESENT PRINCIPLES OF HEALTH POLICY FORMULATION IN LITHUANIA

TO PRESENT VALUE SYSTEM AND SCIENTIFIC BACKING-UP OF HEALTH POLICY FORMULATION IN LITHUANIA

TO PRESENT PROCESS OF HEALTH POLICYDEVELOPMENT INCLUDING SOME MONITORING AND EVALUATION ELEMENTS

POLICY AND POLITICS

Vilius GRABAUSKAS

ETHIMOLOGICALLY “POLITICS” COMES FROM OLD GREEK AND LATIN LANGUAGES GREEK “POLIS” CITY – STATE) BY EVOLUTION DEVELOPED INTO LATIN “POLITIA” (STATE)

IN ENGLISH THIS TERMINOLOGY DEVELOPED INTO “POLITY” WHICH MEANT STATE AND “POLICY” WHICH MEANT DOMINATION OF ADMINISTRATIVE POWER IN PUBLIC AFFAIRS

THIS IS WHY TODAY IN THE SCIENTIFIC DISCUSSION “POLITICS” IS USUALLY ASSIGNED TO POLITICAL SCIENCE, WHILE “POLICY” – ADMINISTRATIVE AND MANAGERIAL ISSUES

LITHUANIAN LITHUANIAN DEFINITIONS OF DEFINITIONS OF HEALTH POLICYHEALTH POLICY

POLICY - COORDINATED AND AGREED PLAN OF ACTION

HEALTH POLICY -

COORDINATED AND AGREED ACTION PLAN AIMED AT IMPLEMENTATION OF HEALTH PROMOTION, DISEASE PREVENTION, CARE AND REHABILITATION IN A BALANCED WAY

PUBLIC HEALTH POLICY -

COORDINATED AND AGREED ACTION PLAN AMONG ALL

SECTORS OF SOCIETY AIMED AT IMPLEMENTATION OF

HEALTH PROMOTIVE AND DISEASE PREVENTIVE

ACTIVITIES IN THE ENTIRE SOCIETY Vilius GRABAUSKAS

DEFINITION OF HEALTH

“HEALTH IS COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL BEING, NOT JUST MERELY THE ABSENSE OF

DISEASE OR IMPAIRMENT”

WHO CONSTITUTION, 1948 m. GENEVA

Vilius GRABAUSKAS

FACTORS INFLUENCING HEALTH

Vilius GRABAUSKAS

General socioeconomic and environmental conditions

Age, sex and hereditary factors

FACTORS INFLUENCING HEALTH

GENETICS (20%)

LIFESTYLES (50%)

MEDICAL CARE (10%) Vilius GRABAUSKAS

ENVIRONMENT(20%)

RISK FACTORS RESPONSIBLE FOR PREMATURE DEATHS IN THE WORLD CAUSED BY DISEASES AND INJURIES WORLD STATISTICS. 1990

Nr. RISK FACTORS DEATHS PROPORTION OUT OF TOTAL

DEATHS (%)

UNHEALTHY NUTRITION

TOBACCO

HYPERTENSION

QUALITY OF DRINKING WATER

LACK OF PHYSICAL ACTIVITY

WORKING ENVIRONMENT

UNSAFE SEX

ALCOHOL

AIR POLLUTION

NARCOTICS

5881 000

3038 000

2918 000

2688 000

1991 000

1129 000

1095 000

774 000

568 000

200 000

11.7

6.0

5.8

5.3

3.8

2.2

2.2

1.5

1.1

0.2TOTAL

39.8

1.2.3.4.5.6.7.8.9.10.

PROPORTION OF DEATHS CAUSED BY TOBACCOPROPORTION OF DEATHS CAUSED BY TOBACCO,,

ALCOHOL ALCOHOL AND TRANSPORT INJURIES IN AND TRANSPORT INJURIES IN

LITHUANIAN POPULATION AGED 15-64LITHUANIAN POPULATION AGED 15-64

0

10

20

30

40

50

60

90 91 92 93 94 95 96 97

SMOKING

TRANSPORT INJURIES

ALCOHOL

Vilius GRABAUSKAS

TRADITIONAL UNDERSTANDING OF ILL HEALTH

BIOMEDICAL MODEL OF DISEASE CONTROL

PRINCIPAL ORIENTATION DISEASE OUTCOMES:

•SYMPTOMS

•DIAGNOSIS

•TREATMENT

•REHABILITATION

PASSIVE HEALTH CARE STRATEGY

Vilius GRABAUSKAS

MODERN UNDERSTANDING OF ILL HEALTH

BIOSOCIAL MODEL OF DISEASE CONTROL

PRINCIPAL ORIENTATION CAUSES OF DISEASES:

•SOCIAL STRUCTURES

•LIFE STYLES

•ENVIRONMENT

•HEALTH CARE

ACTIVE HEALTH CARE STRATEGY

Vilius GRABAUSKAS

NECESSITY OF SCIENTIFIC BACKING-UP FOR HEALTH POLICY FORMULATION

Vilius GRABAUSKAS

PREVENTION IF EFFECTIVE IS ALWAYS BETTER THAN DISEASE TREATMENT

SCIENTIC EVIDENCE FOR DISEASE CAUSATION- LIFE STYLES- POLITICAL, ECONOMIC AND SOCIAL ENVIROMENT- PHYSICAL ENVIRONMENT- HEALTH SYSTEM CAPACITY TO DEAL WITH CAUSES

EARLY DIAGNOSIS EFFECTIVE TREATMENT AND REHABILITATION ACCESSIBLE MEDICAL CARE SUFFICIENT RESOURCES

-HUMAN-FINANCES- EFECTIVE MANAGEMENT

HEALTH INFORMATION SYSTEM

Vilius GRABAUSKAS

MAJOR TASK:NEED FOR INFORMATION THAT HELPS EFFECTIVE FUNCTIONING OF HEALTH (NOT JUST CARE!) SYSTEM THROUGH PROPER PLANNING, IMPLEMENTATION, MANAGEMENT, MONITORING AND EVALUATION

MAJOR COMPONENTS: BROAD INDICATORS DESCRIBING ECONOMIC-DEMOGRAPHIC SITUATION

TRADITIONAL ILL-HEALTH DESCRIBING INDICATORS

HEALTH RESOURCE DESCRIBING INDICATORS

HEALTH RESOURCE FUNCTIONING INDICATORS

HEALTH RISK DESCRIBING INDICATORS

INTERSECTORAL COLLABORATION FOR HEALTH INDICATORS

WHO PRINCIPLES FOR HEALTH WHO PRINCIPLES FOR HEALTH POLICY DEVELOPMENTPOLICY DEVELOPMENT

PREREQUISITS FOR HEALTH• POLITICAL• SOCIAL• ECONOMIC• ORGANIZATIONAL

HEALTH SYSTEM INFRASTUCTURE SUPPORT

APPROPRIATE HEALTH CARE

PROTECTION OF HEALTHY ENVIRONMENT

PROMOTION OF HEALTHY LIFE STYLES

• HEALTH INFORMATION SYSTEM AND MONITORING• RESEARCH AND DEVELOPMENT

• TRAINING OF HEALTH PERSONEL

Vilius GRABAUSKAS

LITHUANIAN HEALTH POLICY: KEY PRINCIPLES

SCIENCE BASED EQUITY FOCUSSED PUBLIC HEALTH ORIENTATION

- HEALTH PROMOTION

- DISEASE PREVENTION

HEALTH CARE IN BALANCE

- PRIMARY

- SECONDARY

- TERTIARY

COMMUNITY PARTICIPATION INTERSECTORAL ACTION ACCOUTABILITY RESEARCH

PRIORITY

REFORM}

}

Vilius GRABAUSKAS

PROCESS OF HEALTH POLICY DEVELOPMENT PROCESS OF HEALTH POLICY DEVELOPMENT

IN LITHUANIAIN LITHUANIA

SITUATION ANALYSIS

-DEMOGRAPHIC PROCESSES- MORBIDITY- MORTALITY- DISABILITY- RESOURCES- DETERMINANTS- TREND ANALYSIS

PRIORITY SETTING TARGET SETTING RESOURCE ALLOCATION INTERSECTORIALITY/PARTNERSHIP MONITORING AND EVALUATION

Vilius GRABAUSKAS

FROM EPIDEMIOLOGY TO PUBLIC HEALTH(CONTRIBUTION OF RESEARCH) - 1

1970 -1980 – EPIDEMIOLOGY & PREVENTION: KRIS, (WHO/HQ), AMI COMMUNITY REGISTERS (WHO/EURO), MRFICT, JUVENILE HYPERTENSION, PRECURSORS OF ATHEROSCLEROSIS IN CHILDREN, BIOLOGICAL MARKERS OF ATHEROSCLEROSIS, ETC.

Vilius GRABAUSKAS

COLABORATION WITH WORLD HEALTH ORGANIZATION

FROM EPIDEMIOLOGY TO PUBLIC HEALTH(CONTRIBUTION OF RESEARCH) - 2

Vilius GRABAUSKAS

1980 -1990 – INTEGRATED APROACHES IN NCD PREVENTION AND HEALTH PROMOTION: CINDI (WHO/EURO), INTERHEALTH (WHO/HQ)

COLABORATION WITH WORLD HEALTH ORGANIZATION

FROM EPIDEMIOLOGY TO PUBLIC HEALTH(CONTRIBUTION OF RESEARCH) - 3

Vilius GRABAUSKAS

1990 -1994 – HEALTH PROMOTION IN ACTION AND NATIONAL HEALTH POLICY FORMULATION: NATIONAL CONCEPT OF HEALTH (1991), HEALTHY CITIES, HP SCHOOLS, HP KINDERGARDENS, HP HOSPITALS, HP UNIVERSITIES NATIONAL NETWORKS; EURO REGIONS FOR HEALTH NETWORK

COLABORATION WITH WORLD HEALTH ORGANIZATION

FROM EPIDEMIOLOGY TO PUBLIC HEALTH(CONTRIBUTION OF RESEARCH) - 4

Vilius GRABAUSKAS

1994 -2000 – RESEARCH AND TRAINING IN PH, NATIONAL HEALTH POLICY IMPLEMENTATION: BRIMHEALTH 1992, OPENING OF PH FACULTY AT KMU (1994); NATIONAL HEALTH PROGRAMME (1998); PRESIDENCY OF NATIONAL BOARD OF HEALTH (1998 – 2000), ASPHER MEMBERSHIP (2001)

COLABORATION WITH WORLD HEALTH ORGANIZATION

ADOPTING MEDICAL EDUCATION TO THE PRIORITIES OF HEALTH REFORM IN LITHUANIA NEW NATIONAL CONCEPT OF HEALTH

NEW SPECIALTIES WITHIN HEALTH PROFESSION

REDUCING NARROW SPECIALIZATION Vilius GRABAUSKAS

MORE HEALTH FOR LITHUANIAN PEOPLE THROUGH HEALTHIER ENVIRONMENT AND LIFE STYLES THUS LEADING TO HEALTH PROMOTION AND DISEASE PREVENTION

PRIORITY TO PRIMARY HEALTH CARE WITHIN HEALTH CARE SYSTEM

BALANCE BETWEEN PRIMARY, SECONDARY AND TERTIARY CARE

GENERAL PRACTICE/FAMILY MEDICINE

NURSING

SOCIAL WORK

PUBLIC HEALTH

ADMINISTRATION / MANAGEMENT

OTHER

MAJOR MAJOR STEPS STEPS ININ HEALTHHEALTH POLICY POLICY DEVELOPMENTDEVELOPMENT IN LITHUANIA IN LITHUANIA

MAY, 1989 MAY, 1989 REESTABLISHMENT OF LITHUANIAN MEDICAL ASSOCIATIONREESTABLISHMENT OF LITHUANIAN MEDICAL ASSOCIATION

OCTOBER, 1991 OCTOBER, 1991 APPROVAL OF NEW NATIONAL CONCEPT OF HEALTH APPROVAL OF NEW NATIONAL CONCEPT OF HEALTH BY THE PARLIAMENTBY THE PARLIAMENT

MARCH, 1993MARCH, 1993 FIRST NATIONAL HEALTH POLICY CONFERENCEFIRST NATIONAL HEALTH POLICY CONFERENCE

DECEMBER, 1993DECEMBER, 1993 ESTABLISHMENT OF HEALTH REFORM MANAGEMENT ESTABLISHMENT OF HEALTH REFORM MANAGEMENT BUREAUBUREAU

JUNE, 1994JUNE, 1994 ADOPTION OF HEALTH SYSTEM LAWADOPTION OF HEALTH SYSTEM LAW NOVEMBER, 1995NOVEMBER, 1995 PARLIAMENTARY DISCUSSION ON HEALTH SYSTEM REFORMPARLIAMENTARY DISCUSSION ON HEALTH SYSTEM REFORM

Vilius GRABAUSKAS

NATIONAL DEPARTMENT OF STATISTICS

LITHUANIAN HEALTH INFORMATION SYSTEMLITHUANIAN HEALTH INFORMATION SYSTEM

LITHUANIAN HEALTH INFORMATION CENTRE (UNDER MINISTRY OF HEALTH) AS EXECUTING AGENCY

STRUCTURE OF INFORMATION ANALYSED AND PUBLISHED ON ANNUAL BASIS

• DEMOGRAPHIC SITUATION

• LIFE STYLES• HEALTH CARE FACILITIES• HEALTH CARE SYSTEM PERFOMANCE• HEALTH CARE FINANCING

• MORBIDITY

LINKAGES:RESEARCH INSTITUTIONS

WHO/HFA DATA BASE

• ENVIRONMENTAL HEALTH

Vilius GRABAUSKAS

LIFE EXPECTANCY AT BIRTH TRENDS LIFE EXPECTANCY AT BIRTH TRENDS IN BALTIC, NORDIC AND EU COUNTRIESIN BALTIC, NORDIC AND EU COUNTRIES

64

66

68

70

72

74

76

78

1970 1975 1980 1985 1990 1995 2000

Estonia Latvia

Lithuania

EU average

Nordicaverage

Vilius GRABAUSKAS

LIFELIFE EXPECTANCY EXPECTANCY TRENDS TRENDS ININ LITHUANIAN LITHUANIAN URBAN URBAN AND RURAL POPULATIONAND RURAL POPULATION

55

60

65

70

75

80

Males

Rural

Urban

Rural

Urban

1970 1975 1980 1985 1990 1997

Females

Vilius GRABAUSKAS

RATIO OF PROBABILITY OF DEATH OF URBAN AND RATIO OF PROBABILITY OF DEATH OF URBAN AND RURAL LITHUANIAN MALES IN 1970 AND 1996 RURAL LITHUANIAN MALES IN 1970 AND 1996

(URBAN MALE MORTALITY EQUALS 1)(URBAN MALE MORTALITY EQUALS 1)

0

0,5

1

1,5

2

2,5

0 1 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85+

Age

Ratio

1970 1997

Vilius GRABAUSKAS

FEMALE - MALE DIFFERENCE OF LIFE EXPECTANCY FEMALE - MALE DIFFERENCE OF LIFE EXPECTANCY IN BALTIC, NORDIC AND EU COUNTRIESIN BALTIC, NORDIC AND EU COUNTRIES

5

6

7

8

9

10

11

12

13

14

1970 1975 1980 1985 1990 1995 2000

Estonia Latvia

Lithuania EU average

Nordicaverage

Vilius GRABAUSKAS

INFANT INFANT MORTALITYMORTALITY IN IN BALTIC, EU AND CEE BALTIC, EU AND CEE COUNTRIESCOUNTRIES

4

6

8

10

12

14

16

18

20

22

24

26

80 82 84 86 88 90 92 94 96 98 Years

Deaths per 1000 live births

EU

CEEC

Latvia

Estonia

Lithuania

Vilius GRABAUSKAS

STRUCTURE OF CAUSE-SPECIFIC MORTALITYSTRUCTURE OF CAUSE-SPECIFIC MORTALITYOF LITHUANIAN POPULATION, 2002OF LITHUANIAN POPULATION, 2002

Total:

55.0 %

18.0 %

13.0 %

4.0 %

3.0 %

1.2 %

5.8 %

100.0 %

Cardiovascular diseases

Cancers

External causes

( injuries, poisoning, suicides)

Respiratory diseases

Digestive system diseases

Infectious and parasitic diseases (tuberculosis = 78 %)

Other

Vilius GRABAUSKAS

MORTALITY TRENDS OF CIRCULATORY SYSTEM DISEASES MORTALITY TRENDS OF CIRCULATORY SYSTEM DISEASES IN BALTIC, NORDIC AND EU POPULATIONS, AGED 0 - 64 IN BALTIC, NORDIC AND EU POPULATIONS, AGED 0 - 64

50

100

150

200

250

300

1970 1975 1980 1985 1990 1995 2000

Estonia Latvia

Lithuania

EU average

Nordicaverage

Vilius GRABAUSKAS

MORTALITY TRENDS OF CEREBROVASCULAR DISEASES MORTALITY TRENDS OF CEREBROVASCULAR DISEASES IN BALTIC, NORDIC AND EU POPULATIONS, AGED 0 - 64IN BALTIC, NORDIC AND EU POPULATIONS, AGED 0 - 64

0

10

20

30

40

50

60

70

1970 1975 1980 1985 1990 1995 2000

Estonia Latvia

Lithuania EU average

Nordicaverage

Vilius GRABAUSKAS

70

80

90

100

110

120

130

1970 1975 1980 1985 1990 1995 2000

CANCER MORTALITY TRENDS IN BALTIC, NORDIC AND EU POPULATIONS AGED 0 - 64

Estonia Latvia

Lithuania EU average

Nordicaverage

100 000100 000

Vilius GRABAUSKAS

0

50

100

150

200

250

1970 1975 1980 1985 1990 1995 2000

EXTERNAL CAUSE MORTALITY TRENDS IN BALTIC, NORDIC AND EU POPULATIONS AGED 0 - 64

Estonia Latvia

Lithuania EU average

Nordicaverage

100 000

PREVALENCE OF SOME RISK FACTORS FOR MAJOR PREVALENCE OF SOME RISK FACTORS FOR MAJOR NONCOMMUNICABLE DISEASES IN ADULT LITHUANIAN NONCOMMUNICABLE DISEASES IN ADULT LITHUANIAN

POPULATION AGED 25-64POPULATION AGED 25-64M

F

M

F

M

F

M

F

M

F

M

F

0 20 40 60 80

HYPERTENSION

HYPERCHOLESTEROLEMIA

OVERWEIGHT

SMOKING

LACK OF PHYSICAL ACTIVITY PROPORTION OF ENERGY

FROM FATS

RISK SCORE: AT LEAST ONE RISK FACTOR PRESENT IN 90 % OF POPULATION PUBLIC HEALTH STRATEGY IS REALISTIC SOLUTION

Vilius GRABAUSKAS

Health Promotion and Investment

EXPERIENCE OF DEVELOPED COUNTRIES

IT IS NOT THE RICHEST SOCIETIES THAT ENJOY HIGHEST LEVEL OF HEALTH BUT THOSE WHERE IS LOWESTDIFFERENCE BETWEEN RICH AND POOR

WHO CONCLUSION:

Vilius GRABAUSKAS

Individuali rizika

Vilius GRABAUSKAS

8,32,4

66,8

16,1

6,4

Prevention Special diet Price Taste Food preference0

10

20

30

40

50

60

70

80

FOOD SELECTION CRITERIAIN LITHUANIAN POPULATION (BALTIC NUTRITIONAL SURVEY)

Vilius GRABAUSKAS

7 8

14

77

69

45

8

15

30

8 811

0

20

40

60

80 PreventionPriceTasteFood preference

FOOD SELECTION CRITERIAIN LITHUANIAN POPULATION BY FAMILY INCOME

(BALTIC NUTRITIONAL SURVEY)

LOW INCOME1TERTILE

MEDIUM INCOME2 TERTILE

HIHG INCOME3 TERTILE

COMPARISON OF MORTALITY OF POPULATION WITHCOMPARISON OF MORTALITY OF POPULATION WITH UNIVERSITY UNIVERSITY AND PRIMARY OR LOWER EDUCATION BY AGE AND PRIMARY OR LOWER EDUCATION BY AGE

(MORTALITY OF THE GROUP WITH UNIVERSITY EDUCATION=1)(MORTALITY OF THE GROUP WITH UNIVERSITY EDUCATION=1)

0

12

3

4

5

67

89

10

11

12

13

25 30 35 40 45 50 55 60 65 70+

Age, yearsMen Women

Ratio

Vilius GRABAUSKAS

PROPORTION (%) OF DAILY SMOKERS, BY EDUCATIONAL LEVEL

36.7

48.5**

68.0*

9.110.817.4*

0

10

20

30

40

50

60

70

Incomplete secondary Secondary University

Men Women

%

Vilius GRABAUSKAS

58.9*

48.143.5

10.4 11.2 10.0

0

10

20

30

40

50

60

70

Low income Average income High income

Men Women

PROPORTION (%) OF DAILY SMOKERS, BY FAMILY INCOME

%

Vilius GRABAUSKAS

LOW BIRTH WEIGHT (>2500 G.) PROPORTIONS BY EDUCATIONAL LEVEL OF MOTHERS

* p<0.001

%

Vilius GRABAUSKAS

0

12

3

45

6

7

89

10

1998199719961995

*** ****** ***

Pradinis

vidurinis

aukštasis

Primary

Secondary

University

V. GRABAUSKASV. GRABAUSKAS

RELATIVE RISK OF UNMARIED LITHUANIAN POPULATION BY AGE AS COMPARIED TO MARIED

(MARIED = 1)

25 30 35 40 45 50 55 60 65 70+0

0,5

1

1,5

2

2,5

3

3,5

4

Vyrai

Moterys

AGE

MalesFemales

LOW BIRTH WEIGHT (>2500 G.) PROPORTIONS BY MARITAL STATUS OF MOTHERS

* p<0.001

%

Vilius GRABAUSKAS

0

12

3

45

6

7

89

10

1998199719961995

Single/Divorsed/Widows

Maried

*** ****** ***

TOTAL MORTALITY LEVEL (PER 100 000 OF POPULATION) TOTAL MORTALITY LEVEL (PER 100 000 OF POPULATION) IN ADMINISTRATIVE AREAS OF LITHUANIA IN QUINTILES IN ADMINISTRATIVE AREAS OF LITHUANIA IN QUINTILES

(1996 YEAR DATA)(1996 YEAR DATA)

Vilius GRABAUSKAS

CARDIOVASCULAR MORTALITY IN ADMINISTRATIVE AREAS IN LITHUANIA IN QUINTILES

Vilius GRABAUSKAS

2000

LITHUANIA566

<1100<940<780<620<460No data

Min: 300

HEALTH EXPENDITURE IN ADMINISTRATIVE AREAS IN LITHUANIA IN QUINTILES

Vilius GRABAUSKAS

1997

LITHUANIA378

Upper2-a3-a4-aLowerNo data

Min: 75.44

LITHUANIAN NATIONAL HEALTH CONCEPTLITHUANIAN NATIONAL HEALTH CONCEPT

HEALTH LAWS

ACTIVE HEALTH POLICY AND STRATEGY

HEALTH PROMOTION

HEALTHY LIFE STYLES

HEALTH CARE

ENVIRONMENTAL PROTECTION

DEVELOPMENT OF ENTIRE HEALTH SYSTEM

WHO“HEALTH FOR ALL” PRINCIPLES

Vilius GRABAUSKAS

TRENDS IN PROPORTION OF BUTTER ON TRENDS IN PROPORTION OF BUTTER ON BREAD USERS IN LITHUANIAN BREAD USERS IN LITHUANIAN

POPULATION AGED 20-64 POPULATION AGED 20-64 BETWEEN 1994 -2000BETWEEN 1994 -2000

71,2

56*

38*37,6*

66,3

50,6*

40,6*38,2*

0

10

20

30

40

50

60

70

80

Males Females

1994199619982000

* p<0.05 compared with year 1994 Vilius GRABAUSKAS

TRENDS IN PROPORTION VEGETABLE OIL FOR COOKING TRENDS IN PROPORTION VEGETABLE OIL FOR COOKING USERS IN LITHUANIAN POPULATION AGED 20-64 USERS IN LITHUANIAN POPULATION AGED 20-64

BETWEEN 1994 - 2000BETWEEN 1994 - 2000

31,1

54*

73,5* 73,1*

47,7

68,8*

86,5* 88,4*

010

2030

405060

708090

100

Males Females

1994199619982000

* p<0.05 compared with year 1994 Vilius GRABAUSKAS

TRENDS IN PROPORTION OF FRESH VEGETABLE TRENDS IN PROPORTION OF FRESH VEGETABLE USERS AT LEAST ON 3 DAYS DURING THE LAST USERS AT LEAST ON 3 DAYS DURING THE LAST

WEEK BETWEEN 1996 - 2000WEEK BETWEEN 1996 - 2000

* p<0.05 compared with year 1996

18,1

36,8*

43,6*

24,8

50* 51,6*

0

10

20

30

40

50

60

Males Females

1996

1998

2000

Vilius GRABAUSKAS

TRENDS PROPORTION OF DAILY SMOKERS TRENDS PROPORTION OF DAILY SMOKERS IN LITHUANIAN POPULATION AGED 20-64 IN LITHUANIAN POPULATION AGED 20-64

BETWEEN 1994 - 2000BETWEEN 1994 - 2000

43,347,3

48,5* 51,2

6,3 9,412,5*15,8*

0

10

20

30

40

50

60

Males Females

1994199619982000

* p<0.05 compared with year 1994 Vilius GRABAUSKAS

TRENDS IN PROPORTION OF STRONG TRENDS IN PROPORTION OF STRONG ALCOHOL USERS AT LEAST ONCE A WEEK ALCOHOL USERS AT LEAST ONCE A WEEK IN LITHUANIAN POPULATION AGED 20-64 IN LITHUANIAN POPULATION AGED 20-64

BETWEEN 1994 - 2000BETWEEN 1994 - 2000

31,2 28,7*27,1*

33,9

5,5* 6,6*6,7*

11,5

0

5

10

15

20

25

30

35

40

Males Females

1994

1996

1998

2000

* p<0.05 compared with year 2000 Vilius GRABAUSKAS

PROPORTION OF BEER USERS AT LEAST ONCE PROPORTION OF BEER USERS AT LEAST ONCE A WEEK IN LITHUANIAN POPULATION A WEEK IN LITHUANIAN POPULATION

AGED 20-64 BETWEEN 1994 - 2000AGED 20-64 BETWEEN 1994 - 2000

* p<0.05 compared with year 1994

43,539,4

48,9*55,8*

7,1 8,1

12,9*18,3*

0

10

20

30

40

50

60

Males Females

1994199619982000

Vilius GRABAUSKAS

19931987 1999MALES FEMALES

HYPERCHOLESTERO-LEMIA ( 5,0 mmol/l )

OVERWEIGHT ( BMI 25 )

HYPERTENSION ( 140/90 or on treatment

)

TRENDS IN AGE STANDARDIZED PREVALENCE OF SOME BIOLOGICAL RISK FACTORS TRENDS IN AGE STANDARDIZED PREVALENCE OF SOME BIOLOGICAL RISK FACTORS IN LITHUANIAIN LITHUANIAN POPULATION AGED 25-64 (LITHUANIAN – CINDI DATA BASE)N POPULATION AGED 25-64 (LITHUANIAN – CINDI DATA BASE)

59,3

57,9

62,3

30405060708090

60,9

56,2

65,3

30405060708090

61,6

79,1

30405060708090

42,1

52,4

51,2

30 40 50 60 70 80 90

64,4

65,6

71,8

30 40 50 60 70 80 90

***

**

63,2

80

83,1

30 40 50 60 70 80 90

***

***

***

***

**

*p<0.05

**p<0.01

***p<0.001

Comparing with 1987

84,9

Vilius GRABAUSKAS

TOTAL MORTALITY TRENDSTOTAL MORTALITY TRENDS IN LITHUANIAN IN LITHUANIAN MALEMALESS AGED 0-64 AGED 0-64

SDR / 100 000

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

500

600

700

800

900

1.000

-2.7%/year, n.s.

6.7%/year, p=0.0001

-6.9%/year, p=0.007

Vilius GRABAUSKAS

TOTAL MORTALITY TRENDSTOTAL MORTALITY TRENDS IN LITHUANIAN IN LITHUANIAN FEMALES AGED 0-64FEMALES AGED 0-64

SDR / 100 000

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

200

250

300

350

-2.2%/year, n.s.

3.4%/year, p=0.002

-6.3%/year, p=0.02

Vilius GRABAUSKAS

CVD MORTALITY TRENDSCVD MORTALITY TRENDS IN LITHUANIAN IN LITHUANIAN MALEMALESS AGED 0-64 AGED 0-64

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

180

200

220

240

260

280

300

2.6%/year, n.s.

5.8%/year, p=0.0004

-6.6%/year, p=0.04

SDR / 100 000

Vilius GRABAUSKAS

CVD MORTALITY TRENDSCVD MORTALITY TRENDS IN IN LITHUANIAN FEMALELITHUANIAN FEMALESS AGED 0-64 AGED 0-64

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

50

60

70

80

90

100

- .5%/year, n.s.

3.0%/year, p=0.02

- 8.1%/year, p=0.03

SDR / 100 000

Vilius GRABAUSKAS

CHD MORTALITY TRENDS IN LITHUANIAN CHD MORTALITY TRENDS IN LITHUANIAN MALES AGED 0-64MALES AGED 0-64

SDR / 100 000

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

100

120

140

160

180

200

2%/year, n.s.

5.4%/year, p=0.0004

-10%/year, p=0.02

Vilius GRABAUSKAS

CHD MORTALITY TRENDS IN LITHUANIAN CHD MORTALITY TRENDS IN LITHUANIAN FEMALES AGED 0-64FEMALES AGED 0-64

SDR / 100 000

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

0

10

20

30

40

50

60

70

- .6%/year, n.s.

3.6%/year, p=0.01

- 15.6%/year, p=0.01

Vilius GRABAUSKAS

CAN MORTALITY TRENDS IN LITHUANIAN MALES AGED 0-64

SDR / 100 000

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

125

130

135

140

145

150

155

160

1.4%/year, p=0.0001

1%/year, n.s.

-2.7%/year, p=0.04

Vilius GRABAUSKAS

CACANN MORTALITY TRENDS MORTALITY TRENDS IN IN LITHUANIAN FEMALELITHUANIAN FEMALESS AGED 0-64 AGED 0-64

SDR / 100 000

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

50

60

70

80

90

100

-0.3%/year, n.s.

Vilius GRABAUSKAS

LUNG CANCER MORTALITY TRENDSLUNG CANCER MORTALITY TRENDS IN IN LITHUANIAN MALELITHUANIAN MALESS AGED 0-64 AGED 0-64

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

35

40

45

50

55

60

1.8%/year, p=0.02

0.2%/year, p=0.73.

-4.2%/year, p=0.003

SDR / 100 000

Vilius GRABAUSKAS

EXTERNAL CAUSE EXTERNAL CAUSE MORTALITY TRENDSMORTALITY TRENDS IN IN LITHUANIAN MALELITHUANIAN MALESS AGED 0-64 AGED 0-64

SDR / 100 000

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

100

150

200

250

300

350

-6.7%/year, p=0.01

10%/year, p=0.0002 -6.5%/year, p=0.01

Vilius GRABAUSKAS

EXTEXTERNALERNAL CAUSE CAUSE MORTALITY MORTALITY IN IN LITHUANIAN FEMALELITHUANIAN FEMALESS AGED 0-64 AGED 0-64

SDR / 100 000

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

0

25

50

75

100

- 4.5%/year, p=0.04

7.8%/year, p=0.0003 - 6.1%/year, p=0.02

Vilius GRABAUSKAS

CONCLUSIONSCONCLUSIONS LITHUANIAN EXPERIENCE DEMONSTRATES THAT SCIENCE BASED NATIONAL HEALTH POLICY DEVELOPMENT IS MOST IMPORTANT TOOL FOR PLANNING, IMPLEMENTATION, MONITORING AND EVALUATION OF HEALTH SYSTEM REFORM PROCESSES

NATIONAL HEALTH INFORMATION SYSTEM THAT COMBINES NATIONAL STATISTICS, RESEARCH AND INTERNATIONAL DATA BASES EFFECTIVELY SERVES THE ABOVE

MORE SPECIFICALLY, LITHUANIAN HEALTH BEHAVIOUR MONITORING SYSTEM GIVES CLEAR INDICATION AND GUIDANCE WHICH AREAS OF LITHUANIAN HEALTH BEHAVIOURS REQUIRE SUBSTANTIAL IMPROVEMENTS IN HEALTH POLICY IMPLEMENTATION

Vilius GRABAUSKAS