Health Promotion and Investment

1
EXPERIENCE OF DEVELOPED COUNTRIES
WHO CONCLUSION
IT IS NOT THE RICHEST SOCIETIES THAT ENJOY
HIGHEST LEVEL OF HEALTH BUT THOSE WHERE IS
LOWEST DIFFERENCE BETWEEN RICH AND POOR
Health Promotion and Investment
2
Individuali rizika
Vilius GRABAUSKAS
3
FOOD SELECTION CRITERIA IN LITHUANIAN POPULATION
(BALTIC
NUTRITIONAL SURVEY)
80
66,8
70
60
50
40
30
16,1
20
8,3
6,4
10
2,4
0
Prevention
Special diet
Price
Taste
Food preference
Vilius GRABAUSKAS
4
FOOD SELECTION CRITERIA IN LITHUANIAN POPULATION
BY FAMILY INCOME (BALTIC NUTRITIONAL SURVEY)
77
Prevention
80
Price
69
Taste
Food preference
60
45
40
30
15
14
20
11
8
8
8
8
7
0
LOW INCOME 1TERTILE
MEDIUM INCOME 2 TERTILE
HIHG INCOME 3 TERTILE
Vilius GRABAUSKAS
5
COMPARISON OF MORTALITY OF POPULATION WITH
UNIVERSITY AND PRIMARY OR LOWER EDUCATION BY AGE
(MORTALITY OF THE GROUP WITH UNIVERSITY
EDUCATION1)
Ratio
13
12
11
10
9
8
7
6
5
4
3
2
1
0
25
30
35
40
45
50
55
60
65
70
Age, years
Men
Women
Vilius GRABAUSKAS
6
PROPORTION () OF DAILY SMOKERS, BY EDUCATIONAL
LEVEL

68.0
70
60
48.5
50
36.7
40
30
17.4
20
10.8
9.1
10
0
Incomplete secondary
Secondary
University
Men
Women
Vilius GRABAUSKAS
7
PROPORTION () OF DAILY SMOKERS, BY FAMILY INCOME

Vilius GRABAUSKAS
8
LOW BIRTH WEIGHT (gt2500 G.) PROPORTIONS BY
EDUCATIONAL LEVEL OF MOTHERS

• Pradinis
• vidurinis
• auktasis

Primary Secondary University

• plt0.001

Vilius GRABAUSKAS
9
RELATIVE RISK OF UNMARIED LITHUANIAN POPULATION
BY AGE AS COMPARIED TO MARIED (MARIED 1)
Males
Females
AGE
V. GRABAUSKAS
10
LOW BIRTH WEIGHT (gt2500 G.) PROPORTIONS BY
MARITAL STATUS OF MOTHERS

• plt0.001

Vilius GRABAUSKAS
11
TOTAL MORTALITY LEVEL (PER 100 000 OF
POPULATION) IN ADMINISTRATIVE AREAS OF LITHUANIA
IN QUINTILES (1996 YEAR DATA)
Vilius GRABAUSKAS
12
CARDIOVASCULAR MORTALITY IN ADMINISTRATIVE AREAS
IN LITHUANIA IN QUINTILES
2000
LITHUANIA
566
lt1100
lt940
lt780
lt620
lt460
No data
Min 300
Vilius GRABAUSKAS
13
HEALTH EXPENDITURE IN ADMINISTRATIVE AREAS IN
LITHUANIA IN QUINTILES
1997
LITHUANIA
378
Upper
2-a
3-a
4-a
Lower
No data
Min 75.44
Vilius GRABAUSKAS
14
LITHUANIAN NATIONAL HEALTH CONCEPT
HEALTH LAWS
ACTIVE HEALTH POLICY AND STRATEGY
HEALTH PROMOTION HEALTHY LIFE STYLES
HEALTH CARE
ENVIRONMENTAL PROTECTION
DEVELOPMENT OF ENTIRE HEALTH SYSTEM
WHOHEALTH FOR ALL PRINCIPLES
Vilius GRABAUSKAS
15
TRENDS IN PROPORTION OF BUTTER ON BREAD USERS IN
LITHUANIAN POPULATION AGED 20-64 BETWEEN 1994
-2000
80
71,2
66,3
70
56
60
50,6
40,6
50
1994
38
38,2
37,6
1996
40
1998
30
2000
20
10
0
Males
Females
plt0.05 compared with year 1994
Vilius GRABAUSKAS
16
TRENDS IN PROPORTION VEGETABLE OIL FOR COOKING
USERS IN LITHUANIAN POPULATION AGED 20-64
BETWEEN 1994 - 2000
100
88,4
86,5
90
73,5
73,1
80
68,8
70
54
60
1994
47,7
1996
50
1998
40
31,1
2000
30
20
10
0
Males
Females
plt0.05 compared with year 1994
Vilius GRABAUSKAS
17
TRENDS IN PROPORTION OF FRESH VEGETABLE USERS AT
LEAST ON 3 DAYS DURING THE LAST WEEK BETWEEN 1996
- 2000
60
51,6
50
50
43,6
36,8
40
1996
24,8
30
18,1
1998
2000
20
10
0
Males
Females
plt0.05 compared with year 1996
Vilius GRABAUSKAS
18
TRENDS PROPORTION OF DAILY SMOKERS IN LITHUANIAN
POPULATION AGED 20-64 BETWEEN 1994 - 2000
60
51,2
48,5
47,3
50
43,3
40
1994
1996
30
1998
15,8
12,5
20
2000
9,4
6,3
10
0
Males
Females
plt0.05 compared with year 1994
Vilius GRABAUSKAS
19
TRENDS IN PROPORTION OF STRONG ALCOHOL USERS AT
LEAST ONCE A WEEK IN LITHUANIAN POPULATION AGED
20-64 BETWEEN 1994 - 2000
40
33,9
31,2
35
28,7
27,1
30
25
1994
1996
20
11,5
1998
15
2000
6,7
6,6
10
5,5
5
0
Males
Females
plt0.05 compared with year 2000
Vilius GRABAUSKAS
20
PROPORTION OF BEER USERS AT LEAST ONCE A WEEK IN
LITHUANIAN POPULATION AGED 20-64 BETWEEN 1994 -
2000
55,8
60
48,9
43,5
50
39,4
40
1994
1996
30
18,3
1998
12,9
2000
20
7,1
8,1
10
0
Males
Females
plt0.05 compared with year 1994
Vilius GRABAUSKAS
21
TRENDS IN AGE STANDARDIZED PREVALENCE OF SOME
BIOLOGICAL RISK FACTORS IN LITHUANIAN POPULATION
AGED 25-64 (LITHUANIAN CINDI DATA BASE)
HYPERTENSION ( ? 140/90
or on treatment )

OVERWEIGHT ( BMI ?
25 )



84,9
HYPERCHOLESTERO-LEMIA ( ? 5,0 mmol/l )



FEMALES
MALES
Vilius GRABAUSKAS
22
TOTAL MORTALITY TRENDS IN LITHUANIAN MALES AGED
0-64
SDR / 100 000
1.000
900
6.7/year, p0.0001
-2.7/year, n.s.
-6.9/year, p0.007
800
700
600
500
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Vilius GRABAUSKAS
23
TOTAL MORTALITY TRENDS IN LITHUANIAN FEMALES
AGED 0-64
SDR / 100 000
350
3.4/year, p0.002
300
-6.3/year, p0.02
250
-2.2/year, n.s.
200
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Vilius GRABAUSKAS
24
CVD MORTALITY TRENDS IN LITHUANIAN MALES AGED
0-64
SDR / 100 000
300
280
5.8/year, p0.0004
260
-6.6/year, p0.04
240
2.6/year, n.s.
220
200
180
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Vilius GRABAUSKAS
25
CVD MORTALITY TRENDS IN LITHUANIAN FEMALES AGED
0-64
SDR / 100 000
100
90
3.0/year, p0.02
- .5/year, n.s.
- 8.1/year, p0.03
80
70
60
50
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Vilius GRABAUSKAS
26
CHD MORTALITY TRENDS IN LITHUANIAN MALES AGED 0-64
SDR / 100 000
5.4/year, p0.0004
200
180
2/year, n.s.
160
-10/year, p0.02
140
120
100
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Vilius GRABAUSKAS
27
CHD MORTALITY TRENDS IN LITHUANIAN FEMALES AGED
0-64
SDR / 100 000
70
60
3.6/year, p0.01
50
40
- 15.6/year, p0.01
30
- .6/year, n.s.
20
10
0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Vilius GRABAUSKAS
28
CAN MORTALITY TRENDS IN LITHUANIAN MALES AGED
0-64
SDR / 100 000
160
155
1/year, n.s.
150
-2.7/year, p0.04
145
1.4/year, p0.0001
140
135
130
125
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Vilius GRABAUSKAS
29
CAN MORTALITY TRENDS IN LITHUANIAN FEMALES AGED
0-64
SDR / 100 000
100
90
-0.3/year, n.s.
80
70
60
50
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Vilius GRABAUSKAS
30
LUNG CANCER MORTALITY TRENDS IN LITHUANIAN MALES
AGED 0-64
SDR / 100 000
60
0.2/year, p0.73.
55
50
-4.2/year, p0.003
45
1.8/year, p0.02
40
35
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Vilius GRABAUSKAS
31
EXTERNAL CAUSE MORTALITY TRENDS IN LITHUANIAN
MALES AGED 0-64
SDR / 100 000
350
300
-6.5/year, p0.01
10/year, p0.0002
250
-6.7/year, p0.01
200
150
100
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Vilius GRABAUSKAS
32
EXTERNAL CAUSE MORTALITY IN LITHUANIAN FEMALES
AGED 0-64
SDR / 100 000
100
75
7.8/year, p0.0003
- 6.1/year, p0.02
50
- 4.5/year, p0.04
25
0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Vilius GRABAUSKAS
33
CONCLUSIONS

• 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