Transcript Health inequalities in Tallinn

Well-being of Citizens and
Injury Prevention
Ene Tomberg
Deputy Head
Social Welfare and Health Care Board
Tallinn City Government
Population:
• Inhabitants
• By nationality:
Estonians
Russians
• Children (0-14 y)
• 65+
401,072
55.6%
36.2%
16.0%
17.1%
Communities in Tallinn
Over 65-year-olds – 68,457 (17.1%)
Employment
228,000 people (55.3%)
Communities in Tallinn
Up to 19-year-old Children
80,662 (20.1%)
Life Expectancy, 2009
90
80
70
60
50
men
women
40
30
20
10
0
Sweden
Finland
EU total
Estonia
Latvia
Russia
Competence of the City in Health Issues
• Arrangement of health promotion
• Selecting family doctors to work in the city
– GPs have a contract with the Estonian Health
Insurance Fund, which pays for their work. The city
has no way to motivate GPs to work during national
holidays or afterhours in case of pandemics.
• 3 out of 4 main hospitals in the city are owned by
the city
– They work as private joint stock companies, financed
mainly by health insurance and thus the city has
limited opportunities for influencing their work.
Work of Health Care Department in
Reducing Health Inequalities
• Special department for uninsured people in the city
hospital (providing both inpatient and outpatient
services)
• Financial support for family doctors for working with
uninsured people
• Home nursing
• Payment for certain surgeries if waiting periods are
otherwise too long (some orthopaedic and
ophthalmologic surgeries)
• Vaccination of children against hepatitis B and
haemophilus influenza
• Providing the parents of every newborn with a set of
baby clothes and healthcare products
Vision of the Health
Development Plan for 2007-2015:
Good health of the residents of
Tallinn and their ability to
accomplish themselves in a
socially cohesive city that offers a
feeling of social security and is
ecologically balanced
The Goal of Health Policy
To create possibilities and conditions to
achieve:
prolongation of healthy life years to about 60
years for men and 70 years for women in
Estonia and
rise in the average lifespan to 73 years for men
and 80 years for women by 2015
LEVELS OF INTERVENTION
MICROLEVEL
MACROLEVEL
- Politics
- Macroeconomy
- Legislation
- Regulation
- Tax policy
- Investments
- Opportunities
- Safety
- Justice
- Distribution of
resources
-Social capital
-Environment
-Behaviour
-Family
-Home
-Connections with friends
-Expectations
-Close relations
-Culture
-Social capital
-Environment
MESOLEVEL
-Home
locality/neighbourhood
-School/job
-Employment opportunity
-Clean water/food/air
-Engaging local
government
-Social capital
-Environment
Main Fields of Health Policy
• Increasing social cohesion and decreasing
disparity in health
• Ensuring healthy and safe development of
children and adolescents
• Ensuring a living and working environment that
promotes the maintenance and development of
health
• Promotion of healthy choices and lifestyles
Health Policy Is Based on the
Following Values:
•
•
•
•
•
Human rights
Shared responsibility for health
Equal opportunities and justice
Social involvement
Evidence-based practice
Emergency Medical Service activity in
2011
• 77,596 patients helped by emergency medical services,
12.8% of them children
• 33,275 patients were hospitalized = 42.9%
• 960 persons received aid due to intoxication = 1.2%
• 9915 received aid due to injuries = 12.8%
Hospital bed fund
•
•
•
•
•
2007
2008
2009
2010
2011
Total
active
long term beds
2651
2765
2563
2545
2529
1963
2064
1882
1864
1898
688
701
681
681
631
Uninsured Persons
• 25 beds at AS Ida-Tallinna Keskhaigla (East
Tallinn Central Hospital)
• Daily out-patient care in the same hospital
• Emergency medical care financed by the
Sick Fund
• Annual tests for tuberculosis for people in
homeless shelters
Morbidity of Homeless People
Diseases of the skin and subcutaneous tissue
Injuries, poisonings and other consequences of
external causes
Diseases of the nervous system
Diseases of the musculoskeletal system and
connective tissue
Diseases of the digestive system
Diseases of the respiratory system
Diseases of the circulatory system
Certain infectious and parasitic diseases
Neoplasms
0%
5%
10%
15%
homeless people
20%
25%
general population
30%
Communities in Tallinn
What is the use of curing people from diseases just to send them back
to the conditions that made them ill?
Nursing Treatment:
Financed by the Sick Fund :
• AS Ida-Tallinna Keskhaigla
• SA Põhja-Eesti Regionaalhaigla
• Diakooniahaigla SA
• AS Lääne-Tallinna Keskhaigla
165 beds
40
60
24
Home Nursing Care Service
• OÜ Koduõde contract with the Sick Fund
• Contract with the city
• In a month aid is provided to up to 400
patients.
• In Iru Nursing Home nursing service is
provided by OÜ Koduõde and TNP
Konsultatsioonid from the city budget
Aid to Persons Who Helped Clean Up
the Chernobyl Nuclear Disaster
•
•
•
•
dental care at SA Tallinna Hambapolikliinik
rehabilitation services
compensation for glasses
covering of the operating expenses of the
Chernobyl Association
What Can Tallinn Do to Improve the
Health of Its Residents?
• Support the early development of young children in every
way;
• Get the citizens involved in making the decisions
concerning their health on the levels of city districts, urban
regions and organisations;
• Improve the capacity for the health of residents;
• Improve the living, working and recreational conditions
and environment of people;
• Make easier the choices that support the health of
residents;
• Improve the availability of health services to socially
vulnerable groups.
The main fields of activity for achieving the subgoals of The 2008-2015 Health Development Plan for
the Population of Tallinn
Focusing on the development of Focusing on main
capacity:
problems:
• Extending the number of networks
• I Injury prevention
and health workgroups;
• II HIV/AIDS and drug use
• Developing the competence and
prevention
skills of networks in solving the
health problems in their field of
• III Prevention of
responsibility and/or community;
cardiovascular diseases
• Achieving social support among
city residents in solving local health
problems (see on the right).
Biotechnical Paradigm
• Injuries can be
reduced and
prevented by
changing the
technical devices.
(Hugh DeHaven, 1939)
Tallinn Health Coalition
• Coordinates the work of different city
institutions
• Created by the City Government
• Headed by the Mayor
The changes that have taken place in Estonia
within the last year:
•
•
•
•
•
* 38% have improved their eating habits towards becoming
healthier,
* 32% have increased their physical activity,
* 10% have given up smoking,
* 6% have given up or limited the use of alcohol,
* 5% of the respondents became socially active (selfdevelopment, communicating with friends, spending spare time
with family).
• “Assessments of residents in relation to health and health care
2008” – a survey conducted by the Ministry of Social Affairs
and Estonian Health Insurance Fund
Injuries in Estonia and Tallinn, 2009
Children 0 - 14
Estonia
Adults
Tallinn
Estonia
Tallinn
Injuries, poisonings, and certain other
injuries caused by external factors
52,203
19,343
235,405
84,141
Head and neck
10,139
4,883
30,476
13,931
1,736
730
17,185
6,894
Upper limbs
15,022
6,553
58,753
25,035
Hips and lower limbs
11,515
4,874
56,812
24,793
421
180
2,281
1,187
Foreign bodies in body cavities
1,391
643
12,850
5,474
Burns and corrosion
1,338
602
4,208
1,653
Poisonings
1,384
739
4,628
2,265
98
10
588
71
Body
Multiple areas and not specified
Other
Main Causes of Injury by Age Groups,
Tallinn Childrens Hospital, 2011
90
80
70
60
50
40
30
20
10
0
O
1
2
3
4
fall (excl. by bike)
car accident
5
6
7
burn
poisoning
8
9
10
11
12
fall by bike
13
14
Main Cases of Falling at the Age of
0-4 Yrs, 2010
Age
O
1
2
3
4
TOTAL
4
12
5
5
1
27
Safety seat, shopping cart, baby pram, pram bag
12
3
A person’s hands/lap or pushed
11
2
Furniture
24
Floor, ground
7
Nursery table
7
Stairs, ladder
Playground structure, slide
1
16
1
2
16
8
13
9
9
63
8
12
5
11
43
7
5
3
Bicycle or scooter
Window, balcony
2
Inside or from vehicle
Washing machine
9
5
22
3
3
2
4
3
3
3
3
Places of Injury
0%
10%
20%
30%
40%
2O1O
2O11
kodu
mänguväljak
kaubakeskus, kauplus, toitl-ettevõte
kool, va. spordiala koolis
lastesõim, lasteaed
spordiala, sh. koolis; park, puhkeala
lisaks uisuväljakud, jäähallid
lisaks ujula
tänav, maantee, parkla
muu, teadmata
2OO9
50%
60%
va
pu
,p
le
t
m
ür
in
e
us
tu
s
gi
s
õr
ut
us
ju
m
up
,m
ul
põ
v
ur
d
ha
a
lu
um
in
e
ea
aj
ru
tu
s
st
us
põ
la
ht
Types of Injury
400
350
300
250
2OO9
200
2O1O
2O11
150
100
50
0
Most Common Injuries in Estonia
and Across the World (WHO, 2008)
37%
33% 32%
17%
12%
11%
9%
vapustus,
peaajupõrutus
luumurd
lahtine haav
Eesti
maailm
6% 6%
6%
põletus
mürgistus
Side Effects and Sequels
• Some 50% of up to 12-year-old children
hospitalised with accidental trauma maintain an
abnormality, the risk is even greater in case of
traffic traumas
• The sequel may be physical, mental or
psychological and manifest in incapacity to go to
school, find a suitable job or get involved in the
social life
• Physical sequels include constant pain
• The task of supporting such people often falls with
the family and friends
“We must do that which we think we can.”
Eleanor Roosevelt (1884-1962!)