Transcript Health, public health and the EU integration process

What determines health?
National health promotion
policy to address inequalities
Mihály Kökény, MD
Ministry of Health, Social and Family Affairs
What determines health?
National health promotion policy to address inequalities
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„Generate healthy population” an economic, political
and welfare factor
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Countries have different approaches to address health
issues
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To place health high on the political agenda as part of
the overall development plan → key to success
What determines health?
National health promotion policy to address inequalities
Expectations of European citizens
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Long, wealthy and healthy life
Health considered as value and investment
To be protected against illness/disease
To bring up children in healthy environment
Safe and hygienic workplace
Well informed choice on lifestyle
Access to high quality health service
What determines health?
National health promotion policy to address inequalities
Governments’ response and rationale to healthy population I.
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Economic factor
 Loss in GDP by disease and disability
 Healthy workforce
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Public health factor
 Good health indicators show good quality of life in a
country
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Health is determined by many factors: biological, genetic,
lifestyle factors; physical environment; effective, efficient
and high-quality health services
What determines health?
National health promotion policy to address inequalities
Governments’ response and rationale to healthy population II.
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Comprehensive national public health programme, based on
HFA, Commisioner’s health policy vision; (Hungary)
 Health determinants approach (smoking, alcohol, drugs,
nutrition, physical activity)
 Disease prevention (screening)
 NEHAP II (nearly all European countries – following
Budapest Conference)
 Settings approach
 Life cycle approach
 Any combinations of above
to extend life expectancy, improve health status
What determines health?
National health promotion policy to address inequalities
Governments’ response and rationale to healthy population III.
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Modernisation of health care and financial system (high on agenda)
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Challenges to be met:
 To extend life expectancy, deal with growing elderly population,
 Growing demand of patients for new, expensive technology, cost
containment measures and new interventions
improve quality, equity,
efficiency, effectiveness
 Modernize health system
increase funding
(public/private mix)
 EU integration (workforce, patient mobility)
What determines health?
National health promotion policy to address inequalities
Commission’s response to protect the health of the
EU citizens - „add value”
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Communication on the Health Strategy of the EU
(May 2000)
 Lisbon strategy
 Public health strategy framework
 patient mobility
 establishment of ECDC
 Open method of coordination
 European aims and objectives
 annual national monitoring of programmes
What determines health?
National health promotion policy to address inequalities
High Level Group on Health Services and Medical Care
continuation of High Level Group on Patient
Mobility)
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Cross-border healthcare purchasing and provision (including
rights and duties of patients)
Health professionals
Centres of reference
Health technology assessment
Information and e-health (including data protection)
Health impact assessment and health systems
What determines health?
National health promotion policy to address inequalities health
Minimum prerequisites of success
in investment in health
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Political commitment
Equity and solidarity as key principles
Intersectoral approach
Involvement of key stakeholders incl. business sector,
civil society
Public health programme/intervention
Public health infrastructure/personnel
Involvement of population
Communication strategy
What determines health?
National health promotion policy to address inequalities
Health indicators
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Health indicators show a steady increase in health
status and life expectancy within EU Member
States
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Substantial differences are seen within and
between countries particularly if accession
countries are taken into account
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Large gap exists in new EU Member States
What determines health?
National health promotion policy to address inequalities
Example of a new EU Member State: HUNGARY
Public health, public health infrastructure and capacity
building
key to success
WHY?
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macro-economic rationale (poor health status – 4% loss in
GDP)
public health rationale
 inequalities among the countries of Europe
 inequalities within the countries
What determines health?
National health promotion policy to address inequalities
Public health – epidemiological situation
in Hungary:
life expectancy at birth
 men 8 years
lower than the EU average
 women 6 years
What determines health?
National health promotion policy to address inequalities
Epidemiological situation
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Good news
improving trend of
life expectancy at birth since 1996
infant mortality decline (10 yrs)
external causes of death,
suicide (4th place in Europe)
stomach cancer
HIV/AIDS low
syphilis, mumps, whooping
cough low
communicable diseases 0.09
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Bad news
premature death highest in
new Member States
• high middle age mortality
cvd 3 times higher than EU average
cancer (51. place)
- lung (highest in Europe)
- breast
diseases of digestive
system highest in new Member States
smoking – highest in new MSs
alcohol – 9,5l capita
environmental factors
• air, water
060101 +Life expectancy at birth, in years
80
75
Czech Republic
Estonia
Hungary
Latvia
Lithuania
Malta
Poland
Slovakia
Slovenia
EU average
CSEC average
70
65
1970
1980
1990
2000
2010
Source: HFA, 2003 June
Hungary
Year
EU
98
20
00
96
94
92
90
58
88
58
86
63
84
Males
82
63
80
78
78
78
76
83
74
83
72
68
Life expectancy (years)
73
70
98
20
00
96
94
92
90
88
86
84
82
80
78
76
74
72
70
Life expectancy (years)
Life expectancy at birth
Females
73
68
Year
Source: HFA DB, WHO/EURO
What determines health?
National health promotion policy to address inequalities
How do we intend to extend lifespan and increase the number
of healthy years?
Health policy that is conducive to this goal:
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aims at health gain
through public health strategy
based on solidarity, equity; multisectoral approach as well as integrated approach
between health and social issues;
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builds on a health system (
towards health gain);
high
quality care;
with
prevention in the forefront; at all levels incl. PHC;
with
health professionals who follow the complex definition of health
 solidarity principle;
public/private mix: private investment but domination of public funding of public
institutions;
 well-informed patients and strong patients rights protection
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What determines health?
National health promotion policy to address inequalities
National Public Health Programme in Hungary
as a positive example - 4 strategies:
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create supportive social environment for health
 develop healthy lifestyles, reduce risk factors
 reduce avoidable mortality, morbidity, injury
 develop health services and public health
institutions for improving the health of the
population
What determines health?
National health promotion policy to address inequalities
Are these only dreams?
NO!
Progress already made
 during the years of preparation for EU membership we
made a lot of progress already:
 the transposition of the acquis in our sector is an
investment in primary prevention
(water quality, food safety, environmental protection, health
protection at workplace, radiation hygiene etc.)
this is itself a public health programme
What determines health?
National health promotion policy to address inequalities
Public Health institutional development
Parallel to harmonisation, institutional system strengthened
Pre-accession funds well invested: major investment in the
Hungarian National Public Health and Medical Officers’
Service – laboratories, information system, training
programmes
Main areas:
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public health laboratories
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chemical safety
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epidemiology and communicable diseases
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information system
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microbiological laboratories
They serve early detection, modern diagnosis, prevention and
treatment
What determines health?
National health promotion policy to address inequalities
The EU and the Hungarian Public Health
In fact two synergetic processes:
 Acquis, harmonisation – changing public health standards and
practices
 The „Decade of Health Public Health Programme” in close
inter-relation with the Community Action Programme on
Public Health
Impact:
→ improving life expectancy (by 3 years over 10 years)
→ better quality of services
→ consolidation and modernisation of the health system
→ contributing to its sustainable funding
What determines health?
National health promotion policy to address inequalities
Review of Hungarian public health system:
inadequate to serve the public health
programme
(80 % CD-oriented whereas
80 % of public health problems NCD –
oriented)
Full reorganization starts
What determines health?
National health promotion policy to address inequalities
Establishment of the School of
Public Health in Debrecen,
1996-present
to promote public health capacity – building
Major step forward
What determines health?
National health promotion policy to address inequalities
We have our own assets with a few gaps
Assets
health services
 covers the whole
country
 provides wide range
of services
 solidarity principle
 excellent manpower
 well-trained
 devoted
 not very mobile
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reform underway
improvement
needed
- in bad physical condition
- equipment needs
modernization
- quality of care to be
improved
- patient information and
rights to be improved
to modernize
What determines health?
National health promotion policy to address inequalities
Modernization of health systems
improvement needed
Assets
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public health
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national programme
approved by
Parliament
2004 is the year of
dinamization
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infrastructure
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staff
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change in approach: health as
a value/investment (get rid of
paternalistic approach)
responsibility of all
individual responsibility
modern health promotion
concepts
further development of
institutions; training, tools,
methodology
modernize infrastructure (preaccession funds)
What determines health?
National health promotion policy to address inequalities
EU public health strategy framework
2003-2008
Close gaps in public
health
National public health programme for
10 years in line with it (bring it down
to individuals as the effort of the
whole society in 2004.)
technical support: methodology, tools
investment in institution-building and
training (EU funds: structural funds for
2004-2006 and 2007-2013 in line with
National Development Programme)
Thank you for your attention!