Transcript PowerPoint-presentation

The Swedish Public Health
Policy
Gunnar Ågren
Gunnar Ågren 2005
Historical background to the Swedish Public
Health policy
A good system for vital statistics since 1750
From 1800 construction of community health services
A long tradition of popular struggle against the negative
health effects of alcohol
The concern for the health of mothers and children was an
important part of the welfare policy in the 1930’s and further
on
Universal health insurance. Regional councils responsible for
health services
A strong political commitment to health
Gunnar Ågren 2005
A background to present public health work
Health has been an important part of social welfare
On the other hand no comprehensive public health policy
The medical perspective on public health has been very
dominating especially after World War II
No strong emphasis on prevention with exception for
injury prevention and occupational health
Primary care not very well developed
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Factors promoting a new public health
policy
Increasing costs for health care – a disproportionate
amount to highly specialized hospital care. Need for more
preventive in health services
HIV/AIDS illustrated the need for a comprehensive
preventive strategy
Increasing concern about inequity in health
A strategy group on public health in the government
administration was formed in 1987
National Institute of Public Health founded 1992
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Average lifespan in Sweden 1751-2000
100
Rationing of
alcohol
Ended 1955
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Alcohol Sanitation
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Vaccination
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Females
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Males
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79 181 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 198 199 199 200
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National Public Health Committee
In 1997 a national public health committee was formed
All main political parties were represented, a number of
experts
Many important NGO’s were represented
Main task: to propose public health goals and strategies
The committee worked for three years, a number of interim
reports was delivered
The task of the committee – to propose national public
health goals which should guide all sectors of the society
The goals were approved by the parliament in a revised
version 2003.
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Swedish public health policy- main target areas
1.
Participation and influence in the society
2.
Economic and social security
3.
Secure and favorable conditions during childhood and adolescence
4.
Healthier working life
5.
Healthy and safe environments and products
6.
Health and medical care that more actively promotes good health
7.
Effective protection against communicable diseases
8.
Safe sexuality and good reproductive health
9.
Increased physical activity
10. Good eating habits and safe food
11. Reduced use of tobacco and alcohol, a society free from illicit drugs and
doping and a reduction in the harmful effects of excessive gambling.
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To express the goals in relation to health
determinants was an important decision
There is an obvious relation between
the goals and political actions in
order to achieve them
The main area of public health work
becomes placed outside the health
and medical sector
If the goals are broadly accepted
they will guide actions in many
sectors of the society
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Some problems
In some instances it may be hard to show
that the fulfilment of a goal leads to
improved health.
Economists, administrators and others may
have difficulties in accepting population
health as a desirable political goal
Conclusion – you have to provide good
scientific evidence in order to promote public
health policy
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A new role for NIPH
• Monitor the public health policy
• Centre of excellence in the field of methods in
public health policy
• Supervision of legislation concerning alcohol,
tobacco and illicit drugs
• Support to regions and municipalities
• Specific programmes concerning HIV and
gambling depency
How has the public health policy
been implemented?
The main objectives have been approved by the
parliament which gives them a strong political support
Indicators for all main objectives have been decided by
the National Institute of Public Health after
negotiations with other governmental agencies
18 agencies at national level are instructed by the
government to participate in the public health policy
8 regions have been instructed to integrate public
health into regional development plans
More than 50% of the 290 Swedish municipalities have
adopted public health programs
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A public health policy report will be
delivered to the government 2005
• The report will be based on the 38 main
indicators and further indicators in specific
areas
• There will be a report on how the policy have
been implemented and what actions have
been taken
• The report will evaluate the policy and discuss
prioritizations and revisions
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1. Participation and influence in the
society
• Lack of participation and
influence harmful for Public
Health
• Solid scientific evidence for the
causal relation between high
demands-low control and
disease
• Support for local participation,
culture, ethnic integration part
of the public health policy
2. Economic and social security
• Loss of security causes economic
stress
• Lack of employment and lack of
access to social services bad for
health
• The poverty trap: Poverty >
disease > lower incomes and
higher expenditures > increased
poverty
• Social welfare and equality is
good for Public Health
Declining employment rate
Percent employed 20-64 year old
90
Percent
85
80
75
70
65
1970
1975
1980
1985
Year
1990
1995
2000
3. Secure and favorable conditions
during childhood and adolescence
• Childhood conditions important for
health later in life
• Support and education to parents,
good child care, health schools
• Comprehensive maternity care has
been very important for the low
infant mortality in Sweden
• Declining mental health among young
people a major problem
4. Healthier working life
• Taking good care of the
workforce an important factor
for social and economic
developement
• Stress at work-places and lack
of influence important problems
• Worse working conditions for
females
• Large increase in work related
health problems
5. Healthy and safe environments and
products
• Integrate environmental policy with public
health work
• Noise and air pollution the most important
problems from a health perspective in Sweden
• Global warming, air pollution – especially
indoor, access to fresh water
• Injury protection is very effective also in
economic terms
• Cooperation against the great global health
risks
6. Health and medical care that more
actively promotes good health
• A well developed and accessible
primary care important for
prevention
• Maternity and child care of
particular importance
• Integration of medical and social
services
• Health promotion and disease
prevention important for the entire
health sector.
Main problems from a public health
perspective
• Reduced accessability due to high fees
• Increasing costs for drugs
• Difficult to control total costs in a market
system with a lot of providers
• Difficult to introduce prevention
• Lack of cooperation with other sectors in
society especially in rehabilitation
7. Effective protection against
communicable diseases
• HIV/AIDS, Malaria och TBC
important threats to the
entire population and workforce i many countries
• Most new cases of HIV are
infected outside Sweden
• International cooperation is
in the self-interest of all
countries
8. Safe sexuality and good
reproductive health
• Unsafe sex the second most
important health risk in
developing countries
• Sexually transmitted disease
increasing
• Trafficing an important
health risk
9.Increased physical activity
• Sedentary life-style and lack of
healthful physical activity a
major health risk
• Main determinant of
Cardiavascular disease,
diabetes, osteoporosis, cancer
• Promotion of physical activity in
schools and workplaces an
important public health measure
10.Good eating habits and safe food
• Today approximately 1 billion people
suffer from malnutrition
• Approximately the same number are
overweight which is a major cause
of premature mortality
• A unequal distribution of food is a
major problem in all parts of the
world
• To much fat and sugar and to little
fruit and vegetables the main
problem
Access to food – data from FAO
4000
Industrial countries
kcal/person/day
3500
The world
3000
Developing countries
2500
2000
1500
1964-66
1974-76
1984-86
1997-99
2015
2030
11. Reduced use of tobacco and alcohol, a
society free from illicit drugs and doping and
a reduction in the harmful effects of excessive
gambling
• Tobacco the first and alcohol the third
determinant of global burden of disease
• The average taxation on alcohol
beverages has decreased internationally
• The Swedish alcohol consumption of
alcohol has increased
• Tobacco-related mortality increasing
internationally but decreasing in Sweden
• Distribution of illicit drugs an organised
market connected with international
crime. Sweden has a restrictive policy on
illicit drugs
Percentage of daily smokers, 16-84 years,
1980-2002
Andel dagligr ökar e
Males
Females
40
Män
30
Kvinnor
20
10
0
1980
1985
1990
1995
2000
June 1st 2005 – smoking will be prohibited in restaurants
Källa: Undersökningen av levnadsförhållanden, SCB
The main tasks of the Swedish National
Institute of Public Health
National centre of competence in the field of
public health
Follow-up of the effects of the national public
health policy
Supervision of the legislation concerning
alcohol, tobacco and narcotics
Advisory functions to the government
Cooperation with research funding agencies
and support to coordination of public health
research
Strategic support to politicians and
professionals at regional and local levels, who
have the main responsibility for public health
workation and support
to professionals
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at regional and local levels
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Which are the main Swedish public health
problems?
1. The increase in work-related health
problems and absence from work
2. The increase in mental health problems,
especially among young people
3. The increase in obesity and sedentary lifestyle
4. The increasing alcohol consumption
Number of persons
Rise in sickness benefits and early retirement
900000
800000
700000
600000
500000
400000
300000
Longterm sickness
Early retirement
200000
100000
0
1998 1999 2000 2001 2002 2003
Year
Possible actions
•
•
•
•
•
Better working environment
Stricter rules for certification of sick leave
Better occupational health services
Lower benefits during sick-leave
Create jobs for people with decreased
working capacity
The Swedish alcohol consumption
Litres 100% alcohol/inhabitant
10
Sw eden entered EU
9
8
7
6
5
1990
1993
1995
1996
1998
2000
2001
2002
Possible actions
• Restriction on sales and drinking in
restaurants
• Education
• Harder rules against drinking and driving
• Information
Percentage of the Swedish population
reporting insomnia
19
85
19
87
19
89
19
91
19
93
19
95
19
97
19
99
20
01
20
03
Millions of daily doses
Sales of antidepressant drugs in Sweden
250
200
150
100
50
0
Possible actions
•
•
•
•
•
Support to parents of small children
Better maternity and child care
Health promoting schools
Increase work opportunities for young people
Decrease negative stress in work places and
schools
BMI, males and females 16-74 years,
1980-2002
Medel-B MI
26
25,5
25
24,5
Män
24
23,5
Kvinnor
23
1980
1989
Källa: Undersökningen av levnadsförhållanden, SCB
1998
2001
Possible actions
• Decrease the intake of fat and sugar.
Increase fruit and vegetables.- Pricing?
• Increase physical activity at least 30 minutes
a day (60 minutes for young people)
• Prescriptions of physical activity and better
food habits by doctors
• Physical activity in schools and work places.
• Restrictions on food advertisments in TV to
children
Final conclusions
• The Swedish public health is still good in an
international scale
• However, considerable health gaps
• Mental health and self-reported health decreasing,
especially among young people
• A number of threats against the health
• A national public health policy is important to fight
those threats
• International co-operation important in the field of
public health