Creating Creating Environment and Environment and

Health Information Health Information System in System in LithuaniaLithuania::First stepsFirst steps

Ingrida Zurlyte, Aida Laukaitiene

State Public Health Centre, Vilnius, Lithuania

The Central and Eastern European Chapter/ISEE Meeting

4 – 6 September, 2003, Balatonfoldvar

National FrameworkNational Framework

National Public Health Strategy, 2001National Public Health Strategy, 2001 Law on Public Health Care, 2002Law on Public Health Care, 2002 Law on Public Health Monitoring, Law on Public Health Monitoring,

2002 (by-law acts, 2003)2002 (by-law acts, 2003) National Environmental Health National Environmental Health

Action Programme (2003 – 2006)Action Programme (2003 – 2006) National Public Health Monitoring National Public Health Monitoring

Programme (draft)Programme (draft) Strategic Planning for Health SectorStrategic Planning for Health Sector

National FramewokNational Framewok

Long – Term State Development Long – Term State Development Strategy, 2002Strategy, 2002

National Sustainable Development National Sustainable Development Strategy and Implementation Plan, Strategy and Implementation Plan, 20032003

Information Society ProgrammeInformation Society Programme

Environmental Health Information System - Environmental Health Information System - environmental health data collection, environmental health data collection, transmission, processing and delivery to end-transmission, processing and delivery to end-user in the most efficient way in order to user in the most efficient way in order to possess everyday tool for environmental health possess everyday tool for environmental health management management (NEHAP of Lithuania, 2003) (NEHAP of Lithuania, 2003) The purpose is to: The purpose is to:

collect and process environmental health information collect and process environmental health information on geographical principle and with national on geographical principle and with national coverage; coverage;

assess environmental health situation;assess environmental health situation; ensure fast and effective use of environmental health ensure fast and effective use of environmental health

data and information for identification of “hot spots”; data and information for identification of “hot spots”; provide input for environmental health impact provide input for environmental health impact

assessment;assessment; use in forecasting and policy decision – making use in forecasting and policy decision – making

process.process.

Input from international Input from international projectsprojects

WHO/DEPA Project on Implementation WHO/DEPA Project on Implementation of National Environmental Health of National Environmental Health Action Plans in Czech Republic, Action Plans in Czech Republic, Estonia, Lithuania, Poland and Estonia, Lithuania, Poland and Slovakia, 2000 – 2001Slovakia, 2000 – 2001 WHO mission to review EH monitoring WHO mission to review EH monitoring

and information system in Lithuania, 2001and information system in Lithuania, 2001 Analysis and strategic recommendations Analysis and strategic recommendations

for integrated EH information system, for integrated EH information system, 20012001

Input from international Input from international projectsprojects

WHO project: Environment and WHO project: Environment and Health Indicators: developing Health Indicators: developing methodology for the WHO European methodology for the WHO European RegionRegion Planning, set of EH indicatorsPlanning, set of EH indicators Feasibility study for core set of EH Feasibility study for core set of EH

indicatorsindicators Pilot study (data collection, EuroIndy, Pilot study (data collection, EuroIndy,

meta data information, fact – sheets for meta data information, fact – sheets for reporting)reporting)

Feasibility studyFeasibility study

Issues addressed:Issues addressed: Availability and quality of necessary Availability and quality of necessary

data;data; Accessibility and exchange Accessibility and exchange

mechanisms;mechanisms; Use and usefulness of proposed Use and usefulness of proposed

indicators in (sub)national context;indicators in (sub)national context; Capacity for multi – agency working on Capacity for multi – agency working on

the information.the information.

Results of Feasibility Results of Feasibility StudyStudy

From the WHO core set of indicators From the WHO core set of indicators (55):(55):- most were feasible (24)- most were feasible (24)- 17 partly feasible- 17 partly feasible- 14 not feasible - 14 not feasible (exposure related indicators; (exposure related indicators; noise related effect indicators (annoyance, sleep noise related effect indicators (annoyance, sleep disturbance; exceedance of WHO drinking water disturbance; exceedance of WHO drinking water guidelines)guidelines)

Only 3 indicators not useful Only 3 indicators not useful (consumption of (consumption of leaded gasoline; blood lead level in children; leaded gasoline; blood lead level in children; standardized mortality ration by occupation)standardized mortality ration by occupation)

Positive experience – Positive experience – feasibility studyfeasibility study

• Renewed contacts and new contacts established.• More clear and generalized view on existing EH

information, assessment of gaps. • Created understanding, awareness in health and other

sectors;• Standardized forms for information collection and

evaluation.• Cooperation with WHO and EEA.

ProblemsProblems• Problems with identifying data-holders

(additional administrative capacities and time);

• Data is spread in different institutions (27), 10 of them from health sector.

• Lack of institutional co-operation and data exchange, lack of data or data duplication;

• Financial and timing problems – motivation, reluctance from some institutions and experts;

• Transitional period (changes in methods, new and old data are hardly comparable and new data are not complete);

ProblemsProblems

• Reorganization of public health institutions: moving responsibilities

• Each institutions/expert are very specialized difficult to generalize.

• Incompatibility of environment and Incompatibility of environment and health data collection and health data collection and presentation formatspresentation formats

• Poor EH reportingPoor EH reporting

National List of Environmental Health National List of Environmental Health Indicators, adopted by the Order of the Indicators, adopted by the Order of the Minister of Health, August 30, 2002Minister of Health, August 30, 2002

Based on WHO core set of EH indicators, Based on WHO core set of EH indicators, feasibility study results and new proposalsfeasibility study results and new proposals

Discussed with public health, environmental Discussed with public health, environmental institutions and Statistical Departmentinstitutions and Statistical Department

Procedure for data collection, analysis and Procedure for data collection, analysis and reporting, end of 2003.reporting, end of 2003.

Example from the Example from the national listnational list

IndicatorIndicator WHO core setWHO core set Lithuanian setLithuanian set

Incidence of skin Incidence of skin cancercancer

YesYes YesYes

Effective monitoringEffective monitoring YesYes YesYes

Amount of Amount of radioactive waste radioactive waste generated per yeargenerated per year

-- Yes (new)Yes (new)

% of population % of population receiving a receiving a cumulative radiation cumulative radiation dose in excess of 5 dose in excess of 5 mS/yearmS/year

-- YesYes

UV light indexUV light index -- YesYes

Number of workers Number of workers with ionizing with ionizing radiation sourcesradiation sources

-- Yes (new)Yes (new)

Topicality of permits Topicality of permits on the use of on the use of radioactive radioactive substancessubstances

-- YesYes

Some other differencesSome other differences Children statistics: 0-2; 3-6; 0-14; 0-15 years Children statistics: 0-2; 3-6; 0-14; 0-15 years

oldold Mortality due to external causes in children under 6 Mortality due to external causes in children under 6

years oldyears old Acute communicable intestinal diseases morbidity in Acute communicable intestinal diseases morbidity in

children under 6 years of agechildren under 6 years of age

Different formulation of food safety Different formulation of food safety indicatorsindicators Number of outbreaks of communicable disease Number of outbreaks of communicable disease

transmitted by food per yeartransmitted by food per year Incidence rate of acute intestinal communicable disease Incidence rate of acute intestinal communicable disease

and bacterial food toxic infectionsand bacterial food toxic infections

Annual emissions of SO2 total and by economic sectors in Lithuania in 1996-2000

0

10

20

30

40

50

60

70

80

90

100

1996 1997 1998 1999 2000

years

kton

s/yr

SO2 emissions: Total SO2 emissions: Industry SO2 emissions: Pow er generation

SO2 emissions: Domestic SO2 emissions: Transport

Rate of road traffic causalties Rate of road traffic causalties (injury+death)(injury+death)

0

25

50

75

100

125

150

175

200

225

250

1996 1997 1998 1999 2000

years

rate

per

100

000

popu

latio

n

Rate of road traff ic casualties Rate of injuries due to road traff ic accidents Rate of death due to road traff ic accidents

Useful floor area per person in Useful floor area per person in Lithuania during the year 1996-Lithuania during the year 1996-

20012001

21,121,4

22,1

22,7

23,4

22,8

20,0

20,5

21,0

21,5

22,0

22,5

23,0

23,5

24,0

1996 1997 1998 1999 2000 2001

Year

Squa

re m

etre

s

Notes:Notes: Data of useful floor area are collected in Lithuania. Lithuanian Data of useful floor area are collected in Lithuania. Lithuanian Statistical Department defines Useful floor area as: the floor space of Statistical Department defines Useful floor area as: the floor space of dwellings measured inside the outer walls; excluding cellars, dwellings measured inside the outer walls; excluding cellars, uninhabitable attics and, in multi-dwelling houses, common area.uninhabitable attics and, in multi-dwelling houses, common area.

Proportion of the bathing water analyses exeeding the current guideline values of EC bathing water Directive (76/160/EEC)

22.5

4.4

1.7

9.2

24.523.5

22.2

7.45.6 7.6

21.5

5.4

0

5

10

15

20

25

30

1996 1997 1998 1999 2000 2001

Year

%

Lithuania (freshwater) Lithuania (marine water)

Lithuania (freshwater&marine water)

Problems encounteredProblems encountered Interpretation in environmental health termsInterpretation in environmental health terms Lack of data: for drinking water quality; food Lack of data: for drinking water quality; food

action indicators only from the year 2000; action indicators only from the year 2000; sites containing large amount of chemicals – sites containing large amount of chemicals – approximate onlyapproximate only

Action indicators: broad; very approx Action indicators: broad; very approx estimation (subjective judgment)estimation (subjective judgment)

Food borne illness or water born illness – Food borne illness or water born illness – different from WHO indicatorsdifferent from WHO indicators

Regulatory requirements for land use around Regulatory requirements for land use around areas with large quantities of chemicals – who areas with large quantities of chemicals – who is responsible?is responsible?

Application on local levelApplication on local level

Interest from local level existInterest from local level exist

Differences between counties and localitiesDifferences between counties and localities

Need for additional training and guidance Need for additional training and guidance from national levelfrom national level

Should be clear for local authorities what Should be clear for local authorities what data, where to get etc.data, where to get etc.

ExpectationsExpectations

Environmental health assessmentsEnvironmental health assessments Environmental Health (Public Environmental Health (Public

Health) reporting and Health) reporting and communicationcommunication

Contribute to monitoring of Contribute to monitoring of environment and health actionsenvironment and health actions

Incorporate children EH indicatorsIncorporate children EH indicators

TasksTasks Ensure continuity of work doneEnsure continuity of work done Build partnership with stakeholdersBuild partnership with stakeholders Managers and politicians should take Managers and politicians should take

ownership of the environmental health ownership of the environmental health information systeminformation system

Complete legal basis for EHIS functioning.Complete legal basis for EHIS functioning. Create financial – economic basis for EH Create financial – economic basis for EH

information system functioning.information system functioning. Solve issues of EHIS holder(s) Solve issues of EHIS holder(s)

management and subordination.management and subordination.

Thank you Thank you for your for your attention!attention!