what determines health? national health promotion policy to address inequalities mihály kökény,...

What determines health?What determines health?

National health promotion National health promotion policy to address inequalitiespolicy to address inequalities

Mihály Kökény, MDMihály Kökény, MDMinistry of Health, Social and Family AffairsMinistry of Health, Social and Family Affairs

What determines health?What determines health?National health promotion policy to address inequalitiesNational health promotion policy to address inequalities

„„Generate healthy population” an economic, political Generate healthy population” an economic, political and welfare factorand welfare factor

Countries have different approaches to address health Countries have different approaches to address health issuesissues

To place health high on the political agenda as part To place health high on the political agenda as part of the overall development plan of the overall development plan → key to success→ key to success


Expectations of European citizensExpectations of European citizens

Long, wealthy and healthy lifeLong, wealthy and healthy life Health considered as value and investmentHealth considered as value and investment To be protected against illness/diseaseTo be protected against illness/disease To bring up children in healthy environmentTo bring up children in healthy environment Safe and hygienic workplaceSafe and hygienic workplace Well informed choice on lifestyleWell informed choice on lifestyle Access to high quality health serviceAccess to high quality health service


Governments’ response and rationale to healthy population I.Governments’ response and rationale to healthy population I.

Economic factorEconomic factor Loss in GDP by disease and disabilityLoss in GDP by disease and disability Healthy workforceHealthy workforce

Public health factorPublic health factor Good health indicators show good quality of life in a countryGood health indicators show good quality of life in a country

Health is determined by many factors: biological, genetic, Health is determined by many factors: biological, genetic, lifestyle factors; physical environment; effective, efficient and lifestyle factors; physical environment; effective, efficient and high-quality health serviceshigh-quality health services


Governments’ response and rationale to healthy population II.Governments’ response and rationale to healthy population II.

Comprehensive national public health programme, based on HFA, Comprehensive national public health programme, based on HFA, Commisioner’s health policy vision; (Hungary)Commisioner’s health policy vision; (Hungary)

Health determinants approach (smoking, alcohol, drugs, nutrition, Health determinants approach (smoking, alcohol, drugs, nutrition, physical activity)physical activity)

Disease prevention (screening)Disease prevention (screening) NEHAP II (nearly all European countries – following Budapest NEHAP II (nearly all European countries – following Budapest

Conference)Conference) Settings approachSettings approach Life cycle approachLife cycle approach Any combinations of aboveAny combinations of above

to extend life expectancy, improve health statusto extend life expectancy, improve health status


Governments’ response and rationale to healthy population III.Governments’ response and rationale to healthy population III.

Modernisation of health care and financial system (high on agenda)Modernisation of health care and financial system (high on agenda)

Challenges to be met: Challenges to be met: To extend life expectancy, deal with growing elderly population, To extend life expectancy, deal with growing elderly population, Growing demand of patients for new, expensive technology, cost Growing demand of patients for new, expensive technology, cost

containment measures and new interventionscontainment measures and new interventionsimprove quality, equity, improve quality, equity, efficiency, effectivenessefficiency, effectiveness

Modernize health system Modernize health system increase fundingincrease funding(public/private mix)(public/private mix)

EU integration (workforce, patientEU integration (workforce, patient mobility)mobility)


Commission’s response Commission’s response to protect the health of the to protect the health of the EU citizens - „add value”EU citizens - „add value”

Communication on the Health Strategy of the EU Communication on the Health Strategy of the EU (May 2000)(May 2000)

Lisbon strategyLisbon strategy Public health strategy frameworkPublic health strategy framework

patient mobilitypatient mobility establishment of ECDCestablishment of ECDC

Open method of coordination Open method of coordination European aims and objectivesEuropean aims and objectives annual national monitoring of programmesannual national monitoring of programmes


High Level Group on Health Services and Medical CareHigh Level Group on Health Services and Medical Care continuation of High Level Group on Patient continuation of High Level Group on Patient

Mobility)Mobility)

Cross-border healthcare purchasing and provision (including Cross-border healthcare purchasing and provision (including rights and duties of patients)rights and duties of patients)

Health professionalsHealth professionals Centres of referenceCentres of reference Health technology assessmentHealth technology assessment Information and e-health (including data protection)Information and e-health (including data protection) Health impact assessment and health systemsHealth impact assessment and health systems

What determines health?What determines health?National health promotion policy to address inequalities healthNational health promotion policy to address inequalities health

Minimum prerequisites of success Minimum prerequisites of success in investment in healthin investment in health

Political commitmentPolitical commitment Equity and solidarity as key principlesEquity and solidarity as key principles Intersectoral approachIntersectoral approach Involvement of key stakeholders incl. business sector, Involvement of key stakeholders incl. business sector,

civil societycivil society Public health programme/interventionPublic health programme/intervention Public health infrastructure/personnelPublic health infrastructure/personnel Involvement of populationInvolvement of population Communication strategyCommunication strategy


Health indicatorsHealth indicators

Health indicators show a steady increase in health Health indicators show a steady increase in health status and life expectancy within EU Member status and life expectancy within EU Member StatesStates

Substantial differences are seen within and Substantial differences are seen within and between countries particularly if accession between countries particularly if accession countries are taken into accountcountries are taken into account

Large gap exists in new EU Member StatesLarge gap exists in new EU Member States


Example of a new EU Member State: HUNGARYExample of a new EU Member State: HUNGARY

Public health, public health infrastructure and capacityPublic health, public health infrastructure and capacitybuildingbuilding key to success key to success

WHY?WHY?

macro-economic rationalemacro-economic rationale (poor health status – 4% loss in (poor health status – 4% loss in GDP)GDP)

public health rationalepublic health rationale inequalities among the countries of Europeinequalities among the countries of Europe inequalities within the countriesinequalities within the countries


Public health – epidemiological situationPublic health – epidemiological situation

in Hungarin Hungary:y:

life expectancy at birthlife expectancy at birth men 8 yearsmen 8 years women 6 yearswomen 6 years

lower than the EU average


Epidemiological situationEpidemiological situation

Good newsGood news Bad newsBad news•• improving trend ofimproving trend of • p• preremature death highest inmature death highest in

life expectancy at birth since 1996life expectancy at birth since 1996 new Member Statesnew Member States•• infant mortality decline (10 yrs) infant mortality decline (10 yrs) • high middle age mortality• high middle age mortality•• external causes of death, external causes of death, • c• cvvd 3 times higher than EU d 3 times higher than EU

averageaveragesuicide (4th place in Europe) suicide (4th place in Europe) • cancer (51. place)• cancer (51. place)

•• stomach cancerstomach cancer - lung (highest in Europe)- lung (highest in Europe)•• HIV/AIDS lowHIV/AIDS low - breast- breast•• syphilis, mumps, whooping syphilis, mumps, whooping • diseases of digestive • diseases of digestive cough low cough low

system highestsystem highest in new Member States in new Member States•• communicable diseases 0.09 communicable diseases 0.09 • smoking – highest in • smoking – highest in new MSsnew MSs

• • alcohol – 9,5l capitaalcohol – 9,5l capita • • envirenvironmental factorsonmental factors

• air, water• air, water

65

70

75

80

1970 1980 1990 2000 2010

Czech RepublicEstoniaHungaryLatviaLithuaniaMaltaPolandSlovakiaSloveniaEU average CSEC average

060101 +Life expectancy at birth, in years

Source: HFA, 2003 June

Life expectancy at birth

58

63

68

73

78

83

Year

Life

exp

ecta

ncy (

year

s)

58

63

68

73

78

83

Year

Life

exp

ecta

ncy

(yea

rs)

Males Females

Hungary EU Source: HFA DB, WHO/EUROSource: HFA DB, WHO/EURO

How do we intend to extend lifespan and increase the number of healthy years?

Health policy that is conducive to this goal:

aims at health gain through public health strategy

based on solidarity, equity; multisectoral approach as well as integrated approach between health and social issues;

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



National National Public Health ProgrammePublic Health Programme in Hungary in Hungary as a positive example - as a positive example - 4 strategies4 strategies::

create supportive social environment for healthcreate supportive social environment for health develop healthy lifestyles, reduce risk factorsdevelop healthy lifestyles, reduce risk factors reduce avoidable mortality, morbidity, injuryreduce avoidable mortality, morbidity, injury develop health services and public health develop health services and public health

institutions for improving the health of the institutions for improving the health of the populationpopulation


Are these only dreams?Are these only dreams?

NO!NO!

Progress already madeProgress already made

during the years of preparation for EU membership we during the years of preparation for EU membership we made a lot of progress already:made a lot of progress already:

the transposition of the acquis in our sector is an the transposition of the acquis in our sector is an investment in primary preventioninvestment in primary prevention

(water quality, food safety, environmental protection, health (water quality, food safety, environmental protection, health protection at workplace, radiation hygiene etc.)protection at workplace, radiation hygiene etc.)

this is itself a this is itself a public health programmepublic health programme


Public Health institutional developmentPublic Health institutional development

Parallel to harmonisation, institutional system strengthenedParallel to harmonisation, institutional system strengthened

Pre-accession funds well invested: major investment in the Pre-accession funds well invested: major investment in the Hungarian National Public Health and Medical Officers’ Service – Hungarian National Public Health and Medical Officers’ Service – laboratories, information system, training programmeslaboratories, information system, training programmes

Main areas:Main areas: public health laboratoriespublic health laboratories chemical safetychemical safety epidemiologyepidemiology and communicable diseases and communicable diseases information systeminformation system microbiological laboratoriesmicrobiological laboratories

They serve early detection, modern diagnosis, prevention andThey serve early detection, modern diagnosis, prevention and treatmenttreatment


The EU and the Hungarian Public HealthThe EU and the Hungarian Public Health

In fact two synergetic processes:In fact two synergetic processes: Acquis, harmonisation – changing public health standards and Acquis, harmonisation – changing public health standards and

practicespractices The „Decade of Health Public Health Programme” in close The „Decade of Health Public Health Programme” in close

inter-relation with the Community Action Programme on Public inter-relation with the Community Action Programme on Public HealthHealth

Impact:Impact:→ improving life expectancy (by improving life expectancy (by 33 years years over 10 yearsover 10 years))→ better quality of servicesbetter quality of services→ consolidation and modernisation of the health systemconsolidation and modernisation of the health system→ contributing to its sustainable fundingcontributing to its sustainable funding


Review of Hungarian public health system: Review of Hungarian public health system: inadequate to serve the public health inadequate to serve the public health programme programme

(80 % CD-oriented whereas(80 % CD-oriented whereas

80 % of public health problems NCD – 80 % of public health problems NCD – oriented)oriented)

Full reorganization startsFull reorganization starts


Establishment of the School of

Public Health in Debrecen,1996-present

to promote public health capacity – buildingto promote public health capacity – building

Major step forwardMajor step forward

We have our own assets with a few gaps

health services covers the whole

country provides wide range

of services solidarity principle

improvement needed

- in bad physical condition- equipment needs

modernization- quality of care to be

improved- patient information and

rights to be improved

excellent manpower well-trained devoted not very mobile

Assets

reform underway to modernize


Modernization of health systemsAssets improvement needed

public health

national programme approved by Parliament 2004 is the year of dinamization

infrastructure

staff

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 (pre-accession funds)


Close gaps in public health

EU public health strategy framework 2003-2008

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!

what determines health? national health promotion policy to address inequalities mihály kökény,...

Documents

health systemswhat

health statuswhat

mdministry of health

modernisation of health

healthy environmentsafe

healthy lifehealth

growing elderly population

life expectancy