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Health Promotion and Investment

EXPERIENCE OF DEVELOPED COUNTRIES. WHO CONCLUSION:. IT IS NOT THE RICHEST SOCIETIES THAT ENJOY HIGHEST LEVEL OF HEALTH BUT THOSE WHERE IS LOWEST DIFFERENCE BETWEEN RICH AND POOR. Health Promotion and Investment. Individuali rizika. Vilius GRABAUSKAS. FOOD SELECTION CRITERIA

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Health Promotion and Investment

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  1. EXPERIENCE OF DEVELOPED COUNTRIES WHO CONCLUSION: IT IS NOT THE RICHEST SOCIETIES THAT ENJOY HIGHEST LEVEL OF HEALTH BUT THOSE WHERE IS LOWEST DIFFERENCE BETWEEN RICH AND POOR Health Promotion and Investment

  2. Individuali rizika Vilius GRABAUSKAS

  3. FOOD SELECTION CRITERIA IN LITHUANIAN POPULATION (BALTIC NUTRITIONAL SURVEY) 80 66,8 70 60 50 40 30 20 16,1 8,3 6,4 10 2,4 0 Prevention Special diet Price Taste Food preference Vilius GRABAUSKAS

  4. FOOD SELECTION CRITERIA IN LITHUANIAN POPULATION BY FAMILY INCOME (BALTIC NUTRITIONAL SURVEY) 77 Prevention 80 Price 69 Taste Food preference 60 45 40 30 15 14 20 11 8 8 8 8 7 0 LOW INCOME 1TERTILE MEDIUM INCOME 2 TERTILE HIHG INCOME 3 TERTILE Vilius GRABAUSKAS

  5. COMPARISON OF MORTALITY OF POPULATION WITHUNIVERSITY AND PRIMARY OR LOWER EDUCATION BY AGE (MORTALITY OF THE GROUP WITH UNIVERSITY EDUCATION=1) Ratio 13 12 11 10 9 8 7 6 5 4 3 2 1 0 25 30 35 40 45 50 55 60 65 70+ Age, years Men Women Vilius GRABAUSKAS

  6. PROPORTION (%) OF DAILY SMOKERS, BY EDUCATIONAL LEVEL % 68.0* 70 60 48.5** 50 36.7 40 30 17.4* 20 10.8 9.1 10 0 Incomplete secondary Secondary University Men Women Vilius GRABAUSKAS

  7. PROPORTION (%) OF DAILY SMOKERS, BY FAMILY INCOME % Vilius GRABAUSKAS

  8. * p<0.001 LOW BIRTH WEIGHT (>2500 G.) PROPORTIONS BY EDUCATIONAL LEVEL OF MOTHERS Primary Secondary University • Pradinis • vidurinis • aukštasis % Vilius GRABAUSKAS

  9. RELATIVE RISK OF UNMARIED LITHUANIAN POPULATION BY AGE AS COMPARIED TO MARIED (MARIED= 1) Males Females AGE V. GRABAUSKAS

  10. * p<0.001 LOW BIRTH WEIGHT (>2500 G.) PROPORTIONS BY MARITAL STATUS OF MOTHERS % Vilius GRABAUSKAS

  11. TOTAL MORTALITY LEVEL (PER 100 000 OF POPULATION) IN ADMINISTRATIVE AREAS OF LITHUANIA IN QUINTILES (1996 YEAR DATA) Vilius GRABAUSKAS

  12. CARDIOVASCULAR MORTALITY IN ADMINISTRATIVE AREAS IN LITHUANIA IN QUINTILES 2000 LITHUANIA 566 <1100 <940 <780 <620 <460 No data Min: 300 Vilius GRABAUSKAS

  13. HEALTH EXPENDITURE IN ADMINISTRATIVE AREAS IN LITHUANIA IN QUINTILES 1997 LITHUANIA 378 Upper 2-a 3-a 4-a Lower No data Min: 75.44 Vilius GRABAUSKAS

  14. LITHUANIAN NATIONAL HEALTH CONCEPT HEALTH LAWS ACTIVE HEALTH POLICY AND STRATEGY HEALTH PROMOTION HEALTHY LIFE STYLES HEALTH CARE ENVIRONMENTAL PROTECTION DEVELOPMENT OF ENTIRE HEALTH SYSTEM WHO“HEALTH FOR ALL” PRINCIPLES Vilius GRABAUSKAS

  15. TRENDS IN PROPORTION OF BUTTER ON BREAD USERS IN LITHUANIAN POPULATION AGED 20-64 BETWEEN 1994 -2000 80 71,2 66,3 70 56* 60 50,6* 40,6* 50 1994 38* 38,2* 37,6* 1996 40 1998 30 2000 20 10 0 Males Females * p<0.05 compared with year 1994 Vilius GRABAUSKAS

  16. TRENDS IN PROPORTION VEGETABLE OIL FOR COOKING USERS IN LITHUANIAN POPULATION AGED 20-64 BETWEEN 1994 - 2000 100 88,4* 86,5* 90 73,5* 73,1* 80 68,8* 70 54* 1994 60 47,7 1996 50 1998 40 31,1 2000 30 20 10 0 Males Females * p<0.05 compared with year 1994 Vilius GRABAUSKAS

  17. TRENDS IN PROPORTION OF FRESH VEGETABLE USERS AT LEAST ON 3 DAYS DURING THE LAST WEEK BETWEEN 1996 - 2000 60 51,6* 50* 50 43,6* 36,8* 40 1996 24,8 30 18,1 1998 2000 20 10 0 Males Females * p<0.05 compared with year 1996 Vilius GRABAUSKAS

  18. TRENDS PROPORTION OF DAILY SMOKERS IN LITHUANIAN POPULATION AGED 20-64 BETWEEN 1994 - 2000 60 51,2 48,5* 47,3 50 43,3 40 1994 1996 30 1998 15,8* 12,5* 20 2000 9,4 6,3 10 0 Males Females * p<0.05 compared with year 1994 Vilius GRABAUSKAS

  19. TRENDS IN PROPORTION OF STRONG ALCOHOL USERS AT LEAST ONCE A WEEK IN LITHUANIAN POPULATION AGED 20-64 BETWEEN 1994 - 2000 40 33,9 31,2 35 28,7* 27,1* 30 25 1994 1996 20 11,5 1998 15 2000 6,7* 6,6* 10 5,5* 5 0 Males Females * p<0.05 compared with year 2000 Vilius GRABAUSKAS

  20. PROPORTION OF BEER USERS AT LEAST ONCE A WEEK IN LITHUANIAN POPULATION AGED 20-64 BETWEEN 1994 - 2000 55,8* 60 48,9* 43,5 50 39,4 40 1994 1996 30 18,3* 1998 12,9* 2000 20 7,1 8,1 10 0 Males Females * p<0.05 compared with year 1994 Vilius GRABAUSKAS

  21. *p<0.05 **p<0.01 ***p<0.001 Comparing with 1987 1987 1993 1999 TRENDS IN AGE STANDARDIZED PREVALENCE OF SOME BIOLOGICAL RISK FACTORS IN LITHUANIAN POPULATION AGED 25-64 (LITHUANIAN – CINDI DATA BASE) HYPERTENSION (  140/90 or on treatment ) *** OVERWEIGHT ( BMI  25 ) *** ** *** 84,9 HYPERCHOLESTERO-LEMIA (  5,0 mmol/l ) ** *** *** FEMALES MALES Vilius GRABAUSKAS

  22. TOTAL MORTALITY TRENDSIN LITHUANIAN MALES AGED 0-64 SDR / 100 000 1.000 900 6.7%/year, p=0.0001 -2.7%/year, n.s. -6.9%/year, p=0.007 800 700 600 500 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 2000 1999 Vilius GRABAUSKAS

  23. TOTAL MORTALITY TRENDS IN LITHUANIAN FEMALES AGED 0-64 SDR / 100 000 350 3.4%/year, p=0.002 300 -6.3%/year, p=0.02 250 -2.2%/year, n.s. 200 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Vilius GRABAUSKAS

  24. CVD MORTALITY TRENDSIN LITHUANIAN MALES AGED 0-64 SDR / 100 000 300 280 5.8%/year, p=0.0004 260 -6.6%/year, p=0.04 240 2.6%/year, n.s. 220 200 180 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Vilius GRABAUSKAS

  25. CVD MORTALITY TRENDSIN LITHUANIAN FEMALES AGED 0-64 SDR / 100 000 100 90 3.0%/year, p=0.02 - .5%/year, n.s. - 8.1%/year, p=0.03 80 70 60 50 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Vilius GRABAUSKAS

  26. CHD MORTALITY TRENDS IN LITHUANIAN MALES AGED 0-64 SDR / 100 000 5.4%/year, p=0.0004 200 180 2%/year, n.s. 160 -10%/year, p=0.02 140 120 100 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Vilius GRABAUSKAS

  27. CHD MORTALITY TRENDS IN LITHUANIAN FEMALES AGED 0-64 SDR / 100 000 70 60 3.6%/year, p=0.01 50 40 - 15.6%/year, p=0.01 30 - .6%/year, n.s. 20 10 0 1982 1985 1986 1988 1989 1991 1993 1994 1997 1998 2000 1980 1981 1983 1984 1987 1990 1992 1995 1996 1999 Vilius GRABAUSKAS

  28. CAN MORTALITY TRENDSIN LITHUANIAN MALES AGED 0-64 SDR / 100 000 160 155 1%/year, n.s. 150 -2.7%/year, p=0.04 145 1.4%/year, p=0.0001 140 135 130 125 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Vilius GRABAUSKAS

  29. CAN MORTALITY TRENDSIN LITHUANIAN FEMALES AGED 0-64 SDR / 100 000 100 90 -0.3%/year, n.s. 80 70 60 50 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Vilius GRABAUSKAS

  30. LUNG CANCER MORTALITY TRENDSIN LITHUANIAN MALES AGED 0-64 SDR / 100 000 60 0.2%/year, p=0.73. 55 50 -4.2%/year, p=0.003 45 1.8%/year, p=0.02 40 35 1981 1985 1988 1989 1991 1992 1995 1998 1999 1980 1982 1983 1984 1986 1987 1990 1993 1994 1996 1997 2000 Vilius GRABAUSKAS

  31. EXTERNAL CAUSE MORTALITY TRENDSIN LITHUANIAN MALES AGED 0-64 SDR / 100 000 350 300 -6.5%/year, p=0.01 10%/year, p=0.0002 250 -6.7%/year, p=0.01 200 150 100 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Vilius GRABAUSKAS

  32. EXTERNAL CAUSE MORTALITY IN LITHUANIAN FEMALES AGED 0-64 SDR / 100 000 100 75 7.8%/year, p=0.0003 - 6.1%/year, p=0.02 50 - 4.5%/year, p=0.04 25 0 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Vilius GRABAUSKAS

  33. CONCLUSIONS • LITHUANIAN EXPERIENCE DEMONSTRATES THAT SCIENCE BASED NATIONAL HEALTH POLICY DEVELOPMENT IS MOST IMPORTANT TOOL FOR PLANNING, IMPLEMENTATION, MONITORING AND EVALUATION OF HEALTH SYSTEM REFORM PROCESSES • NATIONAL HEALTH INFORMATION SYSTEM THAT COMBINES NATIONAL STATISTICS, RESEARCH AND INTERNATIONAL DATA BASES EFFECTIVELY SERVES THE ABOVE • MORE SPECIFICALLY, LITHUANIAN HEALTH BEHAVIOUR MONITORING SYSTEM GIVES CLEAR INDICATION AND GUIDANCE WHICH AREAS OF LITHUANIAN HEALTH BEHAVIOURS REQUIRE SUBSTANTIAL IMPROVEMENTS IN HEALTH POLICY IMPLEMENTATION Vilius GRABAUSKAS

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