REDUCTION OF HEALTH INEQUALITIES IN ROKISKIS

DISTRICT MUNICIPALITY

REDUCTION OF HEALTH INEQUALITIES IN ROKISKIS

DISTRICT MUNICIPALITY An Action Plan

Authors: dr. Laura Narkauskaitė, Jolanta Valentienė

Institute of Hygiene, Vilnius, 2013

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Contents

Introduction.....................................................................................................................................4

I. The Development of the Action Plan ...................................................................................6

1. Health inequalities in Rokiskis district municipality ..........................................................6

2. Framework of the Action Plan ..............................................................................................7

II. Content of the Action Plan.....................................................................................................7

Aim 1. Encourage public health and primary health care sectors collaboration and enhance public health specialists and family doctors' awareness of health inequalities in the region... .........................................................................................................................................7

Aim 2. Reducing health inequalities in maintaining / supporting risk groups......................9

Aim 3. Reduce health inequalities carrying out health strengthening and healthy lifestyles... ...................................................................................................................................11

Aim 4. Improve population mental health...............................................................................12

Aim 5. Ensure for all equal opportunities to natural resources..............................................13

III. Conclusion..............................................................................................................................15

IV. References: .............................................................................................................................16

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Introduction

“Health disparity”, in the context of public health and social science, therefore has begun to take on the implication of injustice, but nonetheless may be distinguished from the general term “inequality”. A health disparity should be viewed as a chain of events signified by a difference in: (1) environment, (2) access to, utilization of, and quality of care, (3) health status, or (4) a particular health outcome that deserves scrutiny. Such a difference should be evaluated in terms of both inequality and inequity, since what is unequal is not necessarily inequitable [1].

Health inequities are avoidable inequalities in health between groups of people within countries and between countries. These inequities arise from inequalities within and between societies. Social and economic conditions and their effects on people’s lives determine their risk of illness and the actions taken to prevent them becoming ill or treat illness when it occurs [2].

1 figure. The main determinants of health [3].

The development of public health care services to prolong the lifetime without disease improves quality of life and reduces health inequalities between different population groups. If public health is developed by community level it would effectively add the primary health care system.

Social development of Lithuanian regions is highly variable and partly dependent on the economic growth and structure. The unequal rates of economic process, different demographic and social composition, all these increase the gap between villages and towns and cities, as well as between different regions of the country. In recent years, increased

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disparities of income caused, increased unemployment and emigration, death rates, decreased fertility which is influenced health decline by of total population.

In national progress program 2014-2020 shall be established to implement the State Progress strategy “Lithuania progress strategy “Lithuania 2030” and create an innovative, modern and strong state, characterized by an intelligent society, knowledge economy and the smart management of the tune. On the basis of the priority objectives of the national program will be to develop an action plan which should satisfy with the 2014-2020 EU structural support resort approved European Parliament and the Council [10].

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I. The Development of the Action Plan

1. Health inequalities in Rokiskis district municipality

The main human factors affecting the prevalence of cardiovascular diseases in Lithuania and Rokiskis district municipality are the age, sex, marital status, location and lifestyle.

In Rokiskis district municipality live 34 235 people in January 1st in 2012 (15 923 males, 46,5%; 18 312 females, 53,5%).

Job loss is one of the biggest stressors which negative influenced health. One of the most vulnerable groups in Rokiskis district municipality is unemployed, which present a significant part of region population. The unemployment rate in 2012 was 11.7% (14.6% male, 10.6% female). The unemployment rate on 2013 March 1st was 14,2 % (15.3 % among men and 13 % women). The unemployment rate of 18-29 years persons was 6,7 %.Unemployed total of were 2888, women's - 1261 and men's- 1627, youth 18-29 years - 275 on March 1st 2013 in Rokiskis district municipality. In 2011 years food products support from EU got 8589 inhabitants, in 2012 years - 7491. In these numbers are included the social allowance recipients. The percentage of the total population at risk of living under 60% of the income-poverty line in 2011 is quite high, namely 20.0%

Department of statistics of Lithuania data shows average income for the Rokiskis district was 532.47 euros in 2012 III quarter.

The major health problem in Rokiskis district municipality as in all country is cardiovascular diseases. This problem is distributed unequally among age groups and by gender. There is no certain area where prevalence or mortality of cardiovascular diseases would be especially high – rates mostly depend on the age structure of population and social conditions. The High cardiovascular risk primary prevention programme is implemented with aim to decrease mortality from cardiovascular diseases in all country.

Prevalence of cardiovascular diseases in Rokiskis district municipality in 2011 was 25 798,0/100 000 pop. More accurate data about geographical distribution over selected region is unavailable. Considering the prevalence urban population (31 901,8/100 000 pop.) was affected more by cardiovascular diseases than rural population (20 509,0/100 000 pop.) in Rokiskis district municipality in 2011. Also females (31 533,7/100 000 pop.) were affected more than males (19 269,8/100 000 pop.).

Standardized mortality rates of cardiovascular diseases (I00-I99) in Rokiskis district municipality in 2011 was 519,3/100 000 pop. (739,1/100 000 pop. for males; 360,7/100 000 pop. for females).

Prevalence of cardiovascular diseases in Rokiskis district municipality in 2011 was 25 798/100 000 pop. (19 269,8/100 000 pop. for males; 31 533,7/100 000 pop. for females). Prevalence of hypertensive diseases was 20 642,2/100 000 pop. (14 534,4/100 000 pop. for males, 26 008,6/100 000 pop. for females).

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The main cause of death and one of the most significant social, economic and health problems in Rokiskis district municipality is cardiovascular diseases.

2. Framework of the Action Plan

The action plan has been developed as part of the DG SANCO funded project entitled ‘Reducing health inequalities: Preparation for action plans and structural funds projects’ (ACTION-FOR-HEALTH) (2012-2014).

Planning method

The Action Plan for Rokiskis district municipality requires preparation and a process which can inform the plan. A situational analysis was carried out in order to gather evidence and information on the key issues for the health of Rokiskis district municipality population.

II. Content of the Action Plan

The main goal - reduction of health inequalities in Rokiskis district municipality using health promotion

Aim 1. Encourage public health and primary health care sectors collaboration and enhance public health specialists and family doctors' awareness of health inequalities in the region.

According to the WHO, now more than ever is necessary for cross-sectorial collaboration [4]. Leadership and innovation provides one hundred per cent chance and minimum health inequalities [5]. Collaboration between primary health care and public health sectors aren’t in Lithuania. In order to more efficient and higher quality health care to reduce health inequalities must be cooperation between these two sectors [6-7].

Objective 1.1 Increase public health and primary health care sectors awareness of health inequalities.

Activities:

1. Organize public health and primary health care sectors meetings, discussions, workshops on issues of health inequalities in the region.

2. Establish and maintain relationships between public health and primary health care professionals.

Indicators:

1. Number of different health communication activities (meetings, discussions, workshops).

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Objective 1.2 Increase public health specialists and family doctors expertise on health inequalities reduce.

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Activities:

1. Develop a training program for reduction of health inequalities. 2. Arrange training for public health and primary health care specialists on health

inequalities issue.

Indicators:

1. Developed training programme. 2. Number of trainings and participants who participated in trainings

Objective 1.3. Strengthen public health and primary health care specialists collaboration through health promotion activities.

Activities:

1. Develop recommendations for a clear definition of public health and primary health care specialists function in order to avoid duplication of services.

2. Create public health and primary health care specialists collaboration model to purse the the State non-infectious disease prevention programs.

3. Organize common health promotion events.

Indicators:

1. Created public health and primary health care specialists collaboration model. 2. Number of common health promotion events

Aim 2. Reducing health inequalities in maintaining / supporting risk groups.

The main health problem is cardiovascular diseases in Rokiskis district municipality. This problem is distributed unequally among the municipalities of Lithuania, among different population age groups and by gender.

According to study of clinically oriented primary cardiovascular prevention in Lithuania (2003-2005) very low activities in this field were identified: both on the primary health care institution level as well as the lack of the specialized cardiovascular prevention units in the country conducting clinically oriented cardiovascular prevention. The lack of the cooperation between the primary health care practitioners and the specialists was observed. The Lithuanian High Cardiovascular Risk (LitHiR) primary prevention programme for the identification of patients at high-risk of cardiovascular disease and the implementation of methods of primary prevention reimbursed from the Statutory Health Insurance Fund was started in Lithuania since 2006 [8].

Prevalence of cardiovascular diseases was higher amongst the urban population and women than amongst rural and men in Rokiskis district municipality. The most affected age group were aged 64 years and over.

Main stream unequal availability of health care services distribution between urban and rural regions. Lack of a consistent health policy and its implementation. Distribution of health care professional contravene health care services. The lack of them in the rural area.

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First of all it should be deal with the lack of physical activity and eating problems. Physical inactivity and unhealthy eating is a complex issue which entails not only cardiovascular diseases, but also other diseases.

Objective 2.1 Promote non-infectious diseases early diagnosis, increase awareness of the State noncommunicable disease prevention and early detection programs, and increase people's motivation to participate in it.

Activities:

1. Develop and produce information materials (e.g. flyers, brochures, posters about the State noncommunicable disease prevention and early diagnosis programs).

2. Organize open days, lectures for residents to learn more about the noncommunicable diseases (diabetes, cardiovascular diseases and malignant tumors).

Indicators:

1. Designed, developed and published material number. 2. Organized event number and number of participant.

Objective 2.2 Increase risk groups knowledge of damage of bad cholesterol in the blood.

Activities:

1. To organize seminar/lecture about damage of bad cholesterol in the blood to risk groups.

2. Arrange free cholesterol testing for risk groups in a public space and it is important to explain the possible damage of bad cholesterol in blood.

Indicators: number of events.

Objective 2.3 Encourage region’s risk groups physical activity organizing mass events.

Activities:

1. Organize Nordic walking lessons. 2. Organize afternoon exercise in nature.

Indicators:

1. Number of events. 2. Number of participants.

Objective 2.4 Encourage region‘s risk groups to follow healthy eating principles.

Activities:

1. Organize lectures/seminars about healthy eating principles, the basic rules. 2. Arrange healthy products fair.

Indicators:

1. Number of lectures/seminars, number of participants. 2. Organized fair.

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Aim 3. Reduce health inequalities carrying out health strengthening and healthy lifestyles.

Lifestyle - whole of habits and mores, which are affected, changed, promoted of process of socialization throughout life. Lifestyle consists of diet, physical activity, alcohol and tobacco consumption and other habits. All of them interact with each other, strengthening or harming health.

According to Lalonde the biggest influence on health has lifestyle and behaviour (50 percent). Unhealthy lifestyle, gore example smoking, alcohol consumption, poor diet, lack of physical activity, adversely affect human health, increased risk of chronic diseases. In order to reduce the population health inequalities must be promoted health strengthening [9].

Objective 3.1 Encourage people to follow a healthy eating principles.

Activities:

1. Develop events about healthy diet promoting (workshops, lessons) 2. Provide knowledge and skills of healthy diet. 3. Provide knowledge of salt damage and salt rational usage.

Indicators:

1. Health literacy about healthy diet, salt damage before and after events. 2. Number of organized events.

Objective 3.2 Promote physical activity.

Activities:

1. Provide knowledge and skills of daily physical activity benefit. 2. Organize physical activity events.

Indicators:

1. Health literacy about benefit of physical activity before and after events. 2. Number of organized events

Objective 3.3 Encourage the development of a society without alcohol and tobacco use.

Activities:

1. Provide knowledge and skills of harmful effects of tobacco and alcohol consumption. 2. Organize events against consumption of tobacco and alcohol. 3. Raise awareness, especially among young people, that they could socialize without

consumption of alcohol and tobacco.

Indicators:

1. Health literacy about benefit of physical activity before and after events. 2. Number of organized events.

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Objective 3.4 Enhance region population health literacy on health prevention.

Activities:

1. Provide information about benefit of early diagnostic of non-infectious diseases. 2. Provide knowledge of preventive health programs. 3. Provide clearly and understandable prepared material non-infection diseases

(brochures, etc.).

Indicators:

1. Increased health literacy. 2. Number of prepared material

Aim 4. Improve population mental health.

Lithuania is between countries which are characterized by extremely poor public mental health indicators: high rate of suicides, number of murders and violent crimes (committed in the juveniles), alcohol consumption and mortality associated with alcohol use. Children and adolescents increasingly use alcohol and drugs, are spreading a new addiction and behavioural disorders. Surveys show that Lithuanian children - unhappiest in Europe, including the high prevalence of bullying. As mental health very dependent on the first year of life, promotion of children and adolescent mental health is an investment in the future. Teaching parenting skills can improve a child's development.

Holistic training approach can improve social skills and capabilities to regain physical and spiritual strength, reduce bullying, anxiety and depressive symptoms. It is also very important to work actively for older people’s mental health strengthening, develop and implement promotion of mental health at the workplace. Mental and behavioural disorders are becoming one of the major health problems.

Objective 4.1 To improve parenting skills, encourage nurse visits to prospective and new parents' at home.

Activities:

1. To organize courses-trainings for parents. 2. Create nurses, who attend prospective and new parents at home, incentive

mechanism.

Indicators:

1. Number of courses-trainings. 2. Created incentive mechanism for nurses.

Objective 4.2 To form a sympathetic school environment and promote the norms of

acceptable behaviour in it.

Activity:

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1. To organize lectures package for parents and teachers about mental health and its prevention.

Indicators:

1. The number of lectures and 2. The number of participants.

Objective 4.1 Strengthening the elderly social support networks and encouraging

participation in community programs. Activities:

1. To organise discussions with aging issues dealing NGOs, and civil organizations to promote older people to speak about the values of health promotion and healthy aging.

2. To organise psychotherapy sessions for the elderly people.

Indicators:

1. The number of organized discussions and psychotherapy sessions.

Aim 5. Ensure for all equal opportunities to natural resources.

A clean and safe environment is one of the most important determinants of human health. Therefore, achieving this objective is to be solved essential people's physical and mental health negative influenced environmental problems. It must also take into account other harmful for people's health and the environment risk factors.

About 660 000 of the population (most of them - live in rural areas) still use groundwater from wells, which are often contaminated and does not meet drinking water requirements.

It is very important to change public behavior in regard to natural environment and natural resources, to educate self-awareness of the population, to create the conditions for the formation of the appropriate lifestyle, which help to conserve natural resources.

Objective 5.1 Promote to environmental friendly society. Activities:

1. To arrange politicians / community meetings / discussions on environmental issues. 2. To organize a campaign for encourage people to domestic using of environmentally

friendly implements. 3. To develop social advertisements, articles in local media about the harmful effects of

the environment on health.

Indicators:

1. The number of meetings and discussions. 2. The number of campaigns/programs.

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3. The number of social advertisements and prepared articles.

Objective 5.2 Keep the environment clean and ensure that it is conducive to human health. Activities:

1. To organise the environment cleaning days (garbage collection day in forests, etc.) 2. To inform residents about environmental pollution and the potential harm to health.

Indicators:

1. The number of organized events. 2. The number of prepared information messages.

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III. Conclusion

This action plan promotes a range of activities and goals which all aim to improve the health and wellbeing of Rokiskis district municipality population. The action plan adopts a health promotion approach to reducing health inequalities which result in lowered life expectancy and increased morbidity, which thus impacts on quality of life and economic activity. This approach has been taken in addressing the risk factors for chronic disease, in particular the biggest killer for Rokiskis district municipality, CVD.

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IV. References:

1. Carter-Pokras, Baquet C. What is a „health disparity“? Public Health reports, September-October 2002, vol. 17, p. 426-434

2. WHO, http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/

3.Whitehead M., Dahlgren C., in “What can be done about inequities and health?” The Lancet, 338, 8774, 26 Oct 1991, 1059-1063.

4. Martin-Misener R, Valaitis R, Wong ST, Macdonald M, Meagher-Stewart D, Kaczorowski J et al. A scoping literature review of collaboration between primary care and public health. Prim Health Care Res Dev 2012 Feb 21;1-20.

5.Cornell S. Public health and primary care collaboration – a case study. J Public Health. 1999;21:199-204

6. Gurevičius R, Valentienė J, Kutkaitė S. The family doctors attitude on collaboration with public health sector, Visuomenės Sveikata (Public Health). 2012; 2(57): 25-35.

7. Gurevičius R, Kutkaitė S, Valentienė J. The public health specialist’s attitude to collaboration with primary health care sector.Visuomenės sveikata (Public Health). 2012; 2(57): 36-44.

8. Laucevicius et al. Lithuanian High Cardiovascular Risk (LitHiR) primary prevention programme – rationale and design. Seminars in Cardiovascular Medicine.2012; 18:3.

9. Javtokas Z. Summary of health strengthening. Vilnius. 2009:6-8

10. About 2014–2020 National progress program approval. Zin. 2012-12-11, Nr. 144-7430.