REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND LIFE STYLE
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Transcript of REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND LIFE STYLE
European Health Forum, Gastein 2002
REGIONAL DIFFERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND LIFE
STYLE
J. Maucec Zakotnik, M.D.State secretary, Ministry of
Health, Slovenia
REPUBLIC OF SLOVENIAMINISTRY OF HEALTH
Content
• Determinants of health
• Regional differences in health and health determinants (Europe, Slovenia)
• Activities carried out to tackle health burden related to food and nutrition (Slovenia)
• Conclusions
Determinants of health
Studies indicate
• Poor and less educated classes of inhabitants die earlier and more frequently in all age groups
• Risk factors (RF) of unhealthy life style and for CND and also psychological disturbances are more frequent in less educated classes
• Poor estimate their health status as worse than their “better standing” fellow inhabitants
Development and Health are correlated
Social and economic development
Improvement of health
Big differences between W and E European countries in:
• Health indicators• Socio/economic development &
Socio/economic determinants of health
• Unhealthy life style and eating habits
Age standardized death rate in groups of European countries
700
750
800
850
900
950
1000
1050
1100
1150
1200
1250
1970 1975 1980 1985 1990 1995 2000
Slovenia
Croatia EU average averagevpr
CEE average
Scandinavian countries average
40
60
80
100
120
140
160
180
200
1970 1975 1980 1985 1990 1995 2000 2005
Czech Republic
Hungary
Slovenia
EU average
090101 +SDR,disease of circulat.syst.,0-64/100000
70
80
90
100
110
120
130
140
150
1970 1975 1980 1985 1990 1995 2000 2005
Czech Republic
Hungary
Slovenia
EU average
100101 +SDR, malignant neoplasms, 0-64, per 100000
10
20
30
40
50
60
70
80
90
1970 1975 1980 1985 1990 1995 2000 2005
Czech Republic
Hungary
Slovenia
EU average
991705 +SDR chron.liver dis&cirrhosis,all/100000
69
70
71
72
73
74
75
76
77
78
79
1970 1975 1980 1985 1990 1995 2000 2005
Czech Republic
Hungary
Slovenia
EU average
060101 +Life expectancy at birth, in years
0
5000
10000
15000
20000
25000
1970 1975 1980 1985 1990 1995 2000 2005
Czech Republic
Hungary
Slovenia
EU average
990001 Gross domestic product, US$ per capita
Food consumption patterns, vegetables and fruit, Slovenia and Greece, Italy Portugal and Spain average, 1992-1999
0
50
100
150
200
250
300
350
92' 93' 94' 95' 96' 97' 98' 99'Year
Kg
per
head
Slovenia
Greace, Italy, Portugaland Spain average
Food consumption patterns, animal fat, Slovenia and Greece, Italy, Portugal and Spain average, 1992-1999
0
2
4
6
8
10
12
14
16
18
20
92' 93' 94' 95' 96' 97' 98' 99'Year
Kg
per
head
Slovenia
Greece, Italy, Portugaland Spain average
Inequalities in Slovenia
• Inequalities in health indicators and socioeconomic determinants of health in different regions (W vs. E)
• Inequalities in life style in:– Regions– Social groups– Gender– Age groups
Koper
Kranj
Nova Gorica Ljubljana
Ravne
Novo mesto
Celje
Maribor
Murska Sobota
INEQUALITIES IN HEALTH INDICATORS
•Age standardized mortality rate (per 100 000 inhabitants) in different regions of Slovenia (1999) •Life expectancy (years)
908
912
837 99972
76174.5
885 72
76975.5
72874.4
792
SLOVENIA 833
From: PHI and NOMEAD, RS, 1999
Koper
Kranj
Nova Gorica Ljubljana
Ravne
Novo mesto
Celje
Maribor
Murska Sobota
INEQUALITIES IN SOCIOECONOMIC DETERMINANTS OF HEALTH
•Level of unemployement (%, 1998)•Number of students per 1000 inhabitants•Gross domestic product (GDP - % of average)
191878
1128.5129
222282
10.625.1102
9.224.798.6
From: PHI and NOMEAD, RS, 1999
Health Monitor Survey-CINDI Slovenia 2001
Sampling:Stratified (by regions), random sample (CPR)Sample size: 15 379 (regional samples: 573 - 4576)
Age if inhabitants:25 - 64 years
Method of data collection:By post
Questionnaire:Questionnaire of WHO project - CINDI Health Monitor
Characteristics of the survey
INEQUALITIES IN EATING HABITS, PHYSICAL ACTIVITY AND BODY WEIGHT
Gender (male, female) Age groups (25 – 29, 30 – 39, 40 – 49, 50 – 59, ≥60) Social class (lower, working, middle, upper middle, upper) Place of living (city, suburbs, village) Region (western, central, eastern)
THE FOLLOWING DEMOGRAFIC AND SOCIOECONOMIC CHARACTERISTICS WERE ANALYSED REGARDING EATING HABITS, BODY WIEGHT (BMI) AND PHYSICAL ACTIVITY :
HEALTHY EATING HABITS were defined as:
• ≥3 meals per day• fruit/vegetables intake at least once per day• intake of fish and sea food at least once per week
PHYSICAL ACTIVITY was defined as:
• INACTIVE - physical inactivity or at most irregular physical activity• ACTIVE - regular physical activity of any kind of intensity
Eating habits of adult Slovene population
Healthy/unhealthy eating habits in all inhabitants (25-64 years)
49,0 51,0
0
10
20
30
40
50
60
ALL
%healthy
unhealthy
54,8
48,846,4
45,2
51,253,6
0
10
20
30
40
50
60
western central eastern
%
healthy unhealthy
Eating habits of adult Slovene population
Healthy/unhealthy eating habits in DIFFERENT REGIONS
40,2
56,359,8
43,7
0
10
20
30
40
50
60
men women
%
healthy unhealthy
Eating habits of adult Slovene population
Healthy/unhealthy eating habits in MEN AND WOMEN
4346
4448
50
5761
5457
54 5652
50
4339
46
0
10
20
30
40
50
60
25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
%
healthy unhealthy
Eating habits of adult Slovene population
Healthy/unhealthy eating habits in DIFFERENT AGE GROUPS
4245
50
56 58
49
5855
50
44 42
51
0
10
20
30
40
50
60
lower working middle upper middle upper not defined
%
healthy unhealthy
Eating habits of adult Slovene population
Healthy/unhealthy eating habits in DIFFERENT SOCIAL CLASSES
Body weight of adult Slovene population
Body weight (BMI) in men and women
0 2
33
5350
31
1714
0
10
20
30
40
50
60
men women
%
<18.5 18.50 - 24.99 25.00 - 29.99 >30
c
Body weight of adult Slovene population
Body weight (BMI) in different age groups
52 1 1 1 0 0 1
5956
45
3833
29 29
24
32 34
4042
47 48 50
7 7 9
1520 20
2320
64
0
10
20
30
40
50
60
70
25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
%
<18.5 18.50 - 24.99 25.00 - 29.99 >30
Body weight of adult Slovene population
Body weight (BMI) in different social classes
1 1 1 20 2
3336
48
5754
4545 44
3833
39 37
21 20
13
7 8
16
0
10
20
30
40
50
60
lower working middle upper middle upper undefined
%
<18.5 18.50 - 24.99 25.00 - 29.99 >30
Body weight of adult Slovene population
Body weight (BMI) in different regions
2 1 1
46 47
414037
41
13 1417
0
10
20
30
40
50
western central eastern
%
<18.5 18.50 - 24.99 25.00 - 29.99 >30
DIETARY HABITS:
•men
•lower social classes
•younger age groups
•central and eastern parts of the country
INTERVENTIONS FOR DIFFERENT RISK FACTORS SHOULD BE PRIMARILY AIMED AT:
CONCLUSION
BODY WEIGHT:
•men
•lower social classes
•older age groups
•eastern parts of the country
PHYSICAL ACTIVITY:
•women
•lower social classes
•middle age groups
•central and western parts of the country
What is doing Slovenia to improve health and to lower differences in health related to
Food and Nutrition?
Led by Ministry of Health:
• Intersectoral development of Food and Nutrition policy (good progress)
• Integration of promotion of healthy life style (healthy nutrition and PA) in all policies and practices (RADENCI DECLARATION)
• Development and testing methods and instruments for intersectoral collaboration (ISC) and for bringing health on others sectors agenda
• Health Impact Assessment of the Agriculture, Food and Nutrition Policy ( WHO)
• Development of HIA as a part of national and local HIA of policies, strategies and programs
• Using HIA as main method for ISC and for involving Health in others sectors agenda
Food and Nutrition Policy development in Slovenia
• Support of the Government Of RS• Establishment of Food and Nutrition
Council and Food and Nutrition Office in the MoH
• Development of Food Safety Strategy in 2001(MoH and MAFF)
• HIA of the Agriculture and FNP (with the aim to influence Agricultural Policy by evidence based results of HIA)
Food and Nutrition Policy development in Slovenia
• Food and Nutrition Action Plan 2003 to 2008 - Priorities– Changes in Agricultural policy– Strengthen collaboration and applying necessary
instruments for achievement of Food Safety from stable to table
– FBDG and NBDG development and implementation – Development of new curriculum in Food and Nutrition
for professional and school curriculum– Education of the population– Special attention and programs for groups at risk and
special needs
Promoting Health trough PA and Healthy Nutrition
• International conference on Promoting Health trough PA and Healthy Nutrition (Slovenia, Radenci, 18. to 21. April 2002)
• THE RADENCI DECLARATION– integrated promotion of healthy
nutrition and PA as healthy life style trough
• international and national level• politicians, professionals, mass
media, industry• public and private sector• Individuals and different groups
trough whole life span
• Development of – Food and Nutrition policy and
action plan – National strategy and action plan
for promotion HEPA– Integration of healthy life style in
both
Project MURA – Health and Development
• Less developed region with worst health indicators
• Health – main potential for development of the region
• Partnership for development at national and local level :
- agriculture/food - tourism - educational institutions - environment- kulture - public health
- private sector and NGO
Project aim
• To identify and implement the best agreed sectoral and intersectoral activities and policies to achieve synergistic outcomes– To improve socio-economic indicators – To improve unhealthy life style and unhealthy
eating habits – To improve health status – To lower inequalities in health
• To develop and test methods and instruments for ISC at national and local level.
Conclusions 1
• Big differences in health and socioeconomic development
• We can improve health by influencing health determinants adequately
• Need to develop and implement HIA as a method of assessing potential impact of different policies on health determinants
• HIA good method to bring Health on others sectors agenda
Conclusions 2
• Need to develop FNP and Action plan
• Need to implement Promotion of Healthy Nutrition and PA as Healthy Life Style in all policies and practicies
Thank you for your attention!