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

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

(MORTALITY OF THE GROUP WITH UNIVERSITY EDUCATION=1) COMPARISON OF MORTALITY OF POPULATION WITH UNIVERSITY 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 25 30 35 40 45 50 55 60 65 70+ Age, years Men Women Vilius GRABAUSKAS

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 * - p<0.05, if compared with secondary and university education ** - p<0.05, if compared with incomplete secondary and university education Incomplete secondary Secondary University Men Women Vilius GRABAUSKAS

PROPORTION (%) OF DAILY SMOKERS, BY FAMILY INCOME % * - p<0.05, if compared with average and high income Vilius GRABAUSKAS

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

RELATIVE RISK OF UNMARIED LITHUANIAN POPULATION BY AGE AS COMPARIED TO MARIED Males Females AGE V. GRABAUSKAS

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

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

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

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

LITHUANIAN NATIONAL HEALTH CONCEPT 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

* p<0.05 compared with year 1994 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* 50 40,6* 38* 1994 37,6* 38,2* 40 1996 1998 30 2000 20 10 Males Females * p<0.05 compared with year 1994 Vilius GRABAUSKAS

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

* p<0.05 compared with year 1996 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 30 24,8 18,1 1998 2000 20 10 Males Females * p<0.05 compared with year 1996 Vilius GRABAUSKAS

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

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 20 1996 11,5 1998 15 2000 6,7* 10 6,6* 5,5* 5 Males Females * p<0.05 compared with year 2000 Vilius GRABAUSKAS

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

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 ) *** *** MALES FEMALES *p<0.05 **p<0.01 ***p<0.001 Comparing with 1987  1993 1987 1999 Vilius GRABAUSKAS

TOTAL MORTALITY TRENDS IN 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 1999 2000 Vilius GRABAUSKAS

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

CVD MORTALITY TRENDS IN 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

CVD MORTALITY TRENDS IN 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

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

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 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Vilius GRABAUSKAS

CAN MORTALITY TRENDS IN 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

CAN MORTALITY TRENDS IN 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

LUNG CANCER MORTALITY TRENDS IN 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 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Vilius GRABAUSKAS

EXTERNAL CAUSE MORTALITY TRENDS IN LITHUANIAN MALES AGED 0-64 SDR / 100 000 350 300 10%/year, p=0.0002 -6.5%/year, p=0.01 250 -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

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 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Vilius GRABAUSKAS

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