Gunnar Ågren 2005 The Swedish Public Health Policy Gunnar Ågren

Historical background to the Swedish Public Health policy A good system for vital statistics since 1750 From 1800 construction of community health services A long tradition of popular struggle against the negative health effects of alcohol The concern for the health of mothers and children was an important part of the welfare policy in the 1930’s and further on Universal health insurance. Regional councils responsible for health services A strong political commitment to health Gunnar Ågren 2005

A background to present public health work Health has been an important part of social welfare On the other hand no comprehensive public health policy The medical perspective on public health has been very dominating especially after World War II No strong emphasis on prevention with exception for injury prevention and occupational health Primary care not very well developed Gunnar Ågren 2005

Factors promoting a new public health policy Increasing costs for health care – a disproportionate amount to highly specialized hospital care. Need for more preventive in health services HIV/AIDS illustrated the need for a comprehensive preventive strategy Increasing concern about inequity in health A strategy group on public health in the government administration was formed in 1987 National Institute of Public Health founded 1992 Gunnar Ågren 2004

Vaccination Alcohol Sanitation Rationing of alcohol Ended 1955

National Public Health Committee In 1997 a national public health committee was formed All main political parties were represented, a number of experts Many important NGO’s were represented Main task: to propose public health goals and strategies The committee worked for three years, a number of interim reports was delivered The task of the committee – to propose national public health goals which should guide all sectors of the society The goals were approved by the parliament in a revised version Gunnar Ågren 2005

7 Swedish public health policy- main target areas 1.Participation and influence in the society 2.Economic and social security 3.Secure and favorable conditions during childhood and adolescence 4.Healthier working life 5.Healthy and safe environments and products 6.Health and medical care that more actively promotes good health 7.Effective protection against communicable diseases 8.Safe sexuality and good reproductive health 9.Increased physical activity 10.Good eating habits and safe food 11.Reduced use of tobacco and alcohol, a society free from illicit drugs and doping and a reduction in the harmful effects of excessive gambling.

To express the goals in relation to health determinants was an important decision There is an obvious relation between the goals and political actions in order to achieve them The main area of public health work becomes placed outside the health and medical sector If the goals are broadly accepted they will guide actions in many sectors of the society Gunnar Ågren 2005

Some problems In some instances it may be hard to show that the fulfilment of a goal leads to improved health. Economists, administrators and others may have difficulties in accepting population health as a desirable political goal Conclusion – you have to provide good scientific evidence in order to promote public health policy Gunnar Ågren 2005

A new role for NIPH Monitor the public health policy Centre of excellence in the field of methods in public health policy Supervision of legislation concerning alcohol, tobacco and illicit drugs Support to regions and municipalities Specific programmes concerning HIV and gambling depency

How has the public health policy been implemented? The main objectives have been approved by the parliament which gives them a strong political support Indicators for all main objectives have been decided by the National Institute of Public Health after negotiations with other governmental agencies 18 agencies at national level are instructed by the government to participate in the public health policy 8 regions have been instructed to integrate public health into regional development plans More than 50% of the 290 Swedish municipalities have adopted public health programs Gunnar Ågren 2005

A public health policy report will be delivered to the government 2005 The report will be based on the 38 main indicators and further indicators in specific areas There will be a report on how the policy have been implemented and what actions have been taken The report will evaluate the policy and discuss prioritizations and revisions Gunnar Ågren 2005

1. 1. Participation and influence in the society Lack of participation and influence harmful for Public HealthLack of participation and influence harmful for Public Health Solid scientific evidence for the causal relation between high demands-low control and diseaseSolid scientific evidence for the causal relation between high demands-low control and disease Support for local participation, culture, ethnic integration part of the public health policySupport for local participation, culture, ethnic integration part of the public health policy

2. Economic and social security Loss of security causes economic stress Lack of employment and lack of access to social services bad for health The poverty trap: Poverty > disease > lower incomes and higher expenditures > increased poverty Social welfare and equality is good for Public Health

Declining employment rate

3. Secure and favorable conditions during childhood and adolescence Childhood conditions important for health later in life Support and education to parents, good child care, health schools Comprehensive maternity care has been very important for the low infant mortality in Sweden Declining mental health among young people a major problem

4. Healthier working life Taking good care of the workforce an important factor for social and economic developement Stress at work-places and lack of influence important problems Worse working conditions for females Large increase in work related health problems

5. Healthy and safe environments and products Integrate environmental policy with public health work Noise and air pollution the most important problems from a health perspective in Sweden Global warming, air pollution – especially indoor, access to fresh water Injury protection is very effective also in economic terms Cooperation against the great global health risks

6. Health and medical care that more actively promotes good health A well developed and accessible primary care important for prevention Maternity and child care of particular importance Integration of medical and social services Health promotion and disease prevention important for the entire health sector.

Main problems from a public health perspective Reduced accessability due to high fees Increasing costs for drugs Difficult to control total costs in a market system with a lot of providers Difficult to introduce prevention Lack of cooperation with other sectors in society especially in rehabilitation

7. Effective protection against communicable diseases HIV/AIDS, Malaria och TBC important threats to the entire population and work- force i many countries Most new cases of HIV are infected outside Sweden International cooperation is in the self-interest of all countries

8. Safe sexuality and good reproductive health Unsafe sex the second most important health risk in developing countries Sexually transmitted disease increasing Trafficing an important health risk

9.Increased physical activity Sedentary life-style and lack of healthful physical activity a major health risk Main determinant of Cardiavascular disease, diabetes, osteoporosis, cancer Promotion of physical activity in schools and workplaces an important public health measure

10.Good eating habits and safe food Today approximately 1 billion people suffer from malnutrition Approximately the same number are overweight which is a major cause of premature mortality A unequal distribution of food is a major problem in all parts of the world To much fat and sugar and to little fruit and vegetables the main problem

Access to food – data from FAO Industrial countries The world Developing countries

11. Reduced use of tobacco and alcohol, a society free from illicit drugs and doping and a reduction in the harmful effects of excessive gambling Tobacco the first and alcohol the third determinant of global burden of disease The average taxation on alcohol beverages has decreased internationally The Swedish alcohol consumption of alcohol has increased Tobacco-related mortality increasing internationally but decreasing in Sweden Distribution of illicit drugs an organised market connected with international crime. Sweden has a restrictive policy on illicit drugs

Källa: Undersökningen av levnadsförhållanden, SCB Percentage of daily smokers, years, Males Females June 1st 2005 – smoking will be prohibited in restaurants

Gunnar Ågren The main tasks of the Swedish National Institute of Public Health National centre of competence in the field of public health Follow-up of the effects of the national public health policy Supervision of the legislation concerning alcohol, tobacco and narcotics Advisory functions to the government Cooperation with research funding agencies and support to coordination of public health research Strategic support to politicians and professionals at regional and local levels, who have the main responsibility for public health work ation and support to professionals at regional and local levels

Which are the main Swedish public health problems? 1. The increase in work-related health problems and absence from work 2. The increase in mental health problems, especially among young people 3. The increase in obesity and sedentary life- style 4. The increasing alcohol consumption

Possible actions Better working environment Stricter rules for certification of sick leave Better occupational health services Lower benefits during sick-leave Create jobs for people with decreased working capacity

Possible actions Restriction on sales and drinking in restaurants Education Harder rules against drinking and driving Information

Percentage of the Swedish population reporting insomnia

Possible actions Support to parents of small children Better maternity and child care Health promoting schools Increase work opportunities for young people Decrease negative stress in work places and schools

Källa: Undersökningen av levnadsförhållanden, SCB BMI, males and females years,

Possible actions Decrease the intake of fat and sugar. Increase fruit and vegetables.- Pricing? Increase physical activity at least 30 minutes a day (60 minutes for young people) Prescriptions of physical activity and better food habits by doctors Physical activity in schools and work places. Restrictions on food advertisments in TV to children

Final conclusions The Swedish public health is still good in an international scale However, considerable health gaps Mental health and self-reported health decreasing, especially among young people A number of threats against the health A national public health policy is important to fight those threats International co-operation important in the field of public health