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 SLOVENIA MINISTRY 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

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 inhabitants) in different regions of Slovenia (1999) Life expectancy (years) 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) From: PHI and NOMEAD, RS, 1999

Health Monitor Survey- CINDI Slovenia 2001 uSampling: Stratified (by regions), random sample (CPR) Sample size: (regional samples: ) uAge if inhabitants: years uMethod of data collection: By post uQuestionnaire: Questionnaire of WHO project - CINDI Health Monitor Characteristics of the survey INEQUALITIES IN EATING HABITS, PHYSICAL ACTIVITY AND BODY WEIGHT

uGender (male, female) uAge groups (25 – 29, 30 – 39, 40 – 49, 50 – 59, ≥60) uSocial class (lower, working, middle, upper middle, upper) uPlace of living (city, suburbs, village) uRegion (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)

Eating habits of adult Slovene population Healthy/unhealthy eating habits in DIFFERENT REGIONS

Eating habits of adult Slovene population Healthy/unhealthy eating habits in MEN AND WOMEN

Eating habits of adult Slovene population Healthy/unhealthy eating habits in DIFFERENT AGE GROUPS

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

Body weight of adult Slovene population Body weight (BMI) in different age groups

Body weight of adult Slovene population Body weight (BMI) in different social classes

Body weight of adult Slovene population Body weight (BMI) in different regions

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 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!