1. 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

2. Individuali rizika
Vilius GRABAUSKAS

3. 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

4. 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

5. (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

6. 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

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

8. 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

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

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

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

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

13. 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

14. 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

15. * p<0.05 compared with year 1994
TRENDS IN PROPORTION OF BUTTER ON BREAD USERS IN LITHUANIAN POPULATION AGED BETWEEN 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

16. * p<0.05 compared with year 1994
TRENDS IN PROPORTION VEGETABLE OIL FOR COOKING USERS IN LITHUANIAN POPULATION AGED BETWEEN
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

17. * p<0.05 compared with year 1996
TRENDS IN PROPORTION OF FRESH VEGETABLE USERS AT LEAST ON 3 DAYS DURING THE LAST WEEK BETWEEN 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

18. TRENDS PROPORTION OF DAILY SMOKERS IN LITHUANIAN POPULATION AGED 20-64 BETWEEN 1994 - 200060
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

19. TRENDS IN PROPORTION OF STRONG ALCOHOL USERS AT LEAST ONCE A WEEK IN LITHUANIAN POPULATION AGED BETWEEN 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

20. * p<0.05 compared with year 1994
PROPORTION OF BEER USERS AT LEAST ONCE A WEEK IN LITHUANIAN POPULATION AGED BETWEEN
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

21. TRENDS IN AGE STANDARDIZED PREVALENCE OF SOME BIOLOGICAL RISK FACTORS
IN LITHUANIAN POPULATION AGED (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

22. TOTAL MORTALITY TRENDS IN LITHUANIAN MALES AGED 0-64
SDR /
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

23. TOTAL MORTALITY TRENDS IN LITHUANIAN FEMALES AGED 0-64
SDR /
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

24. CVD MORTALITY TRENDS IN LITHUANIAN MALES AGED 0-64
SDR /
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

25. CVD MORTALITY TRENDS IN LITHUANIAN FEMALES AGED 0-64
SDR /
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

26. CHD MORTALITY TRENDS IN LITHUANIAN MALES AGED 0-64
SDR /
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

27. CHD MORTALITY TRENDS IN LITHUANIAN FEMALES AGED 0-64
SDR / 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

28. CAN MORTALITY TRENDS IN LITHUANIAN MALES AGED 0-64
SDR /
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

29. CAN MORTALITY TRENDS IN LITHUANIAN FEMALES AGED 0-64
SDR /
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

30. LUNG CANCER MORTALITY TRENDS IN LITHUANIAN MALES AGED 0-64
SDR / 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

31. EXTERNAL CAUSE MORTALITY TRENDS IN LITHUANIAN MALES AGED 0-64
SDR /
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

32. EXTERNAL CAUSE MORTALITY IN LITHUANIAN FEMALES AGED 0-64
SDR /
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

33. 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