1. What determines health? National health promotion policy to address inequalities Mihály Kökény, MD Ministry of Health, Social and Family Affairs

2. What determines health? National health promotion policy to address inequalities  „Generate healthy population” an economic, political and welfare factor  Countries have different approaches to address health issues  To place health high on the political agenda as part of the overall development plan → key to success

3. What determines health? National health promotion policy to address inequalities Expectations of European citizens  Long, wealthy and healthy life  Health considered as value and investment  To be protected against illness/disease  To bring up children in healthy environment  Safe and hygienic workplace  Well informed choice on lifestyle  Access to high quality health service

4. What determines health? National health promotion policy to address inequalities Governments’ response and rationale to healthy population I.  Economic factor  Loss in GDP by disease and disability  Healthy workforce  Public health factor  Good health indicators show good quality of life in a country  Health is determined by many factors: biological, genetic, lifestyle factors; physical environment; effective, efficient and high-quality health services

5. What determines health? National health promotion policy to address inequalities Governments’ response and rationale to healthy population II.  Comprehensive national public health programme, based on HFA, Commisioner’s health policy vision; (Hungary)  Health determinants approach (smoking, alcohol, drugs, nutrition, physical activity)  Disease prevention (screening)  NEHAP II (nearly all European countries – following Budapest Conference)  Settings approach  Life cycle approach  Any combinations of above to extend life expectancy, improve health status

6. What determines health? National health promotion policy to address inequalities Governments’ response and rationale to healthy population III.  Modernisation of health care and financial system (high on agenda)  Challenges to be met:  To extend life expectancy, deal with growing elderly population,  Growing demand of patients for new, expensive technology, cost containment measures and new interventions improve quality, equity, efficiency, effectiveness  Modernize health system increase funding (public/private mix)  EU integration (workforce, patient mobility)

7. What determines health? National health promotion policy to address inequalities Commission’s response to protect the health of the EU citizens - „add value”  Communication on the Health Strategy of the EU (May 2000)  Lisbon strategy  Public health strategy framework  patient mobility  establishment of ECDC  Open method of coordination  European aims and objectives  annual national monitoring of programmes

8. What determines health? National health promotion policy to address inequalities High Level Group on Health Services and Medical Care continuation of High Level Group on Patient Mobility)  Cross-border healthcare purchasing and provision (including rights and duties of patients)  Health professionals  Centres of reference  Health technology assessment  Information and e-health (including data protection)  Health impact assessment and health systems

9. What determines health? National health promotion policy to address inequalities health Minimum prerequisites of success in investment in health  Political commitment  Equity and solidarity as key principles  Intersectoral approach  Involvement of key stakeholders incl. business sector, civil society  Public health programme/intervention  Public health infrastructure/personnel  Involvement of population  Communication strategy

10. What determines health? National health promotion policy to address inequalities Health indicators  Health indicators show a steady increase in health status and life expectancy within EU Member States  Substantial differences are seen within and between countries particularly if accession countries are taken into account  Large gap exists in new EU Member States

11. What determines health? National health promotion policy to address inequalities Example of a new EU Member State: HUNGARY Public health, public health infrastructure and capacity building key to success WHY?  macro-economic rationale (poor health status – 4% loss in GDP)  public health rationale inequalities among the countries of Europe inequalities among the countries of Europe inequalities within the countries inequalities within the countries

12. What determines health? National health promotion policy to address inequalities Public health – epidemiological situation in Hungary: life expectancy at birth  men 8 years  women 6 years lower than the EU average

13. What determines health? National health promotion policy to address inequalities Epidemiological situation Good news Bad news improving trend of premature death highest in improving trend of premature death highest in life expectancy at birth since 1996new Member States infant mortality decline (10 yrs) high middle age mortality infant mortality decline (10 yrs) high middle age mortality external causes of death, cvd 3 times higher than EU average external causes of death, cvd 3 times higher than EU average suicide (4th place in Europe) cancer (51. place) stomach cancer- lung (highest in Europe) stomach cancer- lung (highest in Europe) HIV/AIDS low- breast HIV/AIDS low- breast syphilis, mumps, whooping diseases of digestive cough low system highest in new Member States syphilis, mumps, whooping diseases of digestive cough low system highest in new Member States communicable diseases 0.09 smoking – highest in new MSs communicable diseases 0.09 smoking – highest in new MSs alcohol – 9,5l capita alcohol – 9,5l capita environmental factors air, water environmental factors air, water

14. Source: HFA, 2003 June

15. Life expectancy at birth MalesFemales Hungary EU Source: HFA DB, WHO/EURO

16. How do we intend to extend lifespan and increase the number of healthy years? Health policy that is conducive to this goal:   aims at health gainthrough public health strategy   based on solidarity, equity; multisectoral approach as well as integrated approach between health and social issues;   builds on a health system ( towards health gain);   high quality care;   with prevention in the forefront; at all levels incl. PHC;   with health professionals who follow the complex definition of health   solidarity principle;   public/private mix: private investment but domination of public funding of public institutions;   well-informed patients and strong patients rights protection What determines health? National health promotion policy to address inequalities

17. National Public Health Programme in Hungary as a positive example - 4 strategies:  create supportive social environment for health  develop healthy lifestyles, reduce risk factors  reduce avoidable mortality, morbidity, injury  develop health services and public health institutions for improving the health of the population

18. What determines health? National health promotion policy to address inequalities Are these only dreams? NO! Progress already made  during the years of preparation for EU membership we made a lot of progress already:  the transposition of the acquis in our sector is an investment in primary prevention (water quality, food safety, environmental protection, health protection at workplace, radiation hygiene etc.) this is itself a public health programme

19. What determines health? National health promotion policy to address inequalities Public Health institutional development Parallel to harmonisation, institutional system strengthened Pre-accession funds well invested: major investment in the Hungarian National Public Health and Medical Officers’ Service – laboratories, information system, training programmes Main areas:  public health laboratories  chemical safety  epidemiology and communicable diseases  information system  microbiological laboratories They serve early detection, modern diagnosis, prevention and treatment

20. What determines health? National health promotion policy to address inequalities The EU and the Hungarian Public Health In fact two synergetic processes:  Acquis, harmonisation – changing public health standards and practices  The „Decade of Health Public Health Programme” in close inter-relation with the Community Action Programme on Public Health Impact: → improving life expectancy (by 3 years over 10 years) → better quality of services → consolidation and modernisation of the health system → contributing to its sustainable funding

21. What determines health? National health promotion policy to address inequalities Review of Hungarian public health system: inadequate to serve the public health programme (80 % CD-oriented whereas 80 % of public health problems NCD – oriented) 80 % of public health problems NCD – oriented) Full reorganization starts

22. What determines health? National health promotion policy to address inequalities Establishment of the School of Public Health in Debrecen, 1996-present to promote public health capacity – building Major step forward

23. We have our own assets with a few gaps   health services   covers the whole country   provides wide range of services   solidarity principle improvement needed - -in bad physical condition - -equipment needs modernization - -quality of care to be improved - -patient information and rights to be improved   excellent manpower   well-trained   devoted   not very mobile Assets   reform underway to modernize What determines health? National health promotion policy to address inequalities

24. Modernization of health systems Assets improvement needed   public health   national programme approved by Parliament 2004 is the year of dinamization   infrastructure   staff   change in approach: health as a value/investment (get rid of paternalistic approach)   responsibility of all   individual responsibility   modern health promotion concepts   further development of institutions; training, tools, methodology   modernize infrastructure (pre- accession funds) What determines health? National health promotion policy to address inequalities

25. Close gaps in public health EU public health strategy framework 2003-2008 National public health programme for 10 years in line with it (bring it down to individuals as the effort of the whole society in 2004.) technical support: methodology, tools investment in institution-building and training (EU funds: structural funds for 2004-2006 and 2007-2013 in line with National Development Programme) What determines health? National health promotion policy to address inequalities

26. Thank you for your attention!