Implementation of Health in All Policies on the Local Level for More Effective Prevention

Implementation of Health in All Policies on the local level for more effective prevention of non-communicable diseases

1.  In your country, what kind of political documents (strategies, guidelines, policy papers, recommendations) support the Health in All Policies work/thinking, especially in regard to the implementation of HiAP at the local level?

Requirement to increase integration of health care (not only improve heath care system, but also create healthy environment) reducing prevalence and incidence of diseases provided in “Sustainable Development Strategy” [[1]] and also was included in Lithuanian Health Program 2014-2023 [[2]] which is prepared according to “Health 2020: a European policy framework supporting action across government and society for Health and well being”. Also program indicates that reaching Program strategic goal, there should be general Government, all economic sectors, communities and families movement for population health benefit. “National Public Health Care Strategy 2006-2013” [[3]] provide need to create modern and effective system of public health care by the legacy reform, management of social and economical processes, participation of all sectors and society forming and implementing health policy. In the Lithuania’s progress strategy “Lithuania 2030” [[4]] one of the objectives is to raise quality of life index and happiness index, building sustainable development, clean and safe environment, smart society, smart economy, smart governance, and open creative responsible people. Lithuanian Health System Development Dimensions for 2011-2020 [[5]] predicate that public health at the highest political level is not the part of governmental social and economical politics but also separate economic segment. Solving Health related issues there is predicted that the biggest cooperation should be in health care, education and environment sectors. In order to ensure integrated actions improving health, provisions of international documents were accepted and were implemented interinstitutional programs [[6]].

On the local level there is strong support for HiAP approach from Municipal Development Plans. These plans support thinking that health is strongly related with economic issues of municipalities, so they need to give more and more attention for the inter-sectorial collaboration solving health issues. Municipal strategies maintain cooperation of different sectors to improve health care. Different municipalities strategies supports different sectors, NGO and public institutions contribution improving citizens health: (e.g.: Vilnius City Mental Health Strategy for 2011-2015 [[7]]; “Children Well-being Development Strategy for 2013-2020”; “Elderly People Care Strategy for 2012-2020 [[8]]”. Enforcing Public Health functions in municipalities, different divisions of municipality administration are working together (Departments and Divisions of Administration; Education, Culture, Sport, Public Institutions, Environment and etc.). All Municipality decisions are made with HiAP thinking. Municipal Public Health Bureaus is one of the main institutions implementing HiAP approach on the local level and regulations provide cooperation with social partners and integration of public health promotion to other activities as one of Bureau functions [[9]] .

2.  How HiAP approach is implemented on the local level in your country (cooperation between sectors, more concrete work than policy programs)?

-  Advisory boards and committees

-  Human Impact Assessment (HUIA)

-  Health Impact Assessment (HIA)

-  Social Impact Assessment (SIA)

-  Monitoring and Evaluation (M&E)

-  Social determinants of health

-  Issue-based cross-sectorial committees and boards

-  Policy briefing

-  Expert reviews

-  Use of case studies

The main organ in decision making is Municipal Council. Municipal council is constituted of members from different sectors.

In municipalities there is The Municipality Community Health Council which is independent health coordination council composed of 3 individuals. 1 is delegated by municipality, 1 municipality organizations/ companies/institutions and 1 representative from public organizations defending interests of public health. The Local Community Health Council coordinates preparation and implementation of instruments for education, alcohol/tobacco/drug control, public health care and health promotion, disease prevention [[10]].

On municipality level on implementation of national health policy and combination of municipalities companies, institutions and organizations functions in implementation of health programs is working municipality Doctor Service. His functions usually related with primary health care, but on his competence is preparation of municipalities’ health programs.

On the municipal level on implementation of HiAP approach strongly are working Municipalities Public Health Bureaus. The aim of Public Health Bureaus is to take care of municipality people health, implement public health care and improve the quality of life providing high quality public health care services. Public health Bureaus work as a multi-sectorial body. The Bureaus provides suggestions for municipalities in policy making, also Bureau activities consist of public health promotion in municipality community, public health monitoring, prevention of NCDs and injuries in municipality; implementation of public health programs; children and young people health promotion, collaboration with social partners; administer municipal institutions projects health impact assessment [[11]]. The bureaus are working in close partnership with different sectors and institutions. They coordinate their functions with municipality health boards and are formal partners of schools involved in the development and implementation of the safety promotion, health education and disease prevention programmes. The bureaus closely collaborate with primary health care centers in the implementation of disease prevention programmes and health monitoring [[12]].

Structure of municipalities’ responsible institutions can be seen on table No.1.

Figure No. 1. Responsible institutions on implementation of health in all policies in municipality

3.  How does HiAP support the public health and health promotion interventions (especially on the local level) in your country? Can you give any specific examples?

Decisions on Public Health interventions are made in municipality council, which is elected by citizens. Council is formed by people from different sectors, and they represent community opinion. All decisions in public health interventions are made in this council, for example municipality council made decision to ban smoking in some city areas (main squares, bus stations and etc.), approval from different sectors was necessary in this decision. Also, according to survey done by Drug, Tobacco and Alcohol Control Department 10 municipalities were banned or revoked a license retailed trade in alcoholic beverages according to citizens, public organizations and other institutions opinion [[13]].

Municipalities Public Health Bureaus as multi-sectorial body, implement public health promotion interventions cooperating with other sectors, public institutions and NGOs. Functions of Public Health Bureaus can be seen on graph No. 2. Bureaus competence is to organize public health care in municipality and one of the principal Bureau function is cooperation with social partners, involving social partners in public health promotion organization, public health interventions integration of other sectors also to involve communities in public health promotion [[14]] .

Figure No 2. Main functions of Public Health Bureau

4.  Is HiAP a concept that is used and understood by policy makers in your country?

Yes. Political system, strategic and political documents support HiAP approach, decisions are made according to HiAP principles. HiAP concept is used in Municipalities especially in Municipalities Public Health Bureaus, but there are several gaps in implementation of it.

If in your opinion there is a gap that the HiAP is not understood and used, where do you think the obstacles may be?

There is support for HiAP approach that is understood and used in decisions making, but there is several gaps in implementation. There is lack of inter-sectorial collaboration, NGOs are not enough involved in decision making, in inter-institutional plans there is lack of attention for health promotion and public health care. Analysis of inter institutional cooperation [[15]] showed that the concept of health mainly related to the health care system and interpreted from the sectorial point of view, there is lack of attention for behavioral, lifestyle, social and environmental factors. Public Health Bureaus as main institution implementing HiAP, still have a rather low visibility and unstable financing, which make their functioning challenging [[16]]. The main funding is given for personal health care. There is low leadership in public health sector.

5.  Potential Years of Life Lost – method (PYLL) provides information of premature avoidable mortality. See attached documents that clarify the PYLL-methodology and its potential in strengthening HiAP and also motivating and facilitating traditional health sector interventions.

How is public health statistical information in general used in decision making at local/municipal level in your country? Do you think it is “SMART”?

Municipal Public Health Bureaus, provide statistical information (monitoring report) for municipalities. Decision makers on the local level in decision making use statistical data like: mortality, average life expectancy, incidence, prevalence of diseases, infant mortality, risk factors. I would say that this method is not bad but more effective and evidence based decisions could be made using other methods for (eg.: PYLL or DALY methods).

Do you know if PYLL - Potential Years of Life Lost method is included in the statistical repertoire (yearbooks) of your Central Statistical Bureau and/or National Public Health Institutes (is it available nationally, regionally or locally?).

PYLL method is NOT included in the yearbooks of Statistics Lithuania or Institute of Hygiene. The only way when PYLL is used, when Institute of Hygiene is working with scientific research, also there is ability to refer to Institute of Hygiene Health Information Center with the request to count it.

Do you know if PYLL had ever been used in decision making at municipal level in your country?

There is no practice to count PYLL in Lithuania, so there is more than less chance that it is used in decision making.

6.  From where the data needed for PYLL calculation (see attached document listing the data needed) can be retrieved?

Data needed for PYLL calculation can be retrieved from Lithuanian Death Causes Registry [[17]].

Which organization/institution has responsibility of the official death registry?

Official Death Causes Registry:

Lithuanian ministry of Health is lead institution of Death Causes Registry.

Institute of Hygiene is regulative institution of Death Causes Registry

Are there any fees for the access to the statistical data?

On the registry there is confidential data about dead people: name; surname; identification number, residency etc.

All data is given without fees for all governmental institutions, or for persons who have right by law to get confidential information and data about deceased. In order to obtain information data recipients should form a contract with lead institution of Registry.

References:

1.  Sustainable Development Strategy. Available at: http://www3.lrs.lt/pls/inter3/dokpaieska.showdoc_l?p_id=396083

2.  Lithuanian Health Program 2014-2023. Draft.

3.  National Public Health Care Strategy 2006-2013. Available at: http://www3.lrs.lt/pls/inter3/dokpaieska.showdoc_l?p_id=336278

4.  Lithuania Progress Strategy „Lithuania 2030“. Available at: http://lietuva2030.lt/images/stories/en_lietuva2030.pdf

5.  Lithuanian Health System Development Dimensions for 2011-2020. Available at: http://www3.lrs.lt/pls/inter3/dokpaieska.showdoc_l?p_id=401152&p_query=&p_tr2=2

6.  Report on Interinstitutional Cooperation Analysis Accomplishment, Similar Experiences of EU Countries and the Existing Legal Framework in Lithuania Evaluation. Public Politics and Management Institute. Vilnius, 2012, p.28-29. Available at: http://www.esparama.lt/es_parama_pletra/failai/ESFproduktai/2012_tarpinstitucinio_bendradarbiavimo_analize.pdf

7.  Vilnius City Mental Health Strategy for 2011-2015. Available at: http://www.vilnius.lt/index.php?1243390490

8.  Elderly People Care Strategy for 2012-2020. Available at: http://www.vilnius.lt/index.php?1243390490

9.  Lietuvos Respublikos Sveikatos apsaugos ministro įsakymas „Dėl savivaldybės visuomenės sveikatos biuro pavyzdinių nuostatų patvirtinimo“ Žin.:2008,Nr.35-1253.

10.  Kalediene R., Ščeponavičius A., Kavaliunas A., Asokliene L. Public Health Bureaus: New Players in Health Improvement in Lithuania. Acta Medica Lituanica. Lietuvos mokslų akademija, 2011,18(4) p.183-189

11.  Presentation: Enforcement and Implementation Reports of Public Health Functions in Municipalities. Andrius Kavaliunas. Ministry of Health.

12.  Presentation: Tobacco and Alcohol control in municipalities. Grazina Belian. Drug, Tobbaco and Alcohol Control Department.

13.  Lithuanian Death Causes Registry. Available at: http://sic.hi.lt/mapr1/

Main activities implementing of Health in All Policies on the local level in 2016-2017

1.  Evaluation of HiAP policy documents (Strategies, recomandations);

2. Evaluation of structures, resourses and actions (municipality, community levels) (avoiding duplication);

3. Analysis, experience and best practice on:

- integrated care programmes, structures and policies, including reporting and learning systems, with a view to addressing the cost;

- effectiveness of integrated care interventions and solutions at the local level and evaluation of their transferability;

4. Capacity building;

5. Improve the coordination on HiAP at local level by:

- streamlining the debate on the theoretical HiAP framework and identifying useful methodologies and tools to support policy makers in taking decisions;

- defining criteria for selecting priority areas for HiAP at local level and improving the availability and quality of relevant data and information.

6.  Improve the surveilance and reporting of the HiAP process;

[1] Sustainable Development Strategy. Available at: http://www3.lrs.lt/pls/inter3/dokpaieska.showdoc_l?p_id=396083

[2] Lithuanian Health Program 2014-2023. Draft.

[3] National Public Health Care Strategy 2006-2013. Available at: http://www3.lrs.lt/pls/inter3/dokpaieska.showdoc_l?p_id=336278

[4] Lithuania Progress Strategy „Lithuania 2030“. Available at: http://lietuva2030.lt/images/stories/en_lietuva2030.pdf

[5] Lithuanian Health System Development Dimensions for 2011-2020. Available at: http://www3.lrs.lt/pls/inter3/dokpaieska.showdoc_l?p_id=401152&p_query=&p_tr2=2

[6] Report on Interinstitutional Cooperation Analysis Accomplishment, Similar Experiences of EU Countries and the Existing Legal Framework in Lithuania Evaluation. Public Politics and Management Institute. Vilnius, 2012, p.28-29. Available at: http://www.esparama.lt/es_parama_pletra/failai/ESFproduktai/2012_tarpinstitucinio_bendradarbiavimo_analize.pdf

[7] Vilnius City Mental Health Strategy for 2011-2015. Available at: http://www.vilnius.lt/index.php?1243390490

[8] Elderly People Care Strategy for 2012-2020. Available at: http://www.vilnius.lt/index.php?1243390490

[9] Lietuvos Respublikos Sveikatos apsaugos ministro įsakymas „Dėl savivaldybės visuomenės sveikatos biuro pavyzdinių nuostatų patvirtinimo“ Žin.:2008,Nr.35-1253.

[10] Presentation: Enforcement and Implementation Reports of Public Health Functions in Municipalities. Andrius Kavaliunas. Ministry of Health.

[11] Lietuvos Respublikos Sveikatos apsaugos ministro įsakymas „Dėl savivaldybės visuomenės sveikatos biuro pavyzdinių nuostatų patvirtinimo“ Žin.:2008,Nr.35-1253.

[12] Kalediene R., Ščeponavičius A., Kavaliunas A., Asokliene L. Public Health Bureaus: New Players in Health Improvement in Lithuania. Acta Medica Lituanica. Lietuvos mokslų akademija, 2011,18(4) p.183-189

[13] Presentation: Tobacco and Alcohol control in municipalities. Grazina Belian. Drug, Tobacco and Alcohol Control Department.

[14] Lietuvos Respublikos Sveikatos apsaugos ministro įsakymas „Dėl savivaldybės visuomenės sveikatos biuro pavyzdinių nuostatų patvirtinimo“ Žin.:2008,Nr.35-1253.

[15] Report on Inter institutional Cooperation Analysis Accomplishment, Similar Experiences of EU Countries and the Existing Legal Framework in Lithuania Evaluation, loc.cit.

[16] Kalediene R., Loc.cit.

[17] Lithuanian Death Causes Registry. Available at: http://sic.hi.lt/mapr1/