jan mos rivm 22-4-2010
DESCRIPTION
Rijksinstituut Volksgezondheid en Milieu en de Volksgezondheid toekomst VerkenningenTRANSCRIPT
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Nederland gezond en wel
Gezond blijvenVoorkomen is beter dan genezen?
Rollen en taken RIVM
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Three themes
1. Role of RIVM in the public domain
2. What is needed?
3. VTV: what do we (think) we know?
Discussion and clarification when needed!
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What may citizens expect from their government?
What is the responsibility of the federal government?
What is the role of state and local authorities?
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Government responsible for public health
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Government responsible for safe environment
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Public health is inherently political …
Politics is the process by which groups of people make decisions.
It is the authoritative allocation of values. Although the term is generally applied to behavior within
governments, politics is observed in all human group interactions, including corporate, academic, and religious institutions.
www.en.wikipedia.org/wiki/Politics
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Public health is inherently political
• Within a governmental framework• Involves complex tradeoffs—one value weighed against another• May need to act before all desirable information is known• Frequently need to involve the public — actions, or at least agreement
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But Public Health Institutes must be non-partisan…
• Decisions based on science, not ideology, financial interests, or ‘self-interest’• Complex tradeoffs — decision making transparent, quantitative modelingDecision analysis should identify and quantify areas of uncertaintyPublic communication, engagement
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Political responsibility
Research & policy support
The ministries have political responsibilities
RIVM: independent scientific responsibility (air quality)
Risk-assessment (RIVM, ECDC)
Risk-management (Government, EU, RIVM)
Clear separation of responsibilities
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Summarizing
• Separation of responsibilities• But the same goal• With different roles and interests
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Role of RIVM in the public domain
The aim of the RIVM is to improve public health and safeguard a healthy environment.
This is achieved by:• Research & knowledge integration• Policy support• National / federal coordination functions • Specific intervention programs (NIP, screening)• Effective communication on health (care) and
environment
RIVM serves the public authorities, the professional and the public
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Three themes
1. Role of RIVM in the public domain
2. What is needed?
3. VTV: what do we (think) we know?
discussion
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National Public Health Institute scientific role
• Selection of important public health question• Define appropriate scientific approachFrequently multi-disciplinary
• Obtain needed data• Participate in decision making, regulations• Implement, with partners, programs• Continue monitoring to evaluate impact
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Public Health Questions: Emerging Infections (Zoonoses)
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Public Health Questions: Problems in the air?
particulate matter electromagnetic fields public threat?
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Public Health Questions: Legionella (environment)
Legionella in cooling-towers
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Public Health Questions: Behaviour, trends and concerns for the future
physical inactivity
excessive alcohol use
severe obesity
Overweight
smoking
stablestableStable
badstablegood
badbadbad
badbadbad
stablegoodgood
youthFemalesMales
Trend
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National Public Health Institute scientific role
• Selection of important public health question• Define appropriate scientific approachFrequently multi-disciplinary
• Obtain needed data• Participate in decision making, regulations• Implement, with partners, programs• Continue monitoring to evaluate impact
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Transform information into wisdom (science)
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Understand risk assessment and communication
power lines
benzene
disasters
legionellanoise
passive smoking
airpollution
Radon
traffic
accidentsalcohol
accidents at home
fat food
lack of physical activityobesity
mobile phone base station
smoking
10-2
10-10
10-9
10-8
10-7
10-6
10-5
10-4
10-3 Risk on premature death
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Priority setting: use transparent criteria
Burden of disease and Cost of illnessInclude TrendsEvaluate effectiveness and efficiency of preventive measures
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DALYs in the Netherlands, 1980 - 2020
0
5000
10000
15000
20000
25000
1980
2000
2010
1980
2000
2020
1980
2000
2020
1980
2000
2020
1980
2000
2020
PM10 long-term
Noise Radon UV Trafficaccidents
DA
LY
s p
er m
illi
on p
eop
le
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Relative burden: 7 infectious diseases in Europe
incidence mortality disease burden
influenza measles HIV-infection campylobacteriosisEHEC-infection salmonellosis tuberculosis
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What is needed?
Good scientific background, credibility
Priority setting requires integrated knowledge based onBiomedical & health scienceHealth systems effectsEffective interventions
Thrive for a strong position to advice:Professionals, Politicians, Citizens
Consumer behavior experience Risk communicationEffective interventions
No formal power – authority needed (central vs local)
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What are the consequences for RIVM?
The Dutch government has redefined its role in public healthOur Institute is under reconstruction (mainly research)!
Additional tasks: better preparedness for outbreak / risk managementPrevention and intervention programs (based on burden of dis)Protect and promote health (alcohol, overweight, etc)
This requires to unify many different tasks of our instituteYou need mental maps
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Conceptual model for the Dutch PHSF
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Develop models to get grip on reality
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Need to develop knowledge-model
‘Sources’ ‘Effects’ ‘Systems’ ‘Intervention
laboratory and field research, modeling
Communication
desk research and (inter)national networks
Chain
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NIPH
owner Customers
Sister institutes
Research centers
citizens
professionals
Budget-holder
Need to develop stake-holder model
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Three themes
1. Role of RIVM in the public domain
2. What is needed?
3. VTV: what do we (think) we know?
discussion
Datum invullen25 maart 2010Titel van de presentatieVan gezond naar beter – VTV 201032
Public health reporting in the Netherlands
Public Health Status and Forecast 2010
Fons van der Lucht & Johan Polder
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General purpose of public health reporting
to provide an overview and analysis of the available data and information in the field of public health, on a regular basis
with explicit identification of any gaps in the information supply
for the:
evaluation of current health policy
preparation of new health policy
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Public health reporting by cVTV/RIVM
PHSF report: every four year (2010)
Thematic reports
Websites (regular updates):Public health CompassPublic health AtlasCosts of illnessEuphix.org
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Conceptual model for the Dutch PHSF
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PHSF in The policy cycle(Anderson and Hussey)
Preparation(agendasetting)
Implementation(programme implementation)
Evaluation Development(policy formulation)
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Preparation(agendasetting)
Implementation(programme implementation)
Evaluation Development(policy formulation)
Min. Health:Policy-document(2006/2007)
Municipalities:Policy-documents(2008/2009)
RIVM: PHSF-report(2010)
Healthcare-inspectorate(2009)
Datum invullen25 maart 2010Titel van de presentatieVan gezond naar beter – VTV 201038
From healthy to better
Public health status and forecast 2010(The fifth PHSF)
Fons van der Lucht & Johan Polder
Issued and offered march 25, 2010
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Life expectancy increases
70
72
74
76
78
80
82
84
86
88
90
1970 1980 1990 2000 2010 2020 2030 2040 2050
women man
life expectancy (years)
Life expectancy 2008Man: 78,3Women: 82,3
Dutch Women not in top of Europe
Sharp increase in last 4 years2 Years
Continuation of increase 2050: 6 years more
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Nadenken over consequenties….
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Large differences in life expectancy within the Netherlands
Lower life expectancy in big cities (e.g. Amsterdam, Rotterdam)
Lower life expectancy in ‘rural’ deprived areas (Limburg, Twente, Groningen, Betuwe)
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Persistent and large health inequalities(healthy)Life expectancy by level of education)
0 20 40 60 80
low
highWOMEN
low
highMAN
le without physical limitations
le with physical limitations
life expectancy (years)
Gap in Life expectancy7.3 years men6.4 years women
Life expectancy without limitations:
14 years
Trends in the gap constant/slight increase
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More disease, but more health
0
10
20
30
40
50
60
70
80
90
1983 1986 1989 1992 1995 1998 2001 2004 2007
life expectancy (le)
le without limitations
le in good (self perceived) health
le without chronic diseases
years, men
0
10
20
30
40
50
60
70
80
90
1983 1986 1989 1992 1995 1998 2001 2004 2007
life expectancy (le)
le without limitations
le in good (self perceived) health
le without chronic diseases
years women
More years, with more chronic diseases
But also in good health (trend will continue)
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Most prevalent diseases
Top 5 of diseases: each disease more dan 600.000 cases
(based on health care registrations)
1. Diabetes2. Arthrosis3. Coronary Heart diseases4. Complaints of neck and
shoulder5. Hearing loss
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Why are there more diagnoses?Medical factors
Increasing Knowledge: Prevention and early detection and treatment
(early detection: cancer and DM; better treatment cataract)
Successes in health care attribute to the increasing number of diagnosis
Social factorsless acceptance of inconvenience or discomfortsLess tolerance for variance in behaviour and healthExtension of the health conceptMedicalisation of daily complaintsHigher demands of our knowledge based economy
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…and why is doesn’t have to mean less health
Health is more than the absence of disease
'feel good' 'do the things
you want to do'
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 or more chronicdiseases
percentage
good (self perceived) health no limitations
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Less smokers, but still 27% smokes
0
20
40
60
80
100
1958 1968 1978 1988 1998 2008
men w omen average
percentage
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Overweight stabilizes at high level
0
10
20
30
40
50
1981 1984 1987 1990 1993 1996 1999 2002 2005 2008
obesity men obesity womenoverweight men overwweight women
percentage
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Priority setting: Tackling the biggest problems?
Smoking causes the highest burden of disease
However:- Many determinants of health still unknown- Lifestyle behaviour is clustering and has a common cause- Living healthy is not easy
- (what’s healthy, personal differences, environmental influences)
The social and physical environment as a starting point?
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Opportunities of preventionHealth protection and disease control (vaccination, screening) have produced
a lot of health gain in the pastMaintainanceExpansion
Health promotion (focused on lifestyle changes) is less succesfullNormative aspects (freedom of choice versus lifestylepolicy)Lacking knowledge (effectiviness of interventions is largely unknown)Institutional aspects (Unclear responsibilities, too many parties)
NB. Still opportunities when we deal with these problems
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The future of healthcare
Large increase in health care costs:Demographic developments Medical technologyLess possibilities for laboursaving innovationsMany employees needed in the health care sector
More health ≠ less health care
More health = more participation
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30% van de economische groei door betere voeding en gezondheid
30% van de economische groei door betere voeding en gezondheid
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Investing in health is necessary
Health is wealth
Health is highly appreciatedHealth is a source of human capital (education and employment)Health is a important condition for societal participation (Quality of the society)
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Investing in health is necessary• To get back in the top of Europe• Prevalence of diseases is increasing, limitations stabilize• Lifestyle is still a threat• Persisting health inequalities
And
• Everybody is needed on the labour market• Or in volunteer work or informal care• Health contributes to welfare and societal well-being
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A future for prevention- Long term:– concerted action, clear targets and a framework for assessment and appraisal: normative debate, investing in knowledge, and organisation of the public health field
- Short term:- Investment on effectiveness
- Priorities- Limitations- Health inequalities- Broadening the lifestyle
perspective (societal problem in stead of an individual)
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Gezondheidsbevordering moet anders
Bij gezondheidsbevordering verder kijken dan gedrag
Aandacht voor fysieke én sociale omgeving
Aandachtspunten voor de korte en lange termijn.
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Toekomst van preventie:Lange termijn Maatschappelijk actieprogramma
Heldere doelen op elk niveau
Afweging in samenhang
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Toekomst van preventie: korte termijn Gericht op de algemene bevolking (universele preventie)
Gericht op hoogrisicogroepen (selectieve preventie)
Gericht op individuen met een verhoogd risico (geïndiceerde preventie)
Gericht op het voorkomen van complicaties (zorggerelateerde preventie)
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Een zorgvolle toekomst
Is de zorg een koekoeksjong…
of…
een kip met gouden eieren?