regional dif f erences in health, socio-economic determinants and life style

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European Health Forum, Ga stein 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

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REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND LIFE STYLE. REPUBLIC OF SLOVENIA MINISTRY OF HEALTH. J. Maucec Zakotnik, M.D. State secretary, Ministry of Health, Slovenia. Content. Determinants of health - PowerPoint PPT Presentation

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Page 1: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

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 SLOVENIAMINISTRY OF HEALTH

Page 2: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

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

Page 3: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

Determinants of health

Page 4: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

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

Page 5: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

Development and Health are correlated

Social and economic development

Improvement of health

Page 6: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

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

Page 7: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

Age standardized death rate in groups of European countries

700

750

800

850

900

950

1000

1050

1100

1150

1200

1250

1970 1975 1980 1985 1990 1995 2000

Slovenia

Croatia EU average averagevpr

CEE average

Scandinavian countries average

Page 8: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

40

60

80

100

120

140

160

180

200

1970 1975 1980 1985 1990 1995 2000 2005

Czech Republic

Hungary

Slovenia

EU average

090101 +SDR,disease of circulat.syst.,0-64/100000

Page 9: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

70

80

90

100

110

120

130

140

150

1970 1975 1980 1985 1990 1995 2000 2005

Czech Republic

Hungary

Slovenia

EU average

100101 +SDR, malignant neoplasms, 0-64, per 100000

Page 10: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

10

20

30

40

50

60

70

80

90

1970 1975 1980 1985 1990 1995 2000 2005

Czech Republic

Hungary

Slovenia

EU average

991705 +SDR chron.liver dis&cirrhosis,all/100000

Page 11: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

69

70

71

72

73

74

75

76

77

78

79

1970 1975 1980 1985 1990 1995 2000 2005

Czech Republic

Hungary

Slovenia

EU average

060101 +Life expectancy at birth, in years

Page 12: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

0

5000

10000

15000

20000

25000

1970 1975 1980 1985 1990 1995 2000 2005

Czech Republic

Hungary

Slovenia

EU average

990001 Gross domestic product, US$ per capita

Page 13: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

Food consumption patterns, vegetables and fruit, Slovenia and Greece, Italy Portugal and Spain average, 1992-1999

0

50

100

150

200

250

300

350

92' 93' 94' 95' 96' 97' 98' 99'Year

Kg

per

head

Slovenia

Greace, Italy, Portugaland Spain average

Page 14: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

Food consumption patterns, animal fat, Slovenia and Greece, Italy, Portugal and Spain average, 1992-1999

0

2

4

6

8

10

12

14

16

18

20

92' 93' 94' 95' 96' 97' 98' 99'Year

Kg

per

head

Slovenia

Greece, Italy, Portugaland Spain average

Page 15: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

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

Page 16: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

Koper

Kranj

Nova Gorica Ljubljana

Ravne

Novo mesto

Celje

Maribor

Murska Sobota

INEQUALITIES IN HEALTH INDICATORS

•Age standardized mortality rate (per 100 000 inhabitants) in different regions of Slovenia (1999) •Life expectancy (years)

908

912

837 99972

76174.5

885 72

76975.5

72874.4

792

SLOVENIA 833

From: PHI and NOMEAD, RS, 1999

Page 17: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

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)

191878

1128.5129

222282

10.625.1102

9.224.798.6

From: PHI and NOMEAD, RS, 1999

Page 18: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

Health Monitor Survey-CINDI Slovenia 2001

Sampling:Stratified (by regions), random sample (CPR)Sample size: 15 379 (regional samples: 573 - 4576)

Age if inhabitants:25 - 64 years

Method of data collection:By post

Questionnaire:Questionnaire of WHO project - CINDI Health Monitor

Characteristics of the survey

INEQUALITIES IN EATING HABITS, PHYSICAL ACTIVITY AND BODY WEIGHT

Page 19: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

Gender (male, female) Age groups (25 – 29, 30 – 39, 40 – 49, 50 – 59, ≥60) Social class (lower, working, middle, upper middle, upper) Place of living (city, suburbs, village) Region (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

Page 20: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

Eating habits of adult Slovene population

Healthy/unhealthy eating habits in all inhabitants (25-64 years)

49,0 51,0

0

10

20

30

40

50

60

ALL

%healthy

unhealthy

Page 21: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

54,8

48,846,4

45,2

51,253,6

0

10

20

30

40

50

60

western central eastern

%

healthy unhealthy

Eating habits of adult Slovene population

Healthy/unhealthy eating habits in DIFFERENT REGIONS

Page 22: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

40,2

56,359,8

43,7

0

10

20

30

40

50

60

men women

%

healthy unhealthy

Eating habits of adult Slovene population

Healthy/unhealthy eating habits in MEN AND WOMEN

Page 23: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

4346

4448

50

5761

5457

54 5652

50

4339

46

0

10

20

30

40

50

60

25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

%

healthy unhealthy

Eating habits of adult Slovene population

Healthy/unhealthy eating habits in DIFFERENT AGE GROUPS

Page 24: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

4245

50

56 58

49

5855

50

44 42

51

0

10

20

30

40

50

60

lower working middle upper middle upper not defined

%

healthy unhealthy

Eating habits of adult Slovene population

Healthy/unhealthy eating habits in DIFFERENT SOCIAL CLASSES

Page 25: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

Body weight of adult Slovene population

Body weight (BMI) in men and women

0 2

33

5350

31

1714

0

10

20

30

40

50

60

men women

%

<18.5 18.50 - 24.99 25.00 - 29.99 >30

c

Page 26: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

Body weight of adult Slovene population

Body weight (BMI) in different age groups

52 1 1 1 0 0 1

5956

45

3833

29 29

24

32 34

4042

47 48 50

7 7 9

1520 20

2320

64

0

10

20

30

40

50

60

70

25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64

%

<18.5 18.50 - 24.99 25.00 - 29.99 >30

Page 27: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

Body weight of adult Slovene population

Body weight (BMI) in different social classes

1 1 1 20 2

3336

48

5754

4545 44

3833

39 37

21 20

13

7 8

16

0

10

20

30

40

50

60

lower working middle upper middle upper undefined

%

<18.5 18.50 - 24.99 25.00 - 29.99 >30

Page 28: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

Body weight of adult Slovene population

Body weight (BMI) in different regions

2 1 1

46 47

414037

41

13 1417

0

10

20

30

40

50

western central eastern

%

<18.5 18.50 - 24.99 25.00 - 29.99 >30

Page 29: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

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

Page 30: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

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

Page 31: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

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)

Page 32: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

Food and Nutrition Policy development in Slovenia

• Food and Nutrition Action Plan 2003 to 2008 - 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

Page 33: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

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

Page 34: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

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

Page 35: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

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.

Page 36: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

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

Page 37: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

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

Page 38: REGIONAL DIF F ERENCES IN HEALTH, SOCIO-ECONOMIC DETERMINANTS AND  LIFE STYLE

Thank you for your attention!