NCD policy and programming in Croatia 4th WHO –IUMSP International NCD Seminar NCD policy and programming in Croatia Verica Kralj, MD CROATIAN NATIONAL INSTITUTE OF PUBLIC HEALTH Lausanne, March 2011

Located in Central Europe and the Mediterranean 21 counties According to WHO indicators, Croatia belongs to the Euro A group with low mortality at childhood and adulthood 56,000 sq.km, approx. 4,400,000 inhabitans 44. 000 births-decreased birth rate 10,1/1000 52. 000 deaths-stable mortality rate 11,8/1000 Annual population growth rate is negative (-1,8/1000) Life expectancy at birth 76,3, (M 72,9, F 79,6) Aging population

NCD situation - Structure and organization of prevention and care services According to mortality and morbidity indicators, Croatia’s leading diseases are chronic non-communicable diseases, most commonly cardiovascular and malignant diseases, diabetes, chronic respiratory and mental illnesses, as well as accidents and injuries, responsible together for ca. 85% of overall mortality Health care measures are implemented on the levels of primary, secondary and tertiary health care, in line with the plan and program of measures adopted by the minister of health Through the network of public health institutes (21 county) who are coordinated by the CNIPH, through a few organizational units (chronic disease epidemiology, public health, school medicine, addiction prevention, mental health care)

Main achievements in tackling NCDs Legislation and National Policies Plan and programme of health care measures (2002,2006) Act on the Restriction of the Use of Tobacco Products (1999, 2008, 2009) Croatian Food and Nutrition Policy (1999) National CVD Prevention Programme, passed by the Ministry of Health, but not operationalized or systematically implemented (2001) National Cancer Prevention and Early Detection Programme –Proposal (2006) National Diabetes Prevention Programme (2008) Croatian Obesity Action Plan (2010) National Strategy for Mental Health Care (2010) National Alcohol Action Plan - draft version Croatian Tobacco Control Action Plan - draft version

Main achievements in tackling NCDs Population-based screenings for cancer: National Breast Cancer Screening Programme started in October 2006 Colorectal Cancer Screening Programme started in November 2007 National Cervical Cancer Screening Programmme expected to start in 2011 National Diabetes Prevention Programme started in 2008 – training and health promotion are underway, screening should start in 2011

Challenges NCDs not high enough on the priority list of MoH The health care measure programme has not dealt systematically with the implementation of prevention measures in primary health care as no adequate system of financial support, monitoring and evaluation has been set up. Consequently, implementation is left to personal initiatives of executors themselves (GPs). At the level of county institutes, there are not enough teams for chronic disease prevention and monitoring. Strengthening the capacity of Public Health Infrastructure for Chronic Disease Prevention and also Financial support is needed. Screening coverage should be improved, primarily for colorectal cancer. Enforcement of the Smoking Ban Act (smoking ban in closed public places, smoking permission in bars with special ventilation systems, sale ban on tobacco products to persons under the age of 18) should be strengthened.

Lessons learnt Screening programmes require good preparation, planning and organization, including training of all participants, information of the public and target groups, as well as financial support Local community should be included – through schools promoting health, healthy cities and healthy counties Law enforcement (taxation, packaging and labelling, bans on advertising, bans on smoking at the workplace, bans on smoking in restaurants, bars, sports facilities) should be strengthened Coalitions and partnerships should be built with nongovernmental organizations and the academic community Effective communication strategies

What needs to be done in the next 12 months Organization and implementation of the Cervical Cancer Screening Programme Systematic implementation of activities from the Croatian Obesity Action Plan through the network of Public health institute Start working on the NAP for the implementation of the European Strategy for the Prevention and Control of Noncommunicable Diseases

Thank you for your attention!