1. HEALING THE CRISIS The urgent need to improve public health in SEE Ana Stavljenic-Rukavina Zagreb University School of Medicine and OSI NY:Sub-board for Public Health

2. Increase quality and years of healthy life Eliminate health disparities The fundamental goal The fundamental goal of public health strategies for the 21 st century of public health strategies for the 21 st century

3. Health related MDG Eradicate extreme poverty and hunger Eradicate extreme poverty and hunger Reduce child mortality Reduce child mortality Improve maternal health Improve maternal health Combat HIV AIDS, malaria and other infectictive diseases Combat HIV AIDS, malaria and other infectictive diseases Ensure environmental sustainability Ensure environmental sustainability Develop a global partnership for development Develop a global partnership for development

4. SOUTH EASTERN EUROPE

5. Major problems in SEE countries transition economy transition economy growing poverty and social exclusion growing poverty and social exclusion unemployment unemployment discrimination discrimination limited access to health services limited access to health services financing of health systems and health system reforms financing of health systems and health system reforms

7. Total expenditure for health as % of GDP in 2001 ( WHO 2003) Alb MolCro Rom

8. Total expenditure on health in $ per capita in 2001 (WHO 2003) Bulg. S&M. Mac. Mold.

9. The Reform of Health System Goals Improving the population health Improving the population health Improving the system efficiency Improving the system efficiency Cost containment Cost containment Reallocation of resources Reallocation of resources Increased quality of services Increased quality of services Access and equity Access and equity

10. Reforms of health systems Reform projects dealing with health financing, investment strategy, accounting, hospital control system and health information system (Romania,Albania, Bosnia) positive outcome_Romania with modern cost control system Reform projects dealing with health financing, investment strategy, accounting, hospital control system and health information system (Romania,Albania, Bosnia) positive outcome_Romania with modern cost control system Not all ”old” is bad- (prevention and health promotion) Not all ”old” is bad- (prevention and health promotion) Weekneses: Weekneses: majority of them centered on cost-cutting (even if data show insufficient spending on health), privatisation of primary health care with main goal to strengthen primary care and not on changing of behaviour or promoting healthy society majority of them centered on cost-cutting (even if data show insufficient spending on health), privatisation of primary health care with main goal to strengthen primary care and not on changing of behaviour or promoting healthy society Reforms of health care systems therefore in some SEE countries resulted in even greater health inequalities Reforms of health care systems therefore in some SEE countries resulted in even greater health inequalities

11. Life expectancy at birth for males WHO, 2003

12. Life expectancy at birth for females WHO, 2003

13. Infant mortality per 1,000 live births, WHO, 2003

14. Age- standardised death rate from CVD per 100.000, age 0-64, WHO, 2003

15. Deaths from injuries in childhood (age 0-14) Source: WHO, per 100,000

16. Age-standardised deaths from injuries and violence, all ages, 2000 Source: WHO, per 100,000

17. Deaths from injuries and violence, all ages in 2001 (WHO, 2003)

18. Age standardised death rate from cancer per 100.000 population, WHO, 2003

19. HIV infections newly diagnosed: cases reported in 2000 (per million population) Source: WHO

20. Adult prevalence rate 15.0%–36.0% 5.0a%–15.0% 1.0%–5.0% 0.5%–1.0% 0.1%–0.5% 0.0%–0.1% not available + 1 300% + 60% + 160% + 100% + 30% + 40% + 20% HIV: Current prevalence and change 1996-2001 Source: WHO

21. Indicators Estimated life expectancies in the region did not improve significantly except in Croatia, there is constant gap between SEE region and EU Estimated life expectancies in the region did not improve significantly except in Croatia, there is constant gap between SEE region and EU Epidemics of NCD, injuries and road deaths, high rate od deaths from cancer Epidemics of NCD, injuries and road deaths, high rate od deaths from cancer Mortaliti rate from CAD and cancer in EU declines, in SEE countries it is still growing Mortaliti rate from CAD and cancer in EU declines, in SEE countries it is still growing

22. The reasons for poor health are numerous, but some are particularly significant: are numerous, but some are particularly significant: a) preventable: dietary habits, smoking, HIV,TB a) preventable: dietary habits, smoking, HIV,TB b) non-preventable: inadequate health care (BP, Ca) b) non-preventable: inadequate health care (BP, Ca) long-term disability (poverty, injuries, mental health) long-term disability (poverty, injuries, mental health) inadequate financing of health systems inadequate financing of health systems political will or recognition of importance of good health for country economy political will or recognition of importance of good health for country economy the lack of strategy for health issues the lack of strategy for health issues

23. What are challenges and opportunities in public health for SEE countries? How will they affect the organization and functioning of future health services and systems?

24. Health Services “Turning the map of life into the blueprint for health” Public Health Strategy proposes collaborative action in four major areas: Building capacity to identify and respond to the threats including the development of surveillance, information and training system Investing in appropriate health care financing and delivery systems Cooperation, communication and education; sharing the best practices Coordination of programs, policies, and financing

25. Public Policy improving both, health status and health systems, Disease prevention includes vaccination, safety precautions and rules, screening and testing of target populations. Health promotion aims at enabling people to increase control over the determinants of health (including economic and environmental conditions) and thereby be conducive to individual and public health. promotes best practice in public health care Prevention Diagnosis Treatment Emergency services Health education programs Health promotion Screening programs Cost-effectiveness Safety Efficacy

26. Recommendations and Best Practices Appropriate and needs based technology assessment Multisectorial Evidence-based Policy Development i Evidence-based Decision Making (Clinical) Healthy Public Policies Integrated health information systems: data for decision making Population Health/ Health Promotion Frameworks Equity Determinants Community Interventions and Health Promotion Programs Human Resource Development/ Continuing Education Reoriented training (Aspher) Equitable access to treatment, services and programs Capacity Building for Planning and Follow up Evidence-based Resource Allocation

27. E-mail and web addresses for more information: accession-study@ishtm.ac.uk www.observatory.dk www.lshtm.ac.uk/ecohost/see www.childinfo.org/index2.htm www.euro.who.int/