1. Creating Environment and Health Information System in Lithuania: First steps Ingrida Zurlyte, Aida Laukaitiene State Public Health Centre, Vilnius, Lithuania The Central and Eastern European Chapter/ISEE Meeting 4 – 6 September, 2003, Balatonfoldvar

2. National Framework National Public Health Strategy, 2001 National Public Health Strategy, 2001 Law on Public Health Care, 2002 Law on Public Health Care, 2002 Law on Public Health Monitoring, 2002 (by-law acts, 2003) Law on Public Health Monitoring, 2002 (by-law acts, 2003) National Environmental Health Action Programme (2003 – 2006) National Environmental Health Action Programme (2003 – 2006) National Public Health Monitoring Programme (draft) National Public Health Monitoring Programme (draft) Strategic Planning for Health Sector Strategic Planning for Health Sector

3. National Framewok Long – Term State Development Strategy, 2002 Long – Term State Development Strategy, 2002 National Sustainable Development Strategy and Implementation Plan, 2003 National Sustainable Development Strategy and Implementation Plan, 2003 Information Society Programme Information Society Programme

4. Environmental Health Information System - environmental health data collection, transmission, processing and delivery to end-user in the most efficient way in order to possess everyday tool for environmental health management (NEHAP of Lithuania, 2003) The purpose is to: The purpose is to: collect and process environmental health information on geographical principle and with national coverage; collect and process environmental health information on geographical principle and with national coverage; assess environmental health situation; assess environmental health situation; ensure fast and effective use of environmental health data and information for identification of “hot spots”; ensure fast and effective use of environmental health data and information for identification of “hot spots”; provide input for environmental health impact assessment; provide input for environmental health impact assessment; use in forecasting and policy decision – making process. use in forecasting and policy decision – making process.

5. Input from international projects WHO/DEPA Project on Implementation of National Environmental Health Action Plans in Czech Republic, Estonia, Lithuania, Poland and Slovakia, 2000 – 2001 WHO/DEPA Project on Implementation of National Environmental Health Action Plans in Czech Republic, Estonia, Lithuania, Poland and Slovakia, 2000 – 2001 WHO mission to review EH monitoring and information system in Lithuania, 2001 WHO mission to review EH monitoring and information system in Lithuania, 2001 Analysis and strategic recommendations for integrated EH information system, 2001 Analysis and strategic recommendations for integrated EH information system, 2001

6. Input from international projects WHO project: Environment and Health Indicators: developing methodology for the WHO European Region WHO project: Environment and Health Indicators: developing methodology for the WHO European Region Planning, set of EH indicators Planning, set of EH indicators Feasibility study for core set of EH indicators Feasibility study for core set of EH indicators Pilot study (data collection, EuroIndy, meta data information, fact – sheets for reporting) Pilot study (data collection, EuroIndy, meta data information, fact – sheets for reporting)

7. Feasibility study Issues addressed: Issues addressed: Availability and quality of necessary data; Availability and quality of necessary data; Accessibility and exchange mechanisms; Accessibility and exchange mechanisms; Use and usefulness of proposed indicators in (sub)national context; Use and usefulness of proposed indicators in (sub)national context; Capacity for multi – agency working on the information. Capacity for multi – agency working on the information.

8. Results of Feasibility Study From the WHO core set of indicators (55): From the WHO core set of indicators (55): - most were feasible (24) - 17 partly feasible - 14 not feasible (exposure related indicators; noise related effect indicators (annoyance, sleep disturbance; exceedance of WHO drinking water guidelines) Only 3 indicators not useful (consumption of leaded gasoline; blood lead level in children; standardized mortality ration by occupation) Only 3 indicators not useful (consumption of leaded gasoline; blood lead level in children; standardized mortality ration by occupation)

9. Positive experience – feasibility study Renewed contacts and new contacts established. More clear and generalized view on existing EH information, assessment of gaps. Created understanding, awareness in health and other sectors; Standardized forms for information collection and evaluation. Cooperation with WHO and EEA.

10. Problems Problems with identifying data-holders (additional administrative capacities and time); Data is spread in different institutions (27), 10 of them from health sector. Lack of institutional co-operation and data exchange, lack of data or data duplication; Financial and timing problems – motivation, reluctance from some institutions and experts; Transitional period (changes in methods, new and old data are hardly comparable and new data are not complete);

11. Problems Reorganization of public health institutions: moving responsibilities Each institutions/expert are very specialized difficult to generalize. Incompatibility of environment and health data collection and presentation formatsIncompatibility of environment and health data collection and presentation formats Poor EH reportingPoor EH reporting

12. National List of Environmental Health Indicators, adopted by the Order of the Minister of Health, August 30, 2002 National List of Environmental Health Indicators, adopted by the Order of the Minister of Health, August 30, 2002 Based on WHO core set of EH indicators, feasibility study results and new proposals Based on WHO core set of EH indicators, feasibility study results and new proposals Discussed with public health, environmental institutions and Statistical Department Discussed with public health, environmental institutions and Statistical Department Procedure for data collection, analysis and reporting, end of 2003. Procedure for data collection, analysis and reporting, end of 2003.

13. Example from the national list Indicator WHO core set Lithuanian set Incidence of skin cancer YesYes Effective monitoring YesYes Amount of radioactive waste generated per year - Yes (new) % of population receiving a cumulative radiation dose in excess of 5 mS/year -Yes UV light index -Yes Number of workers with ionizing radiation sources - Yes (new) Topicality of permits on the use of radioactive substances -Yes

14. Some other differences Children statistics: 0-2; 3-6; 0-14; 0-15 years old Children statistics: 0-2; 3-6; 0-14; 0-15 years old Mortality due to external causes in children under 6 years old Mortality due to external causes in children under 6 years old Acute communicable intestinal diseases morbidity in children under 6 years of age Acute communicable intestinal diseases morbidity in children under 6 years of age Different formulation of food safety indicators Different formulation of food safety indicators Number of outbreaks of communicable disease transmitted by food per year Number of outbreaks of communicable disease transmitted by food per year Incidence rate of acute intestinal communicable disease and bacterial food toxic infections Incidence rate of acute intestinal communicable disease and bacterial food toxic infections

16. Rate of road traffic causalties (injury+death)

17. Useful floor area per person in Lithuania during the year 1996-2001 Notes: Data of useful floor area are collected in Lithuania. Lithuanian Statistical Department defines Useful floor area as: the floor space of dwellings measured inside the outer walls; excluding cellars, uninhabitable attics and, in multi-dwelling houses, common area.

19. Problems encountered Interpretation in environmental health terms Interpretation in environmental health terms Lack of data: for drinking water quality; food action indicators only from the year 2000; sites containing large amount of chemicals – approximate only Lack of data: for drinking water quality; food action indicators only from the year 2000; sites containing large amount of chemicals – approximate only Action indicators: broad; very approx estimation (subjective judgment) Action indicators: broad; very approx estimation (subjective judgment) Food borne illness or water born illness – different from WHO indicators Food borne illness or water born illness – different from WHO indicators Regulatory requirements for land use around areas with large quantities of chemicals – who is responsible? Regulatory requirements for land use around areas with large quantities of chemicals – who is responsible?

21. Application on local level Interest from local level exist Interest from local level exist Differences between counties and localities Differences between counties and localities Need for additional training and guidance from national level Need for additional training and guidance from national level Should be clear for local authorities what data, where to get etc. Should be clear for local authorities what data, where to get etc.

22. Expectations Environmental health assessments Environmental health assessments Environmental Health (Public Health) reporting and communication Environmental Health (Public Health) reporting and communication Contribute to monitoring of environment and health actions Contribute to monitoring of environment and health actions Incorporate children EH indicators Incorporate children EH indicators

23. Tasks Ensure continuity of work done Ensure continuity of work done Build partnership with stakeholders Build partnership with stakeholders Managers and politicians should take ownership of the environmental health information system Managers and politicians should take ownership of the environmental health information system Complete legal basis for EHIS functioning. Complete legal basis for EHIS functioning. Create financial – economic basis for EH information system functioning. Create financial – economic basis for EH information system functioning. Solve issues of EHIS holder(s) management and subordination. Solve issues of EHIS holder(s) management and subordination.

24. Thank you for your attention!