1. Bottom-up risk assessment of asthma bronchiale in Slovakia Kallayova, D., Majdan, M., O´Mullane M., Bosak, L., Kvakova, M., Gallova,E. Trnava University Public Health Department XI HIA INTERNATIONAL CONFERENCE, Granada, April 14‐15, 2011

2. RAPID project Risk Assessment from Policy to Impact Dimension Case study from Slovakia is a part of RAPID project The main aim of the project is to develop, pilot test and implement risk assessment methodology for full chain risk assessment Methodology- how to develop full chain R.A. Find feasible methodology for risk assessment which can be used then in HIA from policy -> determinants of health - > risk factors - > health effect (full chain) XI HIA INTERNATIONAL CONFERENCE, Granada, April 14‐15, 2011

3. Specific project aim Conduct risk assessment case studies from policy to health effect and from health effect to policy Bottom-up: check if there’s any policy that can affect asthma The project acknowledges funding by the European Commission Health & Consumer Protection Directorate-General via Executive Agency for Health and Consumers, Grant agreement no 20081105 XI HIA INTERNATIONAL CONFERENCE, Granada, April 14‐15, 2011

4. Policy level Health determinants Health outcome XI HIA INTERNATIONAL CONFERENCE, Granada, April 14‐15, 2011 Bottom-up risk assessment of asthma bronchiale in Slovakia: FULL CHAIN

5. Health outcome data sources relevant to Slovakia (1) XI HIA INTERNATIONAL CONFERENCE, Granada, April 14‐15, 2011 Global level European level National level Local level WHO report 2004 Global WHO mortality database WHO European databases (HFA, Mortality and Hospital Morbidity databases) National health information center -National registry of patients with chronic lung disease Medical records

6. From health outcome to risk factors (2) Methodology should be based on literature reviews - for the purpose of risk assessment phase we strongly recommend using review articles Findings from Reviews: Strongest risk factors for developing asthma are a combination of genetic predisposition with environmental exposure (higher outdoor air levels of priority pollutants such as particulates, ozone, sulfur and nitrogen oxides and carbon monoxide.) XI HIA INTERNATIONAL CONFERENCE, Granada, April 14‐15, 2011

7. Electronic Information SourceKey words (number)Number of publications Pub MedAsthma, Slovakia (2) Asthma (1) risk factors, asthma (2) environmental risk factors, asthma (3) 42 (including 6 reviews) 11 8167 8 278 2592 XI HIA INTERNATIONAL CONFERENCE, Granada, April 14‐15, 2011 Current Contents Connect®Asthma, Slovakia (2) Asthma (1) risk factors, asthma (2) environmental risk factors, asthma (3) 7 54 998 4 504 1 137 (including 151 reviews)

8. Findings from Review: From risk factor to health determinants Genetics and physical environment are crucial within the process of initiation of asthma (plus exacerbation of asthma)… The most important determinants we have identified environment (air pollution) and health care -in case of asthma exacerbations (management of asthma/asthma control) There are very few publication focused on asthma and risk factors research which has been done in Slovakia. XI HIA INTERNATIONAL CONFERENCE, Granada, April 14‐15, 2011

9. From determinants to policy in Slovakia The Government approved the State Health Policy Resolution No. 910 on 8 November 2000. Ministry of Environment has created Environment Strategy for protecting and enhancing the health of citizens SR based on State health Policy. XI HIA INTERNATIONAL CONFERENCE, Granada, April 14‐15, 2011

10. Strategy documents - Declaration of Ministers and Action Plan for Environment and Health children for Europe (CEHAPE) and updating of Action plan for environment and human health SR for the years 2006 - 2010 (NEHAP III) Environment initiation Primary health care policies should be oriented on asthma guidelines implementation in health system (guidelines not compulsory) Health care exacerbation XI HIA INTERNATIONAL CONFERENCE, Granada, April 14‐15, 2011 From determinants to policies in Slovakia

11. Conclusion Pilot for how full chain R.A. can be done, starting with health outcome.. case study on possible risk assessment methodology taking into account whole pathway from health outcome to risk factor, from risk factor to health determinants and from health determinants to policy could be the starting point to processes of ‘‘healthier” policy choices Difficulty is the gap in research.. The outlines options for the future risk appraisal methodology must be further discussed and improved XI HIA INTERNATIONAL CONFERENCE, Granada, April 14‐15, 2011