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A Greek tragedy of our time? Institutional and financial dimension of Health Promotion for Older People in Greece

Agnieszka Sowa

Public Health and Governance, Volume 15, Issue 1, 2017, pp. 62-68

https://doi.org/10.4467/20842627OZ.17.007.6233

Despite the numerous legislative documents and public health institutions in Greece, the country lacks a comprehensive and robust long-term policy perspective in the public health area. The traditionally higher priority attached to curative care than to public health actions, is the major reason of the shortcomings. This country report draws upon several national reports focused on the Greek health system, and other country-specific sources in order to outline the major institutional and financing challenges for health promotion in Greece, and specifically health promotion for older adults. The paper is based on the method of narrative literature review. The findings show that health promotion actions for elderly persons do take place in Greece but mainly in urban areas and/or within the framework of EU-funded projects. Government efforts are required to stimulate coordinated public health interventions at the local level focusing on the positive effects of health promotion. The health promotion programs that are successfully implemented, should receive the necessary government support to assure their long-term sustainability.

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Usługi zdrowotne i socjalne wobec populacji starszej, przewlekle chorej i niepełnosprawnej realizowane w pomocy społecznej: podstawy regulacyjne i praktyka

Agnieszka Sowa

Public Health and Governance, Volume 14, Issue 1, 2016, pp. 63-72

https://doi.org/10.4467/20842627OZ.16.010.5572

The article provides an overview of the scope and main problems related to utilization of medical and social long-term care services in the social assistance sector in Poland. According to the legal regulations medical and social care services can be provided to older dependent people if the family support for a dependent person is found insufficient. However, the number of people receiving care from the social assistance is still relativelly small. Based two qualitiative studies, the article overviews main barriers related to care provision: lack of adequate information on medical, nursing and care services, tensions between health and social sector in provision of care and nursing, negative perception of social assistance and lack of ageing policies at the local level.

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Health promotion for older people in Hungary: The need for more action

Agnieszka Sowa

Public Health and Governance, Volume 15, Issue 1, 2017, pp. 96-107

https://doi.org/10.4467/20842627OZ.17.010.6236

The health status of the Hungarian population is relatively poor, compared to other countries of similar socio-economic development. Unhealthy diet, smoking, alcohol consumption and low physical activity are important risk factors leading to cardiovascular system diseases – the main cause of death in the general population and among people 65+ in Hungary. Yet, the OECD health statistics indicate that Hungary belongs to a group of countries with the lowest per capita expenditure on prevention and public health and that the level of this expenditure is decreasing.

In Hungary, there is no legislation specifically dedicated to public health (Public Health Act) and the matters of public health and health promotion are regulated by various legal documents. The directions for public health policy are set in National Public Health Programmes. To address the problem of the ageing population, in 2009 a National Ageing Strategy (2009–2034) was adopted. The Strategy stresses the need to develop programmes for prevention, rehabilitation and health promotion for older people.

The main actor in public health policy is the central government, namely its agency the National Public Health and Medical Officer Service. Also, territorial governments play an important role, though they have limited financial capacity to spend on health promotion and they need to rely on external unstable sources of funds when implementing health programmes for older people. NGOs might be important partners for health promotion along with public authorities. However, they require more financial and infrastructural support to be able to perform more activities in the field of health promotion for older people.

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Health promotion for older people in Lithuania: Between bureaucratic and financial constraints

Agnieszka Sowa

Public Health and Governance, Volume 15, Issue 1, 2017, pp. 116-124

https://doi.org/10.4467/20842627OZ.17.012.6238

The health system in Lithuania has a strong focus on hospital treatment. Overall, there is a lack of sufficient funds explicitly devoted to public health. This country report draws upon several national reports focused on the Lithuanian health system and other country-specific sources in order to outline the major institutional and financing challenges for health promotion in Lithuania, specifically for older adults. As suggested in our review, the key problems in public health services in Lithuania, including health promotion for older persons, are the bureaucratic and financial constraints, a lack of intersectoral cooperation, staff shortages and capacity problems. The implementations of public health initiatives greatly depend on the political will and the government’s ability to implement policies, which are still weak in Lithuania. Moreover, the public health legislation lacks clarity and fails to provide an adequate base for local-level evidence-based interventions. Concrete action plans, as those recently developed in the area of healthy aging and health inequalities, are needed to provide guidance for health promotion among older adults.

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Health status of older people. Evidence from Europe

Agnieszka Sowa

Public Health and Governance, Volume 13, Issue 4, 2015, pp. 381-396

https://doi.org/10.4467/20842627OZ.15.040.5467

The objective of this article is to show the health status of the older population throughout European countries and indicate the data needs for a comprehensive comparative analysis of health status and its risk factors. The article briefly discusses definitions of health status in older age and presents adequate health status indicators. It discusses life expectancy, healthy life expectancy, disability adjusted life expectancy, the main causes of death as well as the prevalence of long-term illnesses, multimorbidity and functional health limitations across European countries, pointing out regional differences of the health status of older people. Next, several behavioural risks of poor health occurring in older age are shown: smoking, alcohol overuse and falls. The article concludes by demonstrating the need for more detailed, comparative and standardized data on the health status of older people across European countries, presenting sex and age-specific morbidity and health limitations as well as health risks.

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Healthy ageing as a visible public health activity and governmental responsibility. Health promotion for older people in the Czech Republic. Institutional and financial dimension

Agnieszka Sowa

Public Health and Governance, Volume 15, Issue 1, 2017, pp. 85-95

https://doi.org/10.4467/20842627OZ.17.009.6235

The health status of the Czech population has been improving over the past decades. The life expectancy increased from 67.6 for men/75.5 for women in 1990 to 75.9 for men/82.1 for women in 2014, becoming one of the highest in the Central and Eastern European region. Still, the older population faces many health risks related to obesity, high alcohol consumption, physical inactivity and smoking. Over half of the population above the age of 65 suffers from long-lasting illnesses and over half of the population above the age of 75 reports limitation in activities.

Health promotion for older people in the Czech Republic is growing in importance. There have been nationwide health promotion programmes against the main civilisation diseases, which older people could benefit from. In recent years two strategic programmes: the National Strategy for Health Protection and Promotion and Disease Prevention and the National Action Plan for Positive Ageing for the period of 2013–2017 came into existence with healthy ageing being an important target for both of them.

Health promotion policy is strongly centralised, supervised on the one hand by the Ministry of Health and the National Institute of Public Health and on the other hand by the Ministry of Labour and Social Affairs. At the same time, the activity of local governments and – especially – non-governmental organisations is important in supporting visible health promotion programmes for older people at the local level.

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Healthy ageing in Germany – common care and insurance funding. Institutional and financial dimension of health promotion for older people

Agnieszka Sowa

Public Health and Governance, Volume 15, Issue 1, 2017, pp. 20-33

https://doi.org/10.4467/20842627OZ.17.004.6230

In Germany responsibilities for health promotion and prevention lies with a multitude of different actors and institutions. The institutional arrangement of health promotion is shaped by the German federal structure of the state on the one hand and by a health care system that is characterized by divided responsibilities between governmental organisations, self-administered bodies and non-governmental organisations on the other hand. Although federal-level programs are successfully implemented in the country, the attempt of the Federal government to consolidate and clarify responsibilities in the public health area meets resistance. The Preventive Health Care Act from 2015 is an attempt to strengthen health promotion, its effective impact will be for the future to show.

Health promotion activities are initiated and provided by a variety of institutions: governmental, self-administered and voluntary (NGOs) often based on networks form. They cover activities on federal, Länder and local level. The Federal Ministry of Health and federal health agencies (specially BZgA) play an important role in this field. They created a number of health promotion regulation and activities initiatives which added to disease and addiction prevention. In health promotion for older people (HP4OP) programs, there is also a number of regionally and locally oriented initiatives.

In this paper, we outline main features of the HP4OP activities in Germany with regard to institutions and financing mechanism. In addition, we describe health-targeting programmes/projects indicated as good practices:(a) established and developed in Germany and (b) provided by the European Commission with significant participation of German institutions. The multitude and variety of HP4OP programs differentiate positively German health system from other health systems in ageing countries.

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Zasoby kadr dla sektora zdrowotnego. Dotychczasowe tendencje i prognozy

Agnieszka Sowa

Public Health and Governance, Volume 11, Issue 2, 2013, pp. 125-147

https://doi.org/10.4467/20842627OZ.14.012.1622

The article presents the diagnosis of trends in health care sector personnel in Poland, particularly physicians and nurses, and projections of the future personnel taking into account population ageing. The article is based on the NEUJOBS project research performed within the European Commission 7th Framework Programme. The analysis and projections use quantitative data: administrative, Eurostat data and GUS survey results. The density of employment of the health personnel per 1000 inhabitants is lower in Poland than in other EU-countries. In the future the demand for the medical personnel will be growing due to the increased needs for health care and ageing. The projections show that shortages of personnel will be faced by hospitals, particularly for specializations related to treatment of chronic diseases, while this is not the case in primary care. The size of the demand for medical personnel will be subjected to increase in technical efficiency of hospitals.

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Political will against funds deficiency: Health promotion for older people in Bulgaria

Agnieszka Sowa

Public Health and Governance, Volume 15, Issue 1, 2017, pp. 108-115

https://doi.org/10.4467/20842627OZ.17.011.6237

In Bulgaria, health promotion and health education have received less attention in comparison to other public health areas, which has resulted in a small health promotion budget and consequently, in limited health promotion initiatives. This country report draws upon several national reports focused on the Bulgarian health system, and other country specific sources in order to outline the major institutional and financing challenges for health promotion in Bulgaria, and specifically for health promotion for older adults. As evident from this review, the programs and activities oriented toward health promotion for older adults are inconsistent and incomprehensive. The existing programs are mostly in the form of isolated small-scale projects aimed at enabling older workers to reach the statutory retirement, or supporting retired citizens to maintain their health and well-being. Effective strategic vision, coordination and stable funding in the area of health promotion for older adults is indispensable for helping Bulgarian seniors to live longer and healthier.

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Społeczne uwarunkowania stanu zdrowia w Polsce

Agnieszka Sowa

Public Health and Governance, Volume 9, Issue 2, 2011, pp. 28-37

https://doi.org/10.4467/20842627OZ.11.015.0552

The article is devoted to recognition of social inequalities in health status in Poland in 1998 and 2004 based on statistical analysis of survey data collected by the Central Statistical Office (GUS). Social inequalities in health are discussed in the framework of theoretical approaches explaining health variations. Social gradient is measured by the level of education. The analysis shows that educational inequalities in health are not only existing, but persistent and – as in other developed countries – tend to increase over time even though the overall health status of the population has been improving. Poor health can be attributed to poverty, involvement in unhealthy behavior (especially smoking) and insufficient social networking resulting in poor social support.

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Agnieszka Sowa

Department of Social Policy, Institute of Labour and Social Studies, Warsaw, Poland

Department of Social Policy, Institute of Labour and Social Studies, Warsaw, Poland

Agnieszka Sowa Email

Department of Social Policy, Institute of Labour and Social Studies, Warsaw, Poland

Agnieszka Sowa