Vol. 15 Issue 1 Year 2017

2017

Publication date: 30.01.2017

Description

ACKNOWLEDGMENTS

This publication arises from the project Pro-Health 65+ which has received funding from the European Union, in the framework of the Health Programme (2008–2013). The content of this publication represents the views of the authors and it is their sole responsibility; it can in no way be taken to reflect the views of the European Commission and/or the Executive Agency for Health and Consumers or any other body of the European Union. The European Commission and/or the Executive Agency do(es) not accept responsibility for any use that may be made of the information it contains.

Publication co-financed from funds for science in the years 2015–2017 allocated for implementation of an international co-financed project.

Licence: CC BY-NC-ND

Editorial team

Sekretarz numeru Anna Najduchowska

Issue Editors Prof. dr hab. Stanisława Golinowska, Professor Milena Pavlova

Issue content

Advocated but Sidelined: Health promotion for the elderly in the Netherlands

Jelena Arsenijevic, Wim Groot

Public Health and Governance, Volume 15, Issue 1, 2017, pp. 9 - 19

https://doi.org/10.4467/20842627OZ.17.003.6229

Health promotion (HP) in the Netherlands is the responsibility of both the national (the Ministry of Health, Welfare and Sport) and local governments. Two government organizations are involved in the development, implementation and monitoring of HP: the Dutch Institute of Public Health (RIVM) and The Netherlands Organization for Health Research and Development (ZonMw). Within RIVM, the Center for Healthy Living (Loketgezondleven.nl) has been established. ZonMw subsidizes the Academic Collaborative Centers (ACC) in eight areas which together cover the whole of the Netherlands. ACC centers are responsible for transferring evidence based scientific knowledge into practical activities. Also, health promotion “thematic” institutes such as the TRIMBOS institute (Institute for mental health) and NISB (Dutch Insitute for Sport and Physical Activity), the GGDs (the municipal institutes for public health), general practitioners and work and health professionals (Arbo-coördinators) are actors in HP.

There are two laws that regulate the role of HP namely: The Public Health Law (“Wet publieke gezondheid”) (Wpg), and the Social Support Act (Wmo).

Funding for HP comes from the central government, local municipalities, health insurance companies and regional care offices. Health insurance companies are mostly responsible for financing indicated and disease related HP. Evidence from Loketgezondleven.nl shows that only few HP are efficient and effective. Because of this both municipalities and insurance companies are reluctant to invest in HP. HP for elderly are mostly financed by public sources and, basic health insurance premiums but also through patient payments

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

Stanisława Golinowska, Kai Huter, Christoph Sowada , Milena Pavlova , Agnieszka Sowa, Heinz Rothgang

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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Healthy ageing – happy ageing: Health Promotion for Older People in Italy

Andrea Poscia , Roberto Falvo , Daniele Ignazio La Milia, Agnese Collamati , Francesca Pelliccia, Iwona Kowalska-Bobko , Alicja Domagała, Walter Ricciardi, Nicola Magnavita, Umberto Moscato

Public Health and Governance, Volume 15, Issue 1, 2017, pp. 34 - 48

https://doi.org/10.4467/20842627OZ.17.005.6231

Health Promotion for Older People (HP4OP) is a relevant issue in Italy, one of the countries where people live the longest. Strategies, programmes and projects are set and planned at the national level, mainly by the Ministry of Health within the National Health Service, but strong competencies, funds and resources derive also from the Government, the Ministry of Labour and Social Policies and the Ministry of Internal Affairs. Moreover, European funds contribute to programmes and projects in this field. After strategic implementation at the regional level, programmes and projects are carried out at the local level under the National Health Service, mainly by the Local Health Authorities in conjunction with municipalities and other relevant stakeholders such as NGOs, the voluntary sector, families and educational and religious entities, etc. Even though Italy has been engaged in HP4OP to improve active life expectancy since 1992, a lack of planning and resources for HP4OP, policy diversification at the regional level and a prevailing interest in care-assistance rather than health promotion and prevention have prevented consistent implementation of HP4OP throughout the country.

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Health promotion for older people in Portugal

Roberto Falvo , Andrea Poscia , Nicola Magnavita, Daniele Ignazio La Milia, Agnese Collamati , Umberto Moscato, Iwona Kowalska-Bobko , Alicja Domagała, Gisele Câmara, Andreia Costa

Public Health and Governance, Volume 15, Issue 1, 2017, pp. 49 - 61

https://doi.org/10.4467/20842627OZ.17.006.6232

In a country like Portugal where life expectancy is very high, Health Promotion for Older People (HP4OP) is a relevant issue and specific strategies are considered within priority health programmes defined at the national level by the Directorate-General of Health on behalf of the Ministry of Health. The National Health Plan 2016–2020 includes directives to facilitate health promotion and access to health and social services, as well as to reduce the burden of chronic diseases.

HP4OP funds and resources derive mainly from the Ministry of Health and also from the Ministry of Labour, Solidarity and Social Security. Moreover, institutions can access European and other funds to develop projects in this field and some municipalities also finance projects and initiatives.

Health plans, strategies and programmes outlined at the national level are adopted by Regional Health Administrations and the Groups of Health Centres guide implementation at the local level through dedicated units that work within the primary health care context.

The integration of both social and health actions in terms of HP4OP depends on collaboration between the Ministry of Health; the Ministry of Labour, Solidarity and Social Security; municipalities; institutions in the cooperative and social sector and other stakeholders such as families, educational institutions, religious communities and health professionals.

As a whole, health promotion policies for the older people in Portugal tackle the social determinants of health too. Nevertheless, a systematic approach and an integrated strategy to tackle HP4OP might constitute an important condition for the full implementation of such policies. Additionally, fragmentation of initiatives at the regional and local levels, together with other barriers to addressing health promotion activities among health professionals, might lead to the non-homogeneous implementation of interventions of HP4OP throughout the country.

It is expected that many of these constraints will be overcome with the launch and implementation of the intersectoral National Strategy for the Promotion of Active Ageing from 2017.

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

Milena Pavlova , Yannis Skalkidis, Wim Groot, Agnieszka Sowa, Stanisława Golinowska

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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The activities of older people when healthy ageing policy and funding is limited. The institutional and financial dimensions of health promotion for older people in Poland

Christoph Sowada , Iwona Kowalska-Bobko , Anna Mokrzycka , Alicja Domagała, Michał Zabdyr-Jamróz, Marzena Tambor, Stanisława Golinowska

Public Health and Governance, Volume 15, Issue 1, 2017, pp. 69 - 84

https://doi.org/10.4467/20842627OZ.17.008.6234

The presented country profile, based on several national reports, legal acts, international databases, scientific articles and pilot research performed with the use of health care sector templates, outlines the major institutional, organisational and financing challenges for health promotion in Poland, and specifically, health promotion for older adults.

Despite the numerous legislative and organisational changes in the health care sector since 1989 and the strengthening of the public health institutions in Poland, the country lacks a long-term, sustainable policy perspective in the public health area. The traditionally higher priority attached to curative care than to public health actions is one of the major reasons for the shortcomings of public health policy and the insufficient resources for health promotion and primary prevention in general, and health promotion for older adults specifically. However, there are also many weaknesses at the organisational level. One of the most important is the weak cooperation between the different levels of territorial self-government, the central government and other institutions when undertaking health promotion actions, which results in the development of both under- and overprovision of health promotion interventions for different population groups and at different geographical locations. Few self-government associations try to improve the cooperation and experience exchange in this field. However there is a need for a greater coordination and information exchange concerning plans and financial possibilities as well as for more competent health educators with better communication skills, less bureaucratic burdens, and better financial conditions.

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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, Anna Szetela

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

Marzena Tambor, Alicja Domagała, Michał Zabdyr-Jamróz, Iwona Kowalska-Bobko , Agnieszka Sowa, Christoph Sowada , Stanisława Golinowska, Petra Baji

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

Milena Pavlova , Elka Atanasova, Emanuela Moutafova, Agnieszka Sowa, Iwona Kowalska-Bobko , Alicja Domagała, Stanisława Golinowska, Wim Groot

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

Milena Pavlova , Liubove Murauskiene, Elina Miteniece, Agnieszka Sowa, Iwona Kowalska-Bobko , Alicja Domagała, Wim Groot

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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Słowa kluczowe: financing, health promotion, The Netherlands, health promotion, older people, health insurance, Germany, funding and financing, institutions, good practices, Health Promotion, elderly, Public Health, active ageing, policy, Italy, Health Promotion, elderly, Public Health, healthy ageing, policy, Portugal, public health, health promotion, older adults, health policy, Greece, Health Promotion for Older People, public health, health expenditures, Poland, public health, Health Promotion for Older People, healthy ageing, central government, local governments, non-governmental organisations, Czech Republic, public health, health promotion, older people, healthy ageing, Hungary, public health, health promotion, older adults, health policy, Bulgaria, public health, health promotion, older adults, health policy, Lithuania

Volume 15, Issue 1

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2017