EXPERIENCE OF DEVELOPED COUNTRIES WHO CONCLUSION IT IS

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EXPERIENCE OF DEVELOPED COUNTRIES WHO CONCLUSION: IT IS NOT THE RICHEST SOCIETIES THAT ENJOY

EXPERIENCE OF DEVELOPED COUNTRIES WHO CONCLUSION: IT IS NOT THE RICHEST SOCIETIES THAT ENJOY HIGHEST LEVEL OF HEALTH BUT THOSE WHERE IS LOWEST DIFFERENCE BETWEEN RICH AND POOR Health Promotion and Investment

Individuali rizika Vilius GRABAUSKAS

Individuali rizika Vilius GRABAUSKAS

FOOD SELECTION CRITERIA IN LITHUANIAN POPULATION (BALTIC NUTRITIONAL SURVEY) 80 66, 8 70 60

FOOD SELECTION CRITERIA IN LITHUANIAN POPULATION (BALTIC NUTRITIONAL SURVEY) 80 66, 8 70 60 50 40 30 20 10 0 16, 1 8, 3 6, 4 2, 4 Prevention Special diet Price Taste Food preference Vilius GRABAUSKAS

FOOD SELECTION CRITERIA IN LITHUANIAN POPULATION BY FAMILY INCOME (BALTIC NUTRITIONAL SURVEY) 77 80

FOOD SELECTION CRITERIA IN LITHUANIAN POPULATION BY FAMILY INCOME (BALTIC NUTRITIONAL SURVEY) 77 80 Prevention Price Taste Food preference 69 60 45 40 30 15 20 7 8 8 8 14 8 11 0 LOW INCOME 1 TERTILE MEDIUM INCOME 2 TERTILE HIHG INCOME 3 TERTILE Vilius GRABAUSKAS

COMPARISON OF MORTALITY OF POPULATION WITH UNIVERSITY AND PRIMARY OR LOWER EDUCATION BY AGE

COMPARISON OF MORTALITY OF POPULATION WITH UNIVERSITY AND PRIMARY OR LOWER EDUCATION BY AGE (MORTALITY OF THE GROUP WITH UNIVERSITY EDUCATION=1) Ratio 13 12 11 10 9 8 7 6 5 4 3 2 1 0 25 30 35 40 45 Men 50 Women 55 60 65 70+ Age, years Vilius GRABAUSKAS

PROPORTION (%) OF DAILY SMOKERS, BY EDUCATIONAL LEVEL % 70 68. 0* 60 48.

PROPORTION (%) OF DAILY SMOKERS, BY EDUCATIONAL LEVEL % 70 68. 0* 60 48. 5** 50 36. 7 40 30 20 17. 4* 10. 8 10 9. 1 0 Incomplete secondary Secondary Men University Women Vilius GRABAUSKAS

PROPORTION (%) OF DAILY SMOKERS, BY FAMILY INCOME % Vilius GRABAUSKAS

PROPORTION (%) OF DAILY SMOKERS, BY FAMILY INCOME % Vilius GRABAUSKAS

LOW BIRTH WEIGHT (>2500 G. ) PROPORTIONS BY EDUCATIONAL LEVEL OF MOTHERS % Primary

LOW BIRTH WEIGHT (>2500 G. ) PROPORTIONS BY EDUCATIONAL LEVEL OF MOTHERS % Primary q Pradinis Secondary q vidurinis University q aukštasis * p<0. 001 Vilius GRABAUSKAS

RELATIVE RISK OF UNMARIED LITHUANIAN POPULATION BY AGE AS COMPARIED TO MARIED (MARIED =

RELATIVE RISK OF UNMARIED LITHUANIAN POPULATION BY AGE AS COMPARIED TO MARIED (MARIED = 1) Males Females AGE V. GRABAUSKAS

% LOW BIRTH WEIGHT (>2500 G. ) PROPORTIONS BY MARITAL STATUS OF MOTHERS *

% LOW BIRTH WEIGHT (>2500 G. ) PROPORTIONS BY MARITAL STATUS OF MOTHERS * p<0. 001 Vilius GRABAUSKAS

TOTAL MORTALITY LEVEL (PER 100 000 OF POPULATION) IN ADMINISTRATIVE AREAS OF LITHUANIA IN

TOTAL MORTALITY LEVEL (PER 100 000 OF POPULATION) IN ADMINISTRATIVE AREAS OF LITHUANIA IN QUINTILES (1996 YEAR DATA) Vilius GRABAUSKAS

CARDIOVASCULAR MORTALITY IN ADMINISTRATIVE AREAS IN LITHUANIA IN QUINTILES 2000 LITHUANIA 566 <1100 <940

CARDIOVASCULAR MORTALITY IN ADMINISTRATIVE AREAS IN LITHUANIA IN QUINTILES 2000 LITHUANIA 566 <1100 <940 <780 <620 <460 No data Min: 300 Vilius GRABAUSKAS

HEALTH EXPENDITURE IN ADMINISTRATIVE AREAS IN LITHUANIA IN QUINTILES 1997 LITHUANIA 378 Upper 2

HEALTH EXPENDITURE IN ADMINISTRATIVE AREAS IN LITHUANIA IN QUINTILES 1997 LITHUANIA 378 Upper 2 -a 3 -a 4 -a Lower No data Min: 75. 44 Vilius GRABAUSKAS

LITHUANIAN NATIONAL HEALTH CONCEPT HEALTH LAWS ACTIVE HEALTH POLICY AND STRATEGY HEALTH PROMOTION HEALTHY

LITHUANIAN NATIONAL HEALTH CONCEPT HEALTH LAWS ACTIVE HEALTH POLICY AND STRATEGY HEALTH PROMOTION HEALTHY LIFE STYLES HEALTH CARE ENVIRONMENTAL PROTECTION DEVELOPMENT OF ENTIRE HEALTH SYSTEM WHO“HEALTH FOR ALL” PRINCIPLES Vilius GRABAUSKAS

TRENDS IN PROPORTION OF BUTTER ON BREAD USERS IN LITHUANIAN POPULATION AGED 20 -64

TRENDS IN PROPORTION OF BUTTER ON BREAD USERS IN LITHUANIAN POPULATION AGED 20 -64 BETWEEN 1994 -2000 80 70 60 50 40 71, 2 66, 3 56* 50, 6* 38* 37, 6* 40, 6* 38, 2* 30 20 1994 1996 1998 2000 10 0 Males Females * p<0. 05 compared with year 1994 Vilius GRABAUSKAS

TRENDS IN PROPORTION VEGETABLE OIL FOR COOKING USERS IN LITHUANIAN POPULATION AGED 20 -64

TRENDS IN PROPORTION VEGETABLE OIL FOR COOKING USERS IN LITHUANIAN POPULATION AGED 20 -64 BETWEEN 1994 - 2000 100 90 80 70 60 50 40 30 20 10 0 86, 5* 88, 4* 73, 5* 73, 1* 54* 68, 8* 1994 1996 1998 2000 47, 7 31, 1 Males Females * p<0. 05 compared with year 1994 Vilius GRABAUSKAS

TRENDS IN PROPORTION OF FRESH VEGETABLE USERS AT LEAST ON 3 DAYS DURING THE

TRENDS IN PROPORTION OF FRESH VEGETABLE USERS AT LEAST ON 3 DAYS DURING THE LAST WEEK BETWEEN 1996 - 2000 60 50* 51, 6* 50 43, 6* 36, 8* 40 30 24, 8 18, 1 20 1996 1998 2000 10 0 Males Females * p<0. 05 compared with year 1996 Vilius GRABAUSKAS

TRENDS PROPORTION OF DAILY SMOKERS IN LITHUANIAN POPULATION AGED 20 -64 BETWEEN 1994 -

TRENDS PROPORTION OF DAILY SMOKERS IN LITHUANIAN POPULATION AGED 20 -64 BETWEEN 1994 - 2000 60 50 43, 3 47, 3 48, 5* 51, 2 40 30 12, 5* 6, 3 9, 4 20 10 0 Males 15, 8* 1994 1996 1998 2000 Females * p<0. 05 compared with year 1994 Vilius GRABAUSKAS

TRENDS IN PROPORTION OF STRONG ALCOHOL USERS AT LEAST ONCE A WEEK IN LITHUANIAN

TRENDS IN PROPORTION OF STRONG ALCOHOL USERS AT LEAST ONCE A WEEK IN LITHUANIAN POPULATION AGED 20 -64 BETWEEN 1994 - 2000 40 35 30 31, 2 28, 7* 27, 1* 33, 9 25 20 11, 5 15 6, 7* 5, 5* 6, 6* 10 1994 1996 1998 2000 5 0 Males Females * p<0. 05 compared with year 2000 Vilius GRABAUSKAS

PROPORTION OF BEER USERS AT LEAST ONCE A WEEK IN LITHUANIAN POPULATION AGED 20

PROPORTION OF BEER USERS AT LEAST ONCE A WEEK IN LITHUANIAN POPULATION AGED 20 -64 BETWEEN 1994 - 2000 55, 8* 60 50 48, 9* 43, 5 39, 4 40 30 12, 9* 20 18, 3* 1994 1996 1998 2000 7, 1 8, 1 10 0 Males Females * p<0. 05 compared with year 1994 Vilius GRABAUSKAS

TRENDS IN AGE STANDARDIZED PREVALENCE OF SOME BIOLOGICAL RISK FACTORS IN LITHUANIAN POPULATION AGED

TRENDS IN AGE STANDARDIZED PREVALENCE OF SOME BIOLOGICAL RISK FACTORS IN LITHUANIAN POPULATION AGED 25 -64 (LITHUANIAN – CINDI DATA BASE) HYPERTENSION ( 140/90 or on treatment ) *** OVERWEIGHT ( BMI 25 ) *** ** *** 84, 9 HYPERCHOLESTEROLEMIA ( 5, 0 mmol/l ) ** *p<0. 05 **p<0. 01 MALES Comparing with 1987 1993 1999 *** FEMALES ***p<0. 001 Vilius GRABAUSKAS

TOTAL MORTALITY TRENDS IN LITHUANIAN MALES AGED 0 -64 SDR / 100 000 1.

TOTAL MORTALITY TRENDS IN LITHUANIAN MALES AGED 0 -64 SDR / 100 000 1. 000 900 6. 7%/year, p=0. 0001 -2. 7%/year, n. s. 800 -6. 9%/year, p=0. 007 700 600 500 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 Vilius GRABAUSKAS

TOTAL MORTALITY TRENDS IN LITHUANIAN FEMALES AGED 0 -64 SDR / 100 000 350

TOTAL MORTALITY TRENDS IN LITHUANIAN FEMALES AGED 0 -64 SDR / 100 000 350 3. 4%/year, p=0. 002 300 -6. 3%/year, p=0. 02 250 -2. 2%/year, n. s. 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 Vilius GRABAUSKAS

CVD MORTALITY TRENDS IN LITHUANIAN MALES AGED 0 -64 300 SDR / 100 000

CVD MORTALITY TRENDS IN LITHUANIAN MALES AGED 0 -64 300 SDR / 100 000 280 5. 8%/year, p=0. 0004 260 -6. 6%/year, p=0. 04 240 2. 6%/year, n. s. 220 200 180 0 200 9 199 8 199 7 199 6 199 5 199 4 199 3 199 2 199 1 199 0 199 9 198 8 198 7 198 6 198 5 198 4 198 3 198 2 198 1 198 0 198 Vilius GRABAUSKAS

CVD MORTALITY TRENDS IN LITHUANIAN FEMALES AGED 0 -64 100 SDR / 100 000

CVD MORTALITY TRENDS IN LITHUANIAN FEMALES AGED 0 -64 100 SDR / 100 000 90 3. 0%/year, p=0. 02 -. 5%/year, n. s. 80 - 8. 1%/year, p=0. 03 70 60 50 0 200 9 199 8 199 7 199 6 199 5 199 4 199 3 199 2 199 1 199 0 199 9 198 8 198 7 198 6 198 5 198 4 198 3 198 2 198 1 198 0 198 Vilius GRABAUSKAS

CHD MORTALITY TRENDS IN LITHUANIAN MALES AGED 0 -64 SDR / 100 000 5.

CHD MORTALITY TRENDS IN LITHUANIAN MALES AGED 0 -64 SDR / 100 000 5. 4%/year, p=0. 0004 200 180 2%/year, n. s. 160 -10%/year, p=0. 02 140 120 100 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 Vilius GRABAUSKAS

CHD MORTALITY TRENDS IN LITHUANIAN FEMALES AGED 0 -64 SDR / 100 000 70

CHD MORTALITY TRENDS IN LITHUANIAN FEMALES AGED 0 -64 SDR / 100 000 70 60 3. 6%/year, p=0. 01 50 40 - 15. 6%/year, p=0. 01 30 -. 6%/year, n. s. 20 10 0 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 Vilius GRABAUSKAS

CAN MORTALITY TRENDS IN LITHUANIAN MALES AGED 0 -64 160 SDR / 100 000

CAN MORTALITY TRENDS IN LITHUANIAN MALES AGED 0 -64 160 SDR / 100 000 155 1%/year, n. s. 150 -2. 7%/year, p=0. 04 145 140 1. 4%/year, p=0. 0001 135 130 125 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 Vilius GRABAUSKAS

CAN MORTALITY TRENDS IN LITHUANIAN FEMALES AGED 0 -64 100 SDR / 100 000

CAN MORTALITY TRENDS IN LITHUANIAN FEMALES AGED 0 -64 100 SDR / 100 000 90 -0. 3%/year, n. s. 80 70 60 50 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 Vilius GRABAUSKAS

LUNG CANCER MORTALITY TRENDS IN LITHUANIAN MALES AGED 0 -64 60 SDR / 100

LUNG CANCER MORTALITY TRENDS IN LITHUANIAN MALES AGED 0 -64 60 SDR / 100 0. 2%/year, p=0. 73. 55 50 -4. 2%/year, p=0. 003 45 1. 8%/year, p=0. 02 40 35 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 Vilius GRABAUSKAS

EXTERNAL CAUSE MORTALITY TRENDS IN LITHUANIAN MALES AGED 0 -64 350 SDR / 100

EXTERNAL CAUSE MORTALITY TRENDS IN LITHUANIAN MALES AGED 0 -64 350 SDR / 100 000 300 -6. 5%/year, p=0. 01 10%/year, p=0. 0002 250 -6. 7%/year, p=0. 01 200 150 100 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 Vilius GRABAUSKAS

EXTERNAL CAUSE MORTALITY IN LITHUANIAN FEMALES AGED 0 -64 100 SDR / 100 000

EXTERNAL CAUSE MORTALITY IN LITHUANIAN FEMALES AGED 0 -64 100 SDR / 100 000 75 7. 8%/year, p=0. 0003 - 6. 1%/year, p=0. 02 50 - 4. 5%/year, p=0. 04 25 0 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 Vilius GRABAUSKAS

q LITHUANIAN CONCLUSIONS EXPERIENCE DEMONSTRATES THAT SCIENCE BASED NATIONAL HEALTH POLICY DEVELOPMENT IS MOST

q LITHUANIAN CONCLUSIONS EXPERIENCE DEMONSTRATES THAT SCIENCE BASED NATIONAL HEALTH POLICY DEVELOPMENT IS MOST IMPORTANT TOOL FOR PLANNING, IMPLEMENTATION, MONITORING AND EVALUATION OF HEALTH SYSTEM REFORM PROCESSES q NATIONAL HEALTH INFORMATION SYSTEM THAT COMBINES NATIONAL STATISTICS, RESEARCH AND INTERNATIONAL DATA BASES EFFECTIVELY SERVES THE ABOVE q MORE SPECIFICALLY, LITHUANIAN HEALTH BEHAVIOUR MONITORING SYSTEM GIVES CLEAR INDICATION AND GUIDANCE WHICH AREAS OF LITHUANIAN HEALTH BEHAVIOURS REQUIRE SUBSTANTIAL IMPROVEMENTS IN HEALTH POLICY IMPLEMENTATION Vilius GRABAUSKAS