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EUGLOREH project THE STATUS OF HEALTH IN THE EUROPEAN UNION:
TOWARDS A HEALTHIER EUROPE
FULL REPORT PART IV - PROTECTING AND PROMOTING PUBLIC HEALTH AND TREATING DISEASES: HEALTH SYSTEMS, SERVICES AND POLICIES 12. INSTITUTIONAL AND POLICY DEVELOPMENTS AT EU AND MEMBER STATE LEVEL 12.10. Policy developments in Member States | «» |
12.10. Policy developments in Member States
Remarkable
developments have taken place not only at European level during the last
decades, but also at national level. It can be said that while Member States
institutions and policies have been deeply affected by changes at European
level, also the contrary is true as, through their successive presidencies of
the Council and the “Troika” mechanism, Member States have had essential roles in
promoting new visions and important developments also at European level (see
Annex 12.3). Through their priorities and many initiatives, Member States have
deeply influenced policies and developments at Community level (see Annex
12.3).
 Annex 12.3 Priorities and initiatives of the EU Council
Presidencies since 2000
While it is
obviously impossible in this Report to address all the developments that have
taken place in Member States, the interested reader is invited to consult the
many national reports and ad hoc documents available on the European
Commission Public Health web site. Policy documents adopted by selected Member
States is given in Annex 12.4.
Annex 12.4. Initiatives adopted at national or local
level on major health determinants and on other areas of community relevance
COUNTRY: Belgium
A) Prevention and control instruments and initiatives
adopted at national or local level on major health determinants
B) Actions adopted in relation with EU initiatives to
improve public health
COUNTRY: DENMARK
A) Prevention and control instruments and initiatives
adopted at national or local level on major health determinants
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Determinants
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Level of Priority for Public Health Interventions
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Main regulations adopted
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MMain programmes on citizen empowerment
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Health-related behaviours
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high
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The Danish Health Act, No. 546 of 24. June 2005
The Health Act gathers and carries on the provisions
of a number of acts within the healthcare sector.
See more: http://www.dkma.dk/1024/visUKLSArtikel.asp?artikelID=11548
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2002-2010: Healthy throughout Life
– the targets and strategies for public health policy
of the Government of Denmark, 2002–2010 http://www.folkesundhed.dk/media/healthythroughoutlife.pdf
The Danish government has set up a commission for health
promotion and disease prevention, which will publish its
recommendation in the beginning of 2009. The commission’s recommendations
will act as input to a national white-paper expected in 2009/10.
The Danish government will work on increasing our
knowledge about which specific practical interventions that actually makes a
difference.
The Danish government will develop tools for continues
monitoring of the field of health promotion and disease
prevention in terms of demand, activity and effect.
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Smoking and tobacco snuff use
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high
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Act No. 512 of 6 June 2007
Smoke-free Environments Act
http://sum.dk/artikler_sum_uk/Files/Fil1/4203.pdf
The purpose of the Act is to promote
smoke-free environments with the aim of preventing harmful health effects of
environmental tobacco smoke and to prevent involuntary
exposure to environmental tobacco smoke.
As an exception the Smoke-free
Environments Act permits smoking indoor at small hospitality establishments
(pubs) if a number of criteria have been met. Moreover in a number of cases
The Smoke-free Environments Act permits a smoking booth or alike.
Act No 213 of 31 March 2004
Act on prohibition of sale af tobacco and alcohol to
people under the age of 16.
https://www.retsinformation.dk/Forms/R0710.aspx?id=9878
Statutory Order No. 817 of 2 October 2003 on limit
values, measurement methods, labelling, product descriptions etc. for tobacco
products
http://www.sum.dk/artikler_sum_dk/Files/Fil1/3533.pdf
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2006 Campaign: FA C T S A N D A D V I C E
about smoking and stopping
http://www.sst.dk/publ/Publ2006/CFF/Rygestop_etn/Rygestop_eng.pdf
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Alcohol consumption
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high
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Act No 213 of 31 March 2004
Act on prohibition of sale af tobacco and alcohol to
people under the age of 16.
https://www.retsinformation.dk/Forms/R0710.aspx?id=9878
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1990-: Week 40 campaigns.
Since 1990 provided by the Danish National Board of
Health yearly campaign in week 40 has been held
www.altomalkohol.dk (danish only)
Numerous campaigns and information every year
provided by the Danish National Board of Health
in order to prevent hazardous alcohol consumption amongst young people as
well as older people.
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Food choices
and nutrition
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high
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Act no 526 of 24 June 2005 Act of foodstuff
https://www.retsinformation.dk/Forms/R0710.aspx?id=31493#K4
(Danish only) – among others – specified on foodchoices and healthy diet.
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1. 2007 was named “The year of physical
activity” by the Danish Minister of Health. As part of this
initiative two large national campaigns aimed at increasing physical
activity was carried through in 2007.
Approximately € 2.5 mill. was in 2007 allocated to
local
projects aimed at reducing and preventing obesity.
As part of a large general reorganization of the
Danish public sector the main responsibility for health
promotion and disease prevention was in 2007 given to the
municipalities. This has increased the possibility of integration with local
projects in other areas – for examples sports and leisure and the social
area.
1. A new initiative in Denmark has been launced in
January 2008 that focuses on motivating families in Denmark with children
between 1-6 years of age to adopt a healthier lifestyle. The message is that
it is easy, fun and obtainable to live a healthy life. The materials, that
are designed for helping lower socioeconomic groups, are distributed through
amongst other GP nurses.
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2. An initiative focused on municipalities is being
developed in during 2007 and 2008. In Denmark municipalities have the primary
responsibility for obesity prevention and promotion of healthy lifestyles.
This initiative is concentrated towards schools and daycare centers. The
objective if the initiative is through advice and materials to encourage
municipalities to formulate food and psychical activity policies.
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3. A recently established partnership on wholegrain will
result in information activities and a product development effort from
industry in order to increase the amount of wholegrain in especially white
bread and also development of new bread and flour varieties. Furthermore, it
will focus on making the healthy choice the easy choice by increasing the
availability of whole grain products in canteens etc.
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A. The largest national initiative is
called “Alt om kost “ (Everything about diet) run by The Veterinary and Food
Administration. The project collects information on healthy eating and makes
it widely available through the Internet and through counseling patrols. The
projects main focus is on children in schools and daycare institutions – for
instance by providing information and counseling in establishing healthy
lunches. As of 2008 general counseling on physical
activity is included.
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B. "6 a day" consists of an information initiative and a development project which works to test and document initiatives
that make it easier for Danes to eat more fruit and vegetables, preferably
600 g/d for adults and children (>10 years of age) and 400 g/d for
children (4-10 years of age). This includes fruit and vegetable subscription
schemes in schools, surveys of consumers' attitudes to frozen and processed
fruit and vegetables and attempts to introduce more fruit and vegetables at
workplaces and at meetings.
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C. “GetMoving” is an annual campaign managed
by the National Board of Health to inspire children and youth to be more
physically active.
2003: ACTION PLAN AGAINST OBESITY
http://www.sst.dk/publ/publ2003/National_action_plan.pdf
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Drugs and substance abuse
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high
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2007: Narkoen ud af byen
http://www.sst.dk/Forebyggelse/Alkohol_narkotika_og_tobak/Narkotika/Kampagner_og_projekter/Narkoen_ud_af_byen.aspx?lang=da
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Sexual behaviour
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High
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Numerous campaigns to prevent HIV/AIDS,
save sex, etc. provided by the Danish National Board of Health.
2005: Campaign with young people aged 15 to 19
regarding Clamydia. Website: www.klamydia,.dk
provided by the Danish National Board of Health.
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Personal hygiene
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Safety awareness
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Environmental determinants and settings
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high
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The Danish Government, 2003
Environment and Health are Closely Related
Strategy and Action Plan to Protect Public Health
against Environemntal Factors
http://www2.mst.dk/Udgiv/publications/2003/87-7972-931-2/pdf/87-7972-932-0.pdf
The first Danish overall strategy for the
relation between environmental factors and health, presenting the Danish
Government's outline of the importance of environmental factors for public
health, and goals and initiatives for the coming years. The strategy provides
a common framework for strengthened cooperation between authorities involved
in the future efforts.
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Air pollution
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High
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Drinking and recreational water
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High
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Soil contamination and waste disposal
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High
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Selected chemical contaminants
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High
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Use of pesticides
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High
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Food safety
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High
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Act no 526 of 24 June 2005 Act of foodstuff
https://www.retsinformation.dk/Forms/R0710.aspx?id=31493#K4
(Danish only) – among others – specified on foodchoices and healthy diet and
food safety
See more: http://www.uk.foedevarestyrelsen.dk/Food+Safety/forside.htm
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Physical stressors
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High
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The Danish Government, 2003
Environment and Health are Closely Related
Strategy and Action Plan to Protect Public Health
against Environemntal Factors
http://www2.mst.dk/Udgiv/publications/2003/87-7972-931-2/pdf/87-7972-932-0.pdfely
Related
The first Danish overall strategy for the relation
between environmental factors and health, presenting the Danish Government's
outline of the importance of environmental factors for public health, and
goals and initiatives for the coming years. The strategy provides a common
framework for strengthened cooperation between authorities involved in the
future efforts.
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Human settlements
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High
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Transportation including road safety
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Extreme weather events and health
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Socio-economic determinants
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high
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2002-2010: Healthy throughout Life
– the targets and strategies for public health policy
of the Government of Denmark, 2002–2010 http://www.folkesundhed.dk/media/healthythroughoutlife.pdf
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Poverty
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Gender issues
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2004: Young and pretty: National campaign fostered by
the department of gender equality on young people and health issues
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Work-related health issues
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High
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Consolidated Danish Working Environment
Act No. 268 of 18 March 2005 and
Act No. 300 of 19 April 2006 on Amendment
of the Danish Working Environment Act which became effective on 28 April
2006, and
Act No. 175 of 27 February 2007 on Act on
Amendment of the Danish Working Environment Act (Adjustment of screening
visits, consultancy services and the Smiley scheme, mental health,
preventionbody of 40 million euro (40.000.000)etc.)
http://at.dk/sw12436.asp
Arbejdsmiljøcertifikat (2001):
Virksomheder, der ønsker et arbejdsmiljøcertifikat efter bekg. 923 samt 924
skal have truffet beslutning om, hvordan de vil arbejde med sundhedsfremme.
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Deprivation factors
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Others
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Psychosocial health determinants
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High
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2002-2010: Healthy throughout Life
– the targets and strategies for public health policy
of the Government of Denmark, 2002–2010 http://www.folkesundhed.dk/media/healthythroughoutlife.pdf
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Personal determinants
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High
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2002-2010: Healthy throughout Life
– the targets and strategies for public health policy
of the Government of Denmark, 2002–2010 http://www.folkesundhed.dk/media/healthythroughoutlife.pdf
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Genomics and public health
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Hypertension
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Interactions amongst determinants
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COUNTRY: Germany
A) Prevention and control instruments and
initiatives adopted at national or local level on major health determinants
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Determinants
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Level of Priority for Public Health
Interventions
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Main regulations adopted
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Main programmes on citizen empowerment
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Health-related behaviours
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Smoking and tobacco snuff use
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High priority as reducing tobacco
consumption is one out of six national health targets (Forum Gesundheitsziele
Deutschland, www.gesundheitsziele.de).
National (and in some cases federal) laws e. g. against smoking at public
places and work sites, tobacco advertising and selling tobacco products to
under age youth. While the focus of activities is on smoking, other forms of
tobacco use like snuff or shisha/waterpipe are also addressed.
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Increases in tobacco taxes (5 steps
between 2002 and 2005).
National non-smoker protection act
(smoking ban at public institutions, public transportation etc. and
prohibition of selling tobacco products to under age youth) came into effect
in 2007. Most federal states passed laws banning smoking at schools, bars and
restaurants (coming into force between 2006 and 2008). Employees have the
right to a smoke free working environment (§ 5 Health and Safety at work act
(Arbeitsstättenschutzverodnung) from 2002).
Ban of tobacco advertising (implementation
of EU guideline 2003/33/EG) in 2006.
Monitoring of population attributable
smoking rates by several national surveys: National health surveys, Telephone
health surveys and Health Interview and Examination Survey for Children and
Adolescents (KIGGS) conducted by Robert Koch-Institute (see www.rki.de); Drug
Affinity among Young People (since 1973, young people aged 12 to 25 years)
and Promoting non-smoking among youth (adolescents aged 12 to 19), both
conducted/coordinated by Federal Centre for Health Education, see www.bzga.de). Socio-Economic Panel Study
(SOEP, representative longitudinal study of private households, see www.diw.de/english/soep/soepoverview/27908.html)
and Census Data provided by Federal Statistical Office (see www.destatis.de) are other information
sources used for Public Health Reporting (see www.rki.de).
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List of ingredients of tobacco
products (Tabakzusatzstoffliste) released by German Ministry of food,
agriculture and consumer protection (see www.bmelv.de).
Federal Centre for Health Education (BZgA,
www.bzga.de) is providing, coordinating and/or supporting many non-smoking
activities such as web-sites and internet-platforms for adults and
children/adolescents (see e. g. www.rauchfrei-info.de,
www.rauch-frei.info) including
quit-lines (telephone or internet based), written and other materials for
different target-groups, school-based anti-smoking programs like the European
smoke-free class competition (called “Be smart – don’t start” (see www.ift-nord.de/ift/be), smoke-stop
competitions for general population (WHO-initiative “Quit & Win”, see
www.rauchfrei2008.de), basic life skills training for children (“Kinder stark
machen” see www.kinderstarkmachen.de),
school-based health education programs with broad focus (Class2000, www.klasse2000.de) etc.
Other anti-smoking initiatives and
information resources (examples):
www.ift-nord.de/ift/jbsf
- “Just be smokefree” – information source and quit-aid for adolescents
www.tabakkontrolle.de
– German WHO collaborating centre for tobacco control, based at German Cancer
Research Centre (DKFZ, see www.dkfz.de)
www.krebshilfe.de/rauchen-und-krebs.html
- German Cancer Aid (Deutsche Krebshilfe)
www.dhs.de
- German Centre for Addiction Issues (Deutsche Hauptstelle für Suchtfragen
e.V.)
www.rauchfreie-krankenhaeuser.de – German
network for smoke-free Hospitals (member of European network for smoke-free
hospitals)
www.nichtraucherschutz.de
– German non-smokers initiative
www.aktionsbuendnis-nichtrauchen.de
– “Task force non-smoking”, working group of 9 non-governmental organisations
(e. g. German Medical Association/Bundesärztekammer, German Cancer
Aid/Deutsche Krebshilfe, German Cancer Research Centre/DKFZ)
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Alcohol consumption
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High priority, policy mix approach
according to European guidelines.
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Legal requirements aimed at prevention of
alcohol abuse among young people: Prohibition of selling alcohol to underage
and youth drinking alcohol in public (§ 9 Law for protection of the
youth/Jugendschutzgesetz), young drivers (under age 21 or during qualifying
period) are forbidden to drink any alcohol (Prohibition for novice driver
act), taxes on alcopops are increased in 2004 (Act on alcopop taxes). In
general, blood alcohol concentration limits on drunk driving are 0,03 %
(possible legal consequences) and 0,05 % (lower limit for infringement of the
regulations). Alcohol advertising is banned in cinemas (Law for the
protection of youth). Additional voluntary rules drawn up by the German
Advertising Standards Authority exist.
National level of alcohol consumption as
well as drinking behaviour of subgroups is monitored by several surveys:
National health surveys, Telephone health surveys and Health Interview and
Examination Survey for Children and Adolescents (KIGGS) conducted by Robert
Koch-Institute (see www.rki.de) and Drug
Affinity among Young People (since 1973, young people aged 12 to 25 years)
conducted/coordinated by Federal Centre for Health Education (see www.bzga.de).
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Alcohol prevention is one of the
most important tasks of Federal Drug Coordinator (Bundesdrogenbeauftragte,
see www.bmg.bund.de), Federal Centre for Health Education (BzGA, see www.bzga.de) and German Center on Addiction
Issues (Deutsche Hauptstelle für Suchtfragen, see www.dhs.de).
Several information tools, hotlines and interventions are provided by these
authorities (in co-operation with other organisations like sickness funds,
sports clubs, automobile associations, self-help organizations, communities
etc.):
www.bist-du-staerker-als-alkohol.de
– internet platform targeted at youth
www.kinderstarkmachen.de
– comprehensive program to strengthen children’s ability to say “no’” to
drugs including alcohol
Project “HaLT – Hart am limit” (“Stop -
Close to the limit”): Communal strategies for preventing heavy or risky
alcohol consumption amongst children and adolescents, aided by Federal
Ministry of Health.
Employer’s liability insurance
associations (Berufsgenossenschaften) and Statutory accident insurance
(Gesetzliche Unfallversicherung), respectively offer information and advice
to employers and employees concerning alcohol (see www.hvbg.de).
Detoxification, long term therapy and
rehabilitative measures are services of the German social insurance system
(Statutory Sickness Funds, Accident Insurance and Pension Insurance working
together). Alcohol (and drug addiction in general) prevention projects may be
supported by grants according to § 20 Abs. 1 SGB V (Social Code Book V,
Prevention and health promotion), for a list of projects
see www.gesundheitliche-chancengleichheit.de.
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Food choices and nutrition
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High priority as promotion of healthy food
choices and nutrition is sub-goal of national health targets (Forum Gesundheitsziele
Deutschland, www.gesundheitsziele.de),
Federal Government is working on a “National Action Plan for prevention of
malnutrition, physical inactivity, obesity, and their health consequences”
and several national acts are at least indirectly related.
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§ 20 Abs. 1 SGB V (Social Code Book V,
Prevention and health promotion): for a list of projects
concerning food and nutrition that meet the law’s criteria see www.gesundheitliche-chancengleichheit.de
National action platform Diabetes mellitus
(Nationales Aktionsforum Diabetes Mellitus, NAFDM, www.nafdm.de, since 2004): targets e. g. prevention
of diabetes onset by healthy life style interventions.
§ 21 SGB V (prevention of dental
diseases): nutritional advice is part of national dental health group
programs for children
Statutory health insurances offer many
programs to members (benefit either according to national laws or insurance
statute).
Nutritional assessment is part of national
public health monitoring: German Health Interview and Examination Survey for
Children and Adolescents (KIGGS conducted by Robert Koch-Institute, www.rki.de)
included a nutrition module (EsKiMo; dietary records and personal interviews,
respectively; see http://www.kiggs.de/service/english/index.html).
Dietary habits of adults are evaluated as part of National Health Surveys
(see www.rki.de).
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Nutritional advice is part of many
rehabilitation/secondary prevention programs as well (legal basis: § 43 SGB V
and SGB IX).
National health target “Growing up
healthy” is supported by activities like “Healthy kindergarten and schools”,
“Health promoting full-time schools”, mass media campaigns and information
materials provided by Federal Centre for Health Education (BZgA, see www.bzga.de, www.gutdrauf.net,
www.bzga-kinderuebergewicht.de,
www.kinderliedertour.de, www.tut-mir-gut.net), Nationaler
Aktionsplan "Für ein kindergerechtes Deutschland 2005-2010" (NAP,
national action plan “Germany fit for children”), masterminded by Federal
Ministry of Family, Seniors, Women and Adolescents (see www.bmfsfj.de/Politikbereiche/kinder-und-jugend,did=31372.html).
Further resources and campaigns (for
children):
“easy-peasy” (“Kinderleicht”, see www.kinder-leicht.net) – supported
by Federal Ministry of of Food, Agriculture and Consumer Protection).
“FIT KID” (see www.fitkid-aktion.de) – healthy food
at day-care institutions.
While most programs targeting prevention
of obesity, BzGA provides a web-site focusing on eating disorders (www.bzga-essstoerungen.de) and
three Federal Ministries (departments of Health; Family, Seniors, Women and
Adolescents; Education and Research) initiated a campaign against the
slimming craze (“Life has weight”, see www.bmg.bund.de),
self-help projects are supported by financial grants as well as research on
primary prevention and therapy of eating disorders (see www.ednet-essstoerungen.de –
“Research association eating disorders” as example).
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Physical activity
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High priority as promotion of physical
activity is sub-goal of national health targets (Forum
Gesundheitsziele Deutschland, www.gesundheitsziele.de),
Federal Government is working on a “National Action Plan for prevention of
malnutrition, physical inactivity, obesity, and their health consequences”
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Promotion of adequate physical
activity is part of any recommendation or program concerning
healthy life styles, weight reduction, and prevention of obesity or diabetes
mellitus (see above).
National governmental and federal state
institution, communal authorities, sickness funds, private organizations,
sports clubs and many others co-operate in this field. Physical
activity is target of prevention programs according to § 20 SGB V
(see above) and of different types of workplace health
promotion. According to § 65 SGB V Statutory Sickness Funds can
grant (financial) incentives to their members for taking part in exercise
programs.
Monitoring the level of physical
activity of the German population (with special interest in
subgroups like children, see www.kiggs.de)
is part of national health reporting (see www.rki.de).
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Selected activities:
National campaign “Exercise and health”
(“Bewegung und Gesundheit”, see www.die-praevention.de)
– promotes “3000 footsteps extra a day” as a starting point for elevating the
level of regular physical activity, program supported by
Federal Ministry of Health; website provides also links to other projects
located at day-care centres for children, schools, residential homes for the
elderly, workplaces or sports clubs.
“Germany is moving” (Deutschland bewegt
sich, see www.barmer.de) – cooperation of
a Health insurer, a newspaper and a TV station.
Most of the programs with respect to
healthy food choices cited above comprise physical
activity modules, too.
Additional support comes from Federal
Ministry of Transport, Building and Urban Affairs (Bundesministerium für ür
Verkehr, Bau und Stadtentwicklung, BMVBS), Federal Ministry of the Interior
(Bundesministerium des Inneren, BMI), federal states and communities as improved
local infrastructure (e. g. cycle paths, public gyms and pools) makes it
easier to live a physical active life. Examples: “National Cycling Plan 2002
to 2012” (Nationaler Radverkehrsplan”, see www.bmvbs.de
or www.nationaler-radverkehrsplan.de),
“Support program sports facilities” (Sportstättenbauförderung, see www.bmi.bund.de).
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Drugs and substance abuse
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High priority, a National Anti-Drug and
Addiction Action Plan (2003) specifies policy targets and measures, many
activities at national, federal state and communal level.
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At national level, legal framework in
reference to drugs and substance abuse consists of Narcotics Law
(Betäubungsmittelgesetz), Criminal Code (Strafgesetzbuch), Penal Law
(Strafvollzugsgesetz) and laws concerning Social Security. Legislation and
drug policy are as well part of federal state’s tasks. National Anti-Drugs
and Addiction Action Plan (Aktionsplan Drogen und Sucht, see www.bmg.bund.de)
serves as guideline specifying targets and measures.
As in case of alcohol dependants a
(regional operating) network of Social Insurance Institutions exists for
illegal drug dependants (Suchtkrankenhilfe). Many measures are operated at
local level in close co-operation of communal authorities, private and
self-help organizations (e. g. drug counselling centres).
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Prevention of drug and substance
abuse is one of the most important tasks of Federal Drug Coordinator (Bundesdrogenbeauftragte,
see www.bmg.bund.de), Federal Centre for Health Education (BzGA, see www.bzga.de) and German Center on Addiction
Issues (Deutsche Hauptstelle für Suchtfragen, see www.dhs.de).
Several information tools, hotlines and interventions are provided by these
authorities:
www.drugcom.de
– Internet platform offering information and help targeted at young people
concerning different sorts of drugs (e. g. “Quit the shit”-program for
Cannabis addictive youth) (side provided by BzGA)
“Early Intervention Of First Time Noticed
Drug Users: FreD” – aimed to discourage further drug abuse among young people
(under 25 years) who have been arrested due to the consumption of illegal
drugs (Project supported by Federal Ministry of Health and 8 federal states,
see http://eddra.emcdda.europa.eu).
“JES – junkies, ex-user and people
receiving drug substitution” – networking platform of (ex-)users of illegal
drugs in co-operation with German AIDS Support Federation, see
www.jes.aidshilfe.de.
For further information see “Drugs and
Addiction Report” of Federal Drug Coordinator (annually release, see www.bmg.bund.de) and http://eddra.emcdda.europa.eu/
(European data-bank for drug related programs and interventions).
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Sexual behaviour
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High priority
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Federal Centre for Health Education
(BZgA), (see www.bzga.de) aims to prevent
health risks and to support health-promoting life-styles. Its main targets
are AIDS prevention, sex education and family planning. It offers the
following websites: www.sexualaufklaerung.de:
Website which provides information about sex education and family planning
for disseminators,
www.gib-aids-keine-chance.de:
Central website of the ‘Dont give AIDS a Chance’ campaign, campaign started
in 1987
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Personal hygiene
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Intermediate
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§ 21 SGB V prevention of dental diseases:
prophylaxis for groups in nursery school and primary schools carried out by
dentists,
§ 22 SGB V prevention of dental diseases:
prophylaxis for individuals; health screening is free of charge, regularly, consultation service and expert advice in
oral health for children until 12 years is given, includes prophylactic
fluoridating
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www.die-praevention.de:Website hosted by the Ministry of Health,
Special topic ‘fit durch den Winter’ (Being fit in winter) offers practical
advices how to strengthen the immune system (Stand:
Dezember 2006)
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Safety awareness
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High priority given the many laws,
institutions, and activities concerning safety/risk.
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Safety/risk awareness at the provider
level of health related services or products is addressed by provider’s
(organizations) themselves as well as by Governmental actions. Risk
awareness/management and quality of health care are closely interrelated.
Quality of health care was addressed by almost every law with relevance for
German health system and prevention that came into action during the last 10
years (see www.bmg.bund.de, www.bmj.bund.de).
Institutions and measures with regard to
patient safety (examples):
Federal Ministry of Health set up an
Action Plan to optimize drug safety (Aktionsplan 2008/2009 zur Verbesserung
der Arzneimitteltherapiesicherheit, see www.bmg.bund.de).
Federal Institute for Drugs and Medical
Devices (Bundesinstitut für Arzneimittel und Medizinprodukte, BfArM, see www.bfarm.de) is working on safety of
medicinal products and risk monitoring of medical devices.
The Drug Commission of the German Medical
Association (Arzneimittelkommission der deutschen Ärzteschaft, see www.akdae.de) is an independent institution
collecting and providing information and guidelines on drug safety.
Critical incident reporting – voluntary
online-reporting of critical events, see www.cirsmedical.de
and www.jeder-fehler-zaehlt.de
Institutions and measures with regard to
consumer safety in general (examples):
Federal Ministry of Food, Agriculture and
Consumer Protection (Bundesministerium für Ernährung, Landwirtschaft und
Verbraucherschutz, BMELV, see www.bmelv.bund.de)
Federal Office of Consumer Protection and
Food Safety (Bundesamt für Verbraucherschutz und Lebensmittelsicherheit, BVL,
see www.bvl.bund.de) – responsible for
safe food, animal feed and veterinary drugs, tobacco products, plant
protection products and genetic engering.
Federal Institute for Risk Assessment
(Bundesinstitut für Risikobewertung, BfR, see www.bfr.bund.de) - agency under public law
to strengthen consumer health protection.
Federation of German Consumer
Organisations (Verbraucherzentrale Bundesverband, VZBV, see www.vzbv.de) - umbrella organization for 41
German consumer associations
Foundation for comparative product testing
(Stiftung Warentest, see www.test.de) –
independent foundation under civil law supported by Governmental grants
Concerning aspects of environmental,
traffic, and working safety see homepages of Federal Ministries with
corresponding fields of responsibilities: www.bmu.de,
www.bmvbs.de, www.bmas.de,
www.bmi.bund.de
|
Enhancing safety (or rather: risk!)
awareness at the individual level is part of most measures with focus on
health behaviour (e. g. information concerning health consequences of smoking
on cigarette packages, signs at motorways indicating potential dangers of
drunk or fast driving).
German Coalition for Patient Safety
(Aktionsbündnis Patientensicherheit)– non-profit association, launched in
2005 by health care professionals, institutions, manufactures, insurance
funds, and patient organizations to improve patient safety, see www.aktionsbuendnis-patientensicherheit.de
„Forum Patient safety“ – provided by
German Medical Association (Bundesärztekammer, BÄK), National Association of
Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung,
KBV) and Agency for Quality in Medicine (Ärztliches Zentrum für Qualität in
der Medizin, ÄZQ), see www.forum-patientensicherheit.de
|
|
Environmental determinants and settings
|
|
The protection of the population regarding
environmental health hazards is under the competence of different Federal and
Federal State Ministries and Agencies. The Federal Ministry for the
Environment, Nature Conservation and Nuclear Safety is responsible for the
implementation of Federal law concerning air quality, soil protection,
physical stressors (like ionising radiation) or noise and waste disposal. The
German national environment and health action plan (Aktionsprogramm Umwelt
und Gesundheit, APUG, www.apug.de)
performed jointly by Federal authorities from different sectors is one of the
central means towards an integrated approach to tackle environmental health
issues.
|
|
|
Air pollution
|
High priority
|
Policies to improve outdoor and indoor air
quality have a long tradition in Germany. Several laws and acts support the attempts
to achieve good indoor as well as ambient air quality. Some emissions of
construction materials are regulated. However the emissions of many products
are not restricted up to now. Some emissions of industrial plants are
regulated by the Federal Immission Protection Law. The Chemicals Act will now
be replaced by REACH.
Outdoor air quality is regulated according
to European Directives which have been implemented in national legislation.
Current efforts to further improve outdoor air quality mainly affect
emissions of particulate matter and nitrogen oxides.
|
|
|
Drinking and recreational water
|
High priority
|
European Regulations concerning
drinking and bathing water have been transposed in national legislation
ensuring a high level of water quality in the respective areas. Drinking
water is considered one of the central foodstuffs which has to comply to high
standards regarding biological and chemical contaminants. While the
safeguarding of water quality is under the responsibility of the water suppliers,
monitoring and control is under the competence of local authorities which run
nationwide harmonised monitoring programs (Federal Ordinance on Drinking
Water). The process of implementation of the European Bathing water directive
and the Water Framework Directive is ongoing.
|
|
|
Soil contamination and waste disposal
|
High priority
|
The Federal Government has the competency
to set legislation in the field of soil conservation. This was fulfilled by
decreeing the Federal Soil Protection Act (BbodSchG) 1998 and the Federal
Soil Protection and Contamination Ordinance (BbodSchV) 1999. The Länder are
responsible for the enforcement of the BBodSchG and the BBodSchV and can add
complementary procedural rules.
Product responsibility is regarded as the
key to waste management policy in Germany. Through this the conditions for an
effective and environmentally sound waste avoidance and recovery will already
be created in the production stage. Producers and distributors must design
their products in such a way as to reduce waste occurrence and allow
environmentally sound recovery and disposal of the residual substances, both
in the production of the goods and in their subsequent use.
|
|
|
Selected chemical contaminants
|
High priority
|
In most industrialised countries -
including Germany - the production and use of hazardous chemicals (“the dirty
dozen”, persistent organic pollutants like dioxin, PCB’s) are already banned
or at least stringently regulated. The main emissions sources for adverse
by-products, e.g. waste incineration plants, are subject to strict limit
values so as to minimise health risks and environmental dangers. Germany has
ratified the Stockholm convention on POP and has published it’s national
implementation plan in 2006 (http://www.pops.int/documents/implementation/nips/submissions/Germany_NIP.pdf).
The success of the Convention thus heavily depends on whether the agreements
will be implemented in developing countries and on what form implementation
will take. Chemical substances that pose a risk to human health and the
environment are now covered by the EU REACH-Directive that harmonises the
registration, evaluation, administration and restriction of chemicals entered
into force the 1st June 2007. The Federal Cabinet has just
approved the draft law that transposes the regulations of the EU
REACH-Directive into national law.
|
|
|
Use of pesticides
|
High priority
|
The use and application of pesticides is
regulated by several Federal laws and ordinances . The legal framework covers
the production, distribution and application of licensed pesticides. Maximum
residue levels for pesticides are specified in a specific ordinance.
Foodstuffs are monitored for pesticide residues by federal and federal state
authorities (food-monitoring). Current monitoring results suggest that the
overall contamination of foodstuff in Germany is low. The results of the
annually performed food monitoring programme are published by the Federal
Office of Consumer Protection and Food Safety (www.bvl.bund.de).
|
|
|
Food safety
|
High priority
|
The safeguarding of Food safety in Germany
is under the shared responsibility of the Federal and the Federal State
Government. Federal and Federal State Agencies as well as communal
authorities are responsible for
Institutions and measures with regard to
Food Safety in general (examples):
Federal Ministry of Food, Agriculture and
Consumer Protection (Bundesministerium für Ernährung, Landwirtschaft und
Verbraucherschutz, BMELV, see www.bmelv.bund.de)
Federal Office of Consumer Protection and
Food Safety (Bundesamt für Verbraucherschutz und Lebensmittelsicherheit, BVL,
see www.bvl.bund.de) – responsible for
safe food, animal feed and veterinary drugs, tobacco products, plant
protection products and genetic engering.
Federal Institute for Risk Assessment
(Bundesinstitut für Risikobewertung, BfR, see www.bfr.bund.de) - agency under public law
to strengthen consumer health protection.
|
|
|
Physical stressors
|
High priority
|
Physical stressors which are relevant for
human health are monitored by different bodies in Germany. The Federal Agency
for Radiation Protection (BfS, http://www.bfs.de/en/bfs)
works for the safety and protection of man and the environment against
damages due to ionising and non-ionising radiation. In the field of ionising
radiation there are, e. g., X-ray diagnostics in medicine, safety in the
handling of radioactive substances in nuclear technology and the protection
against enhanced natural radioactivity. The work in the field of non-ionising
radiation includes the protection against ultraviolet radiation and the
effects of mobile communication.
Of special importance are, in addition to
the defence against immediate hazards, the precautions for the protection of
the general public, persons employed in the working world as well as patients
in the medical field.
The protection of the population against
hazardous noise is under the responsibility of the Federal Ministry for
Environment (www.bmu.de) and the Federal
Environmental Agency (www.uba.de). Currently
the EU-Directive on environmental noise (2002/49/EG) is being implemented in national legislation (Federal Immission
Control Act, BImSchG, http://bundesrecht.juris.de/bimschg/index.html).
Limit values for the exposure to environmental noise are laid down in the
Federal Ordinance on immission protection (BImSchV, ).
|
|
|
Human settlements
|
High priority
|
The improvement of living conditions of
the population living in urban areas is subject of several initiatives from
Federal and Federal State Authorities and Non-governmental organisations.
Together with civil society initiatives like “Agenda 21” aim at the implementation of principles of sustainability on the local level.
|
|
|
Transportation including road safety
|
High priority
|
The implementation of measures concerning
road safety lies in the competence of the Federal Ministry of Transport,
Building and Urban affairs (http://www.bmvbs.de/en)
and its agencies (e.g. www.bast.de).
Together with civil society organisations (e.g. Council on Road Traffic
Safety, www.dvr.de ) measures for improving
the safety of road traffic are planned and implemented.
|
|
|
Extreme weather events and health
|
Intermediate priority
|
The health effects of extreme weather
events (2003 heat wave, Elbe flooding, storms) have led to considerable
efforts of Federal and Federal State authorities to improve information on
preventive measures related to extreme weather events. Several Federal States
have implemented early warning systems (e. g. on heat waves) that are
designed to support health care and nursing care facilities to provide the
appropriate measures for vulnerable population groups.
|
|
|
Socio-economic determinants
|
|
|
Poverty
|
High priority, reduction of inequity in
health is an important target of many national activities
|
§ 20 Abs. 1 SGB V (Social Security Code V)
Prevention and Health Promotion Act; Act on primary care
services which should alleviate inequalities in health/contribute to a
decrease in health inequalities
Federal Centre for Health Education
(BZgA): www.gesundheitliche-chancengleichheit.de
Website hosted by BZgA since 2001, internet platform contains a database
which offers information about projects concerning health
promotion with socially disadvantaged, Good Practice
–Examples are listed
Zwölftes Sozialgesetzbuch (Social Security
Code XII) Social Welfare: §67, §68 [Neugestaltung im Jahr 2001]; If social
difficulties and problems accumulate e.g. homelessness, violence affected
living conditions or after release assistance for maintenance is necessary,
especially personal assistance.
Social Health Insurance Modernization Act
(Gesetz zur Modernisierung der gesetzlichen Krankenversicherung, GMG);
Persons who receive social welfare/benefits/assistance and were not insured
are included in Social health insurance since January 2004, equal access to
medical supply is possible
National Action Plan to combat poverty and
social exclusion (Nationaler Aktionsplan zur Bekämpfung von Armut und
sozialer Ausgrenzung); 2001-2003 1st Action Plan, 2003-2005 2nd Action Plan;
includes measures to combat poverty and social exclusion; aims to combat
unemployment, to develop childcare for children under three years of age, to
integrate migrants;
Development and Opportunities of young
people in deprived areas (Entwicklung und Chancen junger Menschen in sozialen
Brennpunkten E&C) http://www.2000-2006.eundc.de
; In cooperation with Federal
Ministry of Transport, Building and Urban Affairs, Federal Ministry of Family,
Seniors, Women and Adolescents, Labour Agency (Bundesagentur für Arbeit);
pilot programme (Bundesmodellprogramm) to improve the prospects of
disadvantaged children and adolescents; started in 2000, 2nd phase 2004-2007; aims to reduce social
exclusion, acquisition of skills which will be helpful in future times (esp.
education, health, work field), strengthening personal responsibility and
social commitment
|
|
|
Gender issues
|
High priority
|
2nd National Action plan to combat
violence against women (Zweiter Aktionsplan der Bundesregierung zur
Bekämpfung von Gewalt gegen Frauen); adopted by the Federal Government in
September 2007; aims to improve the combat against violence effectively;
improvement of protection of concerned women
Stalking and Violence Protection Act (Gesetz zum zivilrechtlichen Schutz vor Gewalttaten
und Nachstellungen, Gewaltschutzgesetz, GewSchG); Federal Law, entered into force in January 2002
www.frauengesundheitsportal.de
; Women’s health & Health Promotion; Portal hosted by Federal Centre for Health Education (BzgA)
|
|
|
Work-related health issues
|
High priority
|
INQA (www.inqa.de)
Initiative Neue Qualität der Arbeit Since May 2002; INQA is a community
initiative of federal authorities, federal states, social partners, social
security authorities, foundations and companies; advocacy for a safe, sound and competitive working
environment
Pilot programme to combat work-related
diseases (Modellprogramm zur Bekämpfung arbeitsbedingter Erkrankungen);
Federal Ministry of Employment and Social Affairs promotes three pilot
projects (01.07.2007 - 30.06.2010):
Kooperationsprogramm zu normativem Management von Belastungen und Risiken
bei körperlicher Arbeit - KoBRA, Institut für Arbeitswissenschaft (IAD) der
Technischen Universität Darmstadt
Programm Arbeit
Rücken Gesundheit - PAKT,
uve GmbH für Managementberatung Berlin
Nachhaltige Präventionskonzepte
zur Reduzierung von Muskel-Skelett-Erkrankungen
in dezentralen Strukturen - naprima, Institut für gesundheitliche Prävention, IFGP Münster
Working conditions act
(Arbeitsschutzgesetz, esp. §3 (1) ArbSchG, §5 (1) ArbSchG); health protection
at the work place is the employer’s duty(1996)
§20b SGB V; Act on prevention of work-related health
risks, cooperation between health insurance fund and accident insurance
organization
|
National Guide on occupational safety
management, published 01/2003 in ‘Bundesarbeitsblatt’
www.die-praevention.de
, Website hosted by the
Ministry of Health, Special topic ‘Moving Office’ (Bewegter Büroalltag), advices for exercises,
postures, nutrition and ergonomics at the workstation
www.praevention-arbeitswelt.de
Prevention at the workplace, joint project from all umbrella organisations of
the health insurance fund and the accident insurance organizations
|
|
Deprivation factors
|
High priority
|
Early Assistance for parents and children
and social warning systems (Frühe Hilfen für Eltern und Kinder und soziale
Frühwarnsysteme); Federal
Programme of Action, Ministry of Families, Seniors, Women and Adolescents,
since 04/2007, see www.fruehehilfen.de,
within the framework of the federal programme: The National Centre for early
aid/intervention (“Nationales Zentrum Frühe Hilfen); operated/conducted by
Federal Centre for Health Education (BZgA) and the German Youth Institute
(DJI), The National Centre supports fieldworkers to recognize risks
(negligence and abuse of children) earlier and more effective, and provides
adequate help.
National Action Plan for a Germany
suitable for children (Nationaler Aktionsplan für ein kindergerechtes
Deutschland 2005-2010), Ministry of Families, Seniors, Women and Adolescents
(BMFSFJ), aims to create a world appropriate for children with equal
opportunities on the basis of education, growing up without violence, promote
a healthy life and environment, children and adolescent participation,
development of an appropriate standard of living for children and young
people.
Forum health targets Germany (Forum
Gesundheitsziele Deutschland (www.gesundheitsziele.de):
initiated by the Federal Gouvernment in December 2000 as pilot project, it is
since 2007 a joint cooperation; development of health targets to create
equity in health; those targets as instruments to improve the health of the
population through screening, treatment and rehabilitation of concrete
diseases, prevention or improvement of health-related structures
|
|
|
Psychosocial health determinants
|
|
there are no special programmes;
psychosocial health determinants are commonly integrated in prevention
programmes esp. for children and young people
|
|
|
Obesity
|
High priority, sub-goal of 2 out six
national health targets, Federal Government is working on a “National Action
Plan for prevention of malnutrition, physical inactivity, obesity, and their
health consequences”
|
See comments 10.2.4 and 10.2.5!
Obesity is subject to Federal Health
Reporting. Adult’s and children’s body weight is
monitored at National Health Surveys (see www.rki.de).
|
|
|
Genomics and public health
|
High priority as of high political, social
and economic importance and subject to many national and international regulations.
|
Genetic Engineering is regulated by
Genetic Engineering Act (Gentechnikgesetz).
Federal Office of Consumer Protection and
Food Safety (Bundesamt für Verbraucherschutz und Lebensmittelsicherheit, BVL,
see www.bvl.bund.de) - federal
authority responsible for the field of genetic engineering/experimental use
of genetically modified organisms, their safety evaluation and approval for
experimental releases as well as environmental monitoring.
Pharmaceuticals and medical devices
produced using genetic engineering are not only subject to Medicines Act and
usual approval procedures (see Federal Institute for Drugs and Medical
Devices/Bundesinstituts für Arzneimittel und Medizinprodukte, www.bfarm.de), but to national and European
regulations concerning genetic engineering and epizootic diseases. Gene
therapy as well is closely controlled: its surveillance is part of the
responsibilities of Paul-Ehrlich-Institute, a National institution reporting
to Federal Ministry of Health (Paul-Ehrlich-Institut, see www.pei.de). For additional information see e.
g. German Registry for Somatic Gene-Transfer Trials (Deutsches Register für
somatische Gentransferstudien, www.dereg.de)
and Committee for Somatic Gene Therapy of the German Medical Association
(Kommission Somatische Gentherapie der Bundesärztekammer, see www.bäk.de)
Usage of stem cells and embryo derived
material for research and other purposes is regulated by Embryo Protection
Act (Embryonenschutzgesetz) and Stem Cell Act (Stammzellgesetz). Further
references to bioethical subjects see e. g. Federal Ministry of Justice
(Bundesministerium der Justiz, www.bmj.Bund.de)
and German Reference Centre for Ethics in Life Sciences (Deutsches
Referenzzentrum für Ethik in Biowissenschaften, www.drze.de).
|
|
|
Hypertension
|
High priority
|
§ 25 SGB V Preventive Health examination
(Gesundheitsvorsorge, so called „Check-up 35“); Persons within the statuory
health insurance system have the oppurtunity to get a medical examination
free of charge, every 2 years (as of the age of 35);
within the framework of disease management
programmes, e.g. DMP CVD, structured hypertension training
Bloodpressure is monitored as part of
national health surveys conducted by Robert Koch-Institute (see www.rki.de)
|
|
B) Actions adopted in relation with EU initiatives to
improve public health
COUNTRY: IRELAND
A) Prevention and control instruments and
initiatives adopted at national or local level on major health determinants
|
Determinants
|
Level of Priority for Public Health Interventions
|
Main regulations adopted
|
Main programmes on citizen empowerment
|
|
Health-related behaviours
|
|
|
|
|
Smoking and tobacco snuff use
|
High
|
Joint Committee on Health and Children examined the
issue of smoking and health (1999 & 2001).
Tobacco Free Policy Review Group established (1998 –
2000). http://www.irlgov.ie/committees-99/c-health/Rep-H&S/default.htm
From August 2001 the legal age to purchase tobacco
rose from 16 to 18 years of age
Public Health (Tobacco) Acts, 2002 and 2004
-
Establishment of
statutory agency, the Office of Tobacco Control, in 2002 www.otc.ie
-
Introduction of
smoke-free workplace legislation in March 2004
-
From May 2007 it
became illegal to sell cigarettes in packs less than 20. The sale of
confectioneries that resemble tobacco products also become illegal
Ratification of WHO Framework Convention on Tobacco
Control (FCTC) (Nov 2005)
Increase in excise duties charged on tobacco in the
“interests of improved public health” (Dec 2006 and Dec 2007)
Further provisions of the Public Health (Tobacco)
Acts, 2002 and 2004 to be commenced from 1 July 2009:-
·
ban on all
in-store/point-of-sale advertising of tobacco products,
·
ban on the display of
tobacco products in retail premises,
·
introduction of a
closed container / dispenser provision,
·
tighter controls on
the location and operation of tobacco vending machines,
·
introduction of a
retail register for tobacco retailers
|
Nicotine Replacement Therapies made available
free of charge to medical card holders on prescription (April 2001)
National Information Campaign highlighting the
introduction of smoke-free workplaces. (2003 & 2004)
National Information Campaign highlighting the
responsibility of retailers not to sell tobacco to those under 18 years
(2007)
|
|
Alcohol consumption
|
High
|
|
Public Awareness Campaigns run by the Health Service
Executive
www.hse.ie
|
|
Food choices and nutrition
|
High
|
|
A National Nutrition Policy will be published later
this year.
|
|
Physical activity
|
High
|
|
Guidelines are being published.
|
|
Drugs and substance abuse
|
High
|
The Misuse of Drugs Act 1977 and the Regulations made thereunder
regulate and control the import, export, production, supply and possession of
a range of named narcotic drugs and psychotropic substances listed in the
schedules to the Act. Substances are scheduled under the Act in accordance
with the Department's obligations under international conventions and/or
where there is evidence that the substances are causing significant harm to
public health in Ireland, which could merit the criminalisation of their sale
and use.
|
Funding
is being provided for locally-based
cocaine awareness campaigns that will dovetail with
the national HSE campaign.
The local campaigns will be run by the
Local and Regional Drugs Task Forces.
Local and Regional Drugs Task Forces
which are partnerships between community,
voluntary and statutory agencies,
develop action plans to deal with
drug misuse within their areas of responsibility.
The role of LDTFs and RDTFs is to research,
develop, implement and monitor
a co-ordinated response to illicit drug use
at local/regional level, based on evidence
based best practice.
|
|
Safety awareness
|
High
|
|
Hand washing
advertising campaign
empowering public
to report failures
to wash hands
Publication of
annual National Hygiene
Services Quality
Review
(last review
published Nov 2007)
The Health
Information and Quality Authority
established in May
2007.
Role includes the
setting and monitoring
standards as well
as conducting investigations
and its findings
will generally be published.
Commission on
Patient Safety and Quality
established in
January 2007.
Will report summer
2008. The Commisison
includes patient
representatives and
has invited and
received
submissions from
the public.
|
|
Environmental determinants and settings
|
|
Air pollution
|
High
|
-
Air Pollution Act, 1987
-
Environmental Protection
Agency Act, 1992
-
Protection of the
Environment Act, 1993
-
Air Quality Standards
Regulations 2002
-
Emissions of Volatile
Organic Compounds from Organic Solvents Regulations 2002
-
Air Pollution Act 1987
(Marketing, Sale and Distribution of Fuels) (Amendment) Regulations 2003
-
Air Pollution Act 1987
(Environmental Specifications for Petrol and Diesel Fuels) Regulations 2003
-
Large Combustion Plants
Regulations 2003
-
Air Pollution Act 1987
(Environmental Specifications for Petrol and Diesel Fuels) (Amendment)
Regulations 2004
-
Ozone in Ambient Air
Regulations 2004
-
European Communities
(National Emissions Ceilings) Regulations, 2004.
-
Air Pollution Act 1987
(Marketing, Sale and Distribution of Fuels) (Amendment) Regulations 2004
-
Control of Substances
that deplete the Ozone Layer Regs, 2006.
-
Limitation of Emissions
of Volatile Organic Compounds due to the Use of Organic Solvents in Certain
Paints, Varnishes and Vehicle Refinishing Products 2007.
-
European Communities
(control of emissions of Gaseous and Particulate Pollutants from non-road
Mobile machinery) regulations 2007
|
|
|
Drinking and recreational water
|
High
Intermediate
|
-
Quality of Bathing
Water Regulations 1992 (as amended),
-
Bathing Water Quality
Regulations 2008
- European Communities (Good Agricultural Practice
for Protection of Waters) Regulations 2006 & 2007
|
Public consultation on making of Bathing Water
Quality Regulations 2008 and provisions in these regulations for public
participation and provision of information to the public
Involved public consultation with farming
representative bodies before the making of the Good Agricultural Practice for
Protection of Waters Regulations.
|
|
Soil contamination and waste disposal
|
High
|
Waste Management Acts 1996-2008
|
Public consultation on making of legislation and
provision in the legislation for access to information and public
participation by the public.
|
|
Selected chemical contaminants
|
High
|
REACH – in force since June 2007
Chemicals Bills 2008
|
See www.hsa.ie and www.entemp.ie
Public consultation on the making of legislation.
Public awareness campaign in advance of introduction of REACH.
|
|
Use of pesticides
|
High/Intermediate
|
S.I. 83 of 2003 - authorisation of plant
protection products
S.I. 624 of 2001 -
classification, packaging & labelling of plant protection products and
biocides
S.I. 625 of 2001 -
authorisation of biocides
S.I. 179 of 1999 - pesticide
residues in products of plant origin including fruit and vegetables
S.I. 180 of 1999 - pesticide
residues in foodstuffs of animal origin
S.I. 181 of 1999 - pesticide
residues in cereals
S.I. 654 of 2006 - pesticide
residues regulations
S.I. 910 0f 2005 - food & feed hygiene regulations
S.I. 220 of 2003 - dangerous
substances & preparations marketing and use regulations
S.I. 135 of 1995 - import and
export of certain dangerous chemicals
S.I. 317 of 2003 - pesticide
residues feedingstuffs
S.I. 320 of 1981 - prohibition
of certain active substances in plant protection products
|
For
further information see
http://www.pcs.agriculture.gov.ie
|
|
Physical stressors
|
Intermediate
Intermediate
|
-
Environmental Protection
Agency Act, 1992.
-
Protection of the
Environment Act, 1993.
-
Environmental Noise
Regulations, 2006.
-
Residential Tenancies
Act, 2004
Radiological Protection Institute of Ireland is the
stautory body that monitors and advises on matters relating to ionising
radiation
|
Implementation by Local Authorities.
Office of Environmental Enforcement (OEE)
of the Environmental Protection Agency
See www.rpii.ie
Process of consultation with the public on the
direction and priorities of the RPII, including, inter alia, information,
monitoring and support services.
|
|
Poverty
|
High
|
No specific regulations
|
The
National Action Plan for Social
Inclusion 2007-2016 includes commitments
and targets across a number of Government
policy areas, including health, aimed at
tackling poverty and addressing health
inequalities.
http://www.socialinclusion.ie/
documents/NAPinclusionreportPDF
.pdf .
The Senior Officials Group on Social
Inclusion, Integration and Children
(SOGSI) provides a cross-Departmental
forum to progress initiatives aimed at
tackling the social determinants of
health and protecting vulnerable groups
in society.
|
|
Gender issues
|
High
|
|
The Women's Health Council continues to
advise the Minister on issues relating to women's health and works with the
HSE on gender mainstreaming health policies. The Department will publish a
Men's Health Policy later this year.
|
|
Work-related health issues
|
High
|
Safety, Health and Welfare at Work Act 2005
(No. 10 of 2005)
|
Health and Safety Authority Strategy 2007 – 2009.
Health and Safety Authority Programme of Work 2008
(Updated Annually)
www.hsa.ie
|
|
Deprivation factors
|
High
|
No specific regulations
|
See poverty
|
|
Others
|
|
|
|
|
Psychosocial health determinants
|
High
|
Mental Health Act 2001
http://acts.oireachtas.ie/en.act.2001.0025.1.html
Mental Health Act 2001
(Approved Centres) Regulations
2006
http://www.dohc.ie/legislation/statutory_instruments/pdf/si20060551.pdf
|
A Vision for Change – Report of the
Expert Group on Mental Health Policy
http://www.dohc.ie/publications/vision_for_change.html
Reach Out -National Strategy for Action
on Suicide Prevention
http://www.dohc.ie/publications/reach_out.html
Establishment of the Office for Disability
and Mental Health (Jan 08)
National Media Campaign – Your Mental Health
(ongoing – launched Oct 07)
http://www.nosp.ie/cgi-bin/show.cgi?news1
Establishment of iNSUE in 2007
(Interim National Services Users Executive)
Introduction of Mental Health Tribunals
to provide an automatic and independent
review of involuntary detentions in
order to ensure the protection of
rights of patients (Nov 06)
Establishment of the National Office for
Suicide Prevention (2005)
|
|
Obesity
|
High
|
|
A major campaign ‘Little Steps Go A Long Way’
was launched on June 16th 2008.
|
|
|
|
|
|
B) Actions adopted by Member States in relation with
EU initiatives to improve public health
C) OTHER INFORMATION ON NATIONAL HEALTH
POLICIES AND REPORTS (IRELAND)
http://www.dohc.ie/publications/quality_and_fairness.html
A new National Health Strategy Quality and Fairness: A Health System for You
was launched in November 2001. The Strategy set out key objectives for the
health system up to 2010 which are based on the following national goals:
·
Better Health for
Everyone
·
Fair
Access
·
Responsive
and Appropriate Care
·
High
Performance
An associated strategy for Primary Care, Primary Care:
A New Direction was also launched. http://www.dohc.ie/publications/primary_care_a_new_direction.html
Health Reform Programme:
http://www.healthreform.ie/
Recognising that new structures and supporting processes
were needed to better meet health needs, as expressed in the Strategy, the
Health Service Reform Programme was announced in June 2003. The reforms are
designed to achieve a health service that provides high quality care, better
value for money and improves health care management.
http://www.hse.ie/eng/
The HSE was established in January 2005 under the
Health Act 2004. The HSE is a single national structure with responsibility
for the delivery of health and personal social services – it replaced and
assumed the functions of the former health board/area board structures and
other specified health agencies which were abolished as part of a major
rationalisation of health service agencies.
The HSE must submit a three-year corporate
plan and an annual service plan to the Minister for approval. Arrangements
have been formalised for planning services and monitoring activity and
expenditure based around these plans. The Executive must also submit a Code of
Governance to the Minister for approval and publish an annual report and
financial statement.
www.dohc.ie
The Department of Health and Children was restructured
in 2005 to focus more clearly on policy, legislative and oversight functions,
with executive functions gradually being transferred to the HSE. Additionally,
three separate offices dealing with (i) children, (ii) older people and (iii)
disability and mental health were established with a view to bringing greater
cohesion to structures across the public service supporting each of these
particular service areas.
HIQA was established in 2007 under the Health Act
2007. HIQA is charged with promoting the delivery of high quality health and
personal social services by setting and monitoring standards for service
delivery and by undertaking special investigations on issues relating to
patient safety. HIQA incorporates the Office of the Chief Inspector of Social
Services which has specific statutory functions in relation to residential
care of children, older people and people with disabilities.
The Health Reform Programme is supported by
legislation, primarily the Health Act 2004 and the Health Act 2007.
Health Act 2004: http://www.dohc.ie/legislation/acts/?year=2004&number=42
Health Act 2007: http://www.dohc.ie/legislation/acts/?year=2007&number=23
Work is proceeding in relation to the development of
proposals for health information legislation which will an information
governance framework for the health service and the aim is to publish a Health
Information Bill in 2009.
Other important pieces of legislation include;
http://www.dohc.ie/legislation/acts/?year=2005&number=27
http://www.dohc.ie/legislation/acts/?year=2007&number=20
Medical Practitioners Act 2007: http://www.dohc.ie/legislation/acts/?year=2007&number=25
Investment in the health sector has
increased significantly since 1997 from €3.67 billion to over €16 billion in
2008.
Some Key Policy /Service Developments are in the areas
of:
·
Children and Families
·
Primary Care
·
Cancer Control
·
Acute Hospitals
·
Disability and Mental
Health
·
Older People
Children and Families
http://www.omcya.ie/viewdoc.asp?DocID=120
As already signalled, the Office
of the Minister for Children (OMC) was established in 2005 to achieve better
outcomes for children by:
· Setting the strategic policy
direction for services for children;
· Monitoring and driving the
implementation of the National Children’s Strategy;
· Encouraging and supporting inter
agency working;
· Fostering a child-centred
approach to service delivery for children.
Current
policy provides for the expansion of primary care services and the development
of Primary Care Teams and Primary Care Networks in line with the Primary Care
Strategy Primary Care - A New Direction and the National Health Strategy
goal of providing responsive and appropriate care. Central to this expansion
is a parallel shift in appropriate activity from hospitals to community-based
settings.
Other
primary care objectives include:
- Improving the prevention and management of
chronic diseases including diabetes, http://www.dohc.ie/publications/diabetes.html
obesity http://www.dohc.ie/publications/report_taskforce_on_obesity.html
heart disease. http://www.dohc.ie/publications/building_healthier_hearts.html
- Addressing health inequalities through the development of
integrated approaches within the health sector to improve access to mainstream
services.
- Improving the promotion, prevention and protection of public
health by implementing a range of programmes in health
promotion, immunisation against infectious diseases, food/water/air
safety, screening and emergency planning.
http://www.allirelandnci.org/pdf/Ireland_cancer_control_2006.pdf
Government policy is to implement
‘A Strategy for Cancer Control in Ireland 2006’
which aims to improve the
organisation, governance and quality of cancer care from prevention and
screening through to treatment services, supportive and palliative care and
research.
The HSE National Cancer Control
Programme is designed to implement the Strategy. The decisions of the HSE in
relation to four managed cancer control networks and eight cancer centres will
be implemented on a managed and phased basis.
In
addition, the Health, Information & Quality Authority has a significant
role in setting standards in Cancer Control, in monitoring implementation of
those standards, in enhancing health information and in conducting health
technology assessment.
The Government is committed to
the provision of safe, high quality hospital services that deliver the best
possible outcomes for patients in line with best practice. The delivery of
hospital services needs to be rebalanced so that in the future those services
that can be safely delivered locally are delivered locally, more complex
services requiring specialist input are concentrated at regional centres and
highly specialised services are delivered in national centres.
Current objectives for the
development of acute hospitals include:
·
Hospital
networks that provide quality care as close as possible to where people live.
·
Equitable
access for public and private patients to public hospitals.
·
Reduction in
inappropriate use of acute facilities and in the average length of stay of
patients
The National Disability Strategy
http://www.nda.ie/cntmgmtnew.nsf/0/A7317F78E8F7919380256F18005A5CFC?OpenDocument
provides a framework of new supports for
people with disabilities. It emphasises equality, in line with recent
legislation, and places the policy of mainstreaming of services for people with
disabilities on a legal footing. The main elements of the Strategy are:
·
*Disability Act 2005
·
**Education for Persons
with Special Educational Needs Act 2004
·
Sectoral Plans of six
Government Departments.
·
***Citizens Information
Act 2007
*http://www.oireachtas.ie/viewdoc.asp?DocID=4338
**//www.oireachtas.ie/viewdoc.asp?fn=/documents/bills28/acts/2004/A3004.pdf
***//www.oireachtas.ie/viewdoc.asp?fn=/documents/bills28/acts/2007/a207.pdf
The Department of Health and Children
published its Sectoral Plan for provision of health and personal social
services to people with disabilities in July 2006.
http://www.dohc.ie/publications/fulltext/disability_sectoral_plan/
A Vision for Change, a new National Policy Framework for the mental health
services was published in January 2006. National policy is to develop mental health
services in line with the recommendations of this framework and to reduce
levels of suicide and deliberate self harm in line with the recommendations of Reach
Out - the Suicide Prevention Strategy published in 2005. http://www.dohc.ie/publications/vision_for_change.html
http://www.dohc.ie/publications/reach_out.html
As already outlined, in
recognition of the need for a whole Government wide approach and general
co-ordination of actions across the public sector on the implementation of
these strategies and plans, the Office for Disability and Mental Health was
established in January 2008.
The proportion of older people
in the population is increasing. It is now at 11% of the overall population,
but it is expected that the numbers in the over-65 age group will more than
triple between now and 2050. Life expectancy is also increasing. Ensuring that
this sector of the population remains healthy and is provided with necessary
services is a significant challenge and a strategy on positive ageing will be
prepared to consider how the challenge can best be met.
Current
national policy is to develop appropriate home and community based services
such as home care packages, home help services and day services and to improve
the quality and availability of affordable residential care
for older people who can no longer live at home. Where residential
care is necessary, the proposed new nursing home support scheme – A
Fair Deal –
http://www.dohc.ie/publications/pdf/a_fair_deal_2008_guide(1).pdf
will
provide a single standard system for admission to, and payment for, nursing
home facilities for those assessed as in need of nursing home care.
The
cross-sectoral nature of service requirements has been recognised in the
establishment of a separate Office for Older People within the Department.
Key Health Data
Slán Survey
http://www.slan06.ie/
SLÁN is a national survey of the lifestyle,
attitudes and nutrition of people living in Ireland. To date surveys have been
carried out in 1998, 2002 and 2007. SLÁN 2007 is the largest survey to date.
The survey covers general health, behaviours relating to health (e.g. exercise,
nutrition) and the use of certain health services. In addition, over 1,200
people who participated in the survey also participated in a detailed medical
examination.
Health in Ireland Key Trends 2007
http://www.dohc.ie/statistics/
This booklet provides an overview of selected
key trends in health in Ireland in recent years. Tables and graphs are
presented which summarise information on demographics, on health status and on
health care in order to give a quick reference guide in major areas of health
and health services.
Health Statistics Ireland 2005 http://www.dohc.ie/publications/health_stats_2005.html
This compendium of health statistics brings
together data from a wide variety of sources on demography, health status and
the delivery of health services. It provides a broad overview of health in
Ireland as well as serving as a resource and reference for those interested in
particular aspects of health and the health services. The report’s format
continues to reflect a shift away from viewing health in terms of illness to a
more population-based approach with an emphasis on improving health and
promoting healthy lifestyles. A 2008 edition is due out later this year.
COUNTRY: GREECE
A) Prevention and control instruments and
initiatives adopted at national or local level on major health determinants
|
Determinants
|
Level of Priority for Public Health Interventions
|
Main regulations adopted
|
Main programmes on citizen empowerment
|
|
Health-related behaviours
|
|
|
|
|
Smoking and tobacco snuff use
|
High
|
·
According Ministerial
Decisions 76017 (1-8-2002) and 82942 (12-9-2003) smoking is forbidden in all public areas, units
providing health services, public transportations and private working areas.
The applied national framework of law allows specific smoking areas.
·
The Common Ministerial
Decision 266 is in compliance with Community Directive
37/2001/ΕΚ, which arranges tobacco production and
sale issues, and the Community Directive 33/2003/ΕΚ which regulates tobacco advertisement and sponsoring.
·
Law 3420/2005
validated the Contract of the World Health Organization for tobacco control
and Greece became a party of the contract with vote rights in 27-04-2006.
The Ministry of Health and Social Solidarity process
a law for the forbiddance of tobacco sale from and to juveniles in compliance
with the Article 16 of the WHO‘s Contract.
|
The Ministry of Health and Social
Solidarity (www.mohaw.gr) enforced the
antismoking campaign and raised the frequency of antismoking messages in the
mass media.
|
|
Alcohol consumption
|
Intermediate
|
Alcohol consumption is forbidden in Bars, Pubs,
Clubs etc
for teenagers younger than 17 years old
|
|
|
Food choices and nutrition
|
High
|
Ministerial
Decision 30528/ (23.3.2005) concerning the reconstruction of the National
Committee for Nutrition Policy.
Ministerial Decision 93828 / 2006, concerning the
permissibly kind of foods, being disposed to children by school buffets.
Also, according the same Decision, the trans lipids of foods are restricted.
|
Many
campaign programs for encouraging citizens to adopt the Mediterranean type of
diet.
Especially, concerning Breast Feeding the Ministry of
Health and Social Solidarity organizes many programmes in order to bring on
light the benefits of breast feeding. Also, the Ministry of Health
participates in the World Week of Breast Feeding and charged the Institute of
Child Health (www.ich.gr) to conduct a
Pan-hellenic study concerning the attributive factors of Breast Feeding
|
|
Physical activity
|
Intermediate
|
|
Main campaign programs
|
|
Drugs and substance abuse
|
High
|
|
|
|
Sexual behaviour
|
High for HIV and transmission diseases
|
|
The Hellenic Centre for Diseases Control and
Prevention (HCDCP) (www.keel.org.gr) has an active role in the prevention of HIV/AIDS
and other sexually transmitted diseases (i.e. Hepatitis B & C, HPV,
Syphilis, and Gonorrhea). It has developed a network of services aiming to
the management of the above cases of patients.
Furthermore the last years HCDCP gave an emphasis to
the health education of the public especially for the sexually transmitted diseases.
The department of HCDCP in Thessaloniki (the second
biggest city in Greece) has an active collaboration with the regional
authorities (i.e. schools, municipalities) of 18 Districts in Greece. More
precisely, it supports sexual health education programs in the schools, in
the Centre for accommodation of the refugees, in the Medicines sans
Frontiers, etc. The last two years 3,158 schoolchildren have been educated in
sexual health.
Recently the Hellenic Ministry of Health and Social
Solidarity has developed the Hellenic National Plan for combating HIV/AIDS
and has given a high priority to the prevention of HIV/AIDS
through the participation and the empowerment of civil society.
Also, the HCDCP supports a hotline in the Andreas
Sigros Hospital (a big dermatological and venereal disease hospital, in
Athens) that offers psychological support and information for the prevention
and the management of HIV infection. According to the data the hotline has
received 51,428 calls. The majority of them included information about the
tests to be performed for the diagnosis of HIV/AIDS and
on the measures for the prevention of HIV/AIDS
transmission.
Moreover, HCDCP provides psychosocial support for persons
living with the HIV virus and for the persons in their environment, through
the provision of: support on issues of interpersonal relations in the family,
social and working environment and on the difficulties in daily life;
assistance in carrying out welfare modalities.
Finally,
special events (including free disposal of condoms to public, disposal of
leaflets) and campaigns are co-organised by the Ministry of Health and the HCDCP, especially on 1st of
December (International Day for AIDS)
|
|
Personal hygiene
|
Low
|
|
|
|
Safety awareness
|
High
|
o
An adequate number of Reporting Centers for some diseases (e.g AIDS, Influenza, Hepatitis
etc) are running in Greece.
o
Our National
Organization of Medicines (EOF) runs continually a program of Pharmacovigilance
|
o
Greece participates in
a European program with the title “Satellites for Epidemiology and health
early warning’’ (ESA AO/1-4914/05/F/IZ, Duration: 01/07/2006-31/12/2007)
The SAFE project, co-funded by the
European Space Agency (ESA), will develop and demonstrate the added value of
satellite communication services, including low and high bandwidth access to
Internet, co-operative working and geolocalisation for all phases of
biological crisis including prevention, early warning, and crisis management.
SAFE aims to establish a roadmap for ESA to determine how satellite services,
by enabling or restoring access to information can be integrated in European
healthcare systems and civil protection authorities. The SAFE project is part
of the ESA telemedicine via satellite transition phase set up to pave the way
for the creation of a European user-driven telemedicine via satellite
programme. ESA together with the World Health Organization (WHO) is joining
forces for reaching this goal. ESA through SAFE and with the assistance of
WHO will specify, develop, and demonstrate a European outbreak early warning
system that will become a key tool for the national and European bodies in
charge of epidemiological surveillance and especially the European Center for
Disease Control (ECDC). SAFE aims towards a better assessment of the
epidemiological risk based on real-time objective data, which is a strategic
objective not only for public health policy but also for the eHealth
industry. An end-to-end case of early warning at the onset of an epidemic
will be demonstrated at the Heraklion prefecture, in the island of Crete,
Greece. The scenario based on epidemiological monitoring after an earthquake,
namely the onset of typhoid fever, will validate the SAFE approach within the
user community and if successful it could become part of regular earthquake
readiness exercises. Furthermore, other demonstrations will be envisaged an
implemented, namely related to avian flu and biological and radiological
threats. These itinerant and on-demand demonstrations will be implemented all
over Europe upon user-request, promoting the added value of SAFE and allowing
potential end-users and stakeholders to assess the demonstration according to
relevant criteria such us availability, interoperability, security. (source: www.ics.forth.gr)
|
|
Environmental determinants and settings
|
|
Air pollution
|
High
|
o
Law 3010/2002
concerning emissions by industries, in compliance with the Council Directive
97/11 and 96/61
o
Common
Ministerial Decision 37411/1829/E 103 defining the relevant bodies, measures
and procedures for the implementation of the Council Directive 2037/2000 concerning the
substances which destroy the layer of ozone.
o
Ministerial
Decision 21475/4707 (published in 1998) concerning measures for containment
of CO2
|
o
The Ministry of
Environment, Physical Planning and Public Works (www.minenv.gr) has undertaken a number of
actions to facilitate the efficient and wider possible involvement of Greek
schools in the Programme GLOBE (Global Learning and Observations to Benefit the
Environment), which aims to establish a transnational network of schools in
order to exchange information about air pollution via internet. It was supposed
that in the participating schools would operate measurement stations for
estimating air pollution. The module of
GLOBE programme for Greece, is called ALEXANDROS
It should be also mentioned that a Steering Committee
consisting of representatives from the Ministry of Environment, the Ministry
of Education and the University of Athens has been established to monitor the
progress of ALEXANDROS.
The three year implementation phase of ALEXANDROS approved on 10 June 1996.
The University of Athens awarded to operate, monitor and support this phase.
o
The
last 5-6 years citizens are encouraged to use Natural Gas for heating
homes. For this purpose, Gas Supply Companies organize campaigns in order to
familiarize residents with the usage and benefits of natural gas. Moreover,
they provide the citizens with some economic initiatives (e.g discounts on
connections fees)
o
In
Greece, all vehicles are obliged to have an Exhaust Control Card which
is updated at least every year.
o
Also, the Ministry has
developed the Greek Web page for the Integrated Pollution Prevention and
Control (IPPC).
The introduction of the IPPC Directive in the European Union aims at the
improvement and upgrading of the environmental protection. Prevention
measures are specified, or where that is not practicable, measures that
reduce emissions to air, land and water from the industrial activities are
proposed. In this manner, a high level of integrated environmental protection
can be archived.
o
Moreover, every day a Report
of Emissions (O3, NO2, SO2, CO, PM-10,
and snuff) is published on the site of the Ministry
o
Useful information
about air pollution and the measures for air protection is published on the
site of the Ministry. Moreover, some non-governmental and non profitable
organizations are organizing intelligent campaigns and actions in order to
familiarize residents with the problem of air pollution and air protection
measures.
o
Finally, a campaign
concerning “The European Day without Car” is organized annually by the
Ministry in order to encourage citizens to participate in this action
|
|
Drinking and recreational water
|
High
|
A progressive system of pricing water consumption is
applied in order to avoid public of water over-consumption
|
Many campaigns (e.g TV spots, leaflets, events etc)
for saving water
|
|
Soil contamination and waste disposal
|
High
|
o
law 2939/01
regarding "Packaging and Alternative Management of Packaging and other
Waste" was enacted. This law makes packaging alternative management
mandatory in our country and conforms our legislation with the relative
legislation of the European Union and in particular with the European Directive 94/62.
o
The
Ministry for the Environment, Planning and Public Works, with its Ministerial
decision number 106453/20-02-2003 approves the Collective Alternative
packaging Management System (CAMS - RECYCLING), which is organised by HERRCo
(Hellenic Recovery Recycling Cooperation) and relates to the collection,
transfer, reuse and recovery of packaging waste.
o
Law 3010/2002 «Updating the law 1650/86 (for environmental protection) in compliance with Council Directives 97/11 and 96/61.
o
Common Ministerial
Decision 29407/3508/2002 in compliance with the Council Directive 99/31
concerning the sanitary land fill of waste
The last decade many sanitary landfills
have been developed in Greece, and most of them have been partly funded by
the E.U
o
Common Ministerial Decision
50910/2727/2003 “Measures and terms for the management of solid soils. National and
Regional Planning”
o
Presidential Degree
117/2004 Measures, terms and program for the
alternative management of Waste Electrical and Electronic Equipment (WEEE) in
compliance with the provisions of the Council Directive 2002/95 “on the
restriction of the use of certain hazardous substances in electrical and
electronic equipment” and Council Directive 2002/96 “on waste electrical and
electronic equipment” of 27 January 2003.
o
The
producers of Electric and Electronic Equipment-EEE are obliged to organise
either an Individual System or to join a Collective System of Management of
WEEE that concern their activity, at application of article of 17, Law
2939/2001 and in accordance with the special terms that are provided for, in
the Presidential Decree 117/2004.
|
Hellenic Recovery Recycling Cooperation-HERRCo (www.hercco.gr) uses tools for the promotion
of its programme, such as intelligent advertising campaigns, easily
understood slogans, hand-outs, stickers, etc.
HERRCo co-organises with the Municipalities different
events at big commercial points, such as the setting up of pavilions, the
distribution of leaflets and small advertising gifts, with an aim to
sensitize and educate the citizens in order to adopt and to promote recycling
programmes that will upgrade their lives.
One of the most progressive ways of promoting the
CAMS - RECYCLING is the distribution - to the citizens of the region, where
the recycling programme is implemented - of a special reusable bag of 35 litres accompanied by the appropriate informative material. The packaging that is part of the
programme is: aluminium tins (beer, refreshments), glass bottles, plastic
bottles (water, refreshments, detergents, foodstuffs), metal cans (milk or
foodstuffs), the cardboards and the paper cartons of liquid products (juices
and milk) and finally, the printed paper from newspapers, magazines and
books.
The citizens participating in the programme must
store in this bag all the above mentioned packaging empty and clean. Then,
they must empty the content in the blue recycling bins that have been placed
in various selected points and keep the bag for the next use.
Another
company (non profitable too) specialized in the area of battery recycling was established in 2005,
called AFIS (www.afis.gr). Many recycling
bins have been placed in Municipalities, Schools, Industries, Super Markets, Hotels, Hospitals, etc. A dynamic advertising
campaign (TV spots, leaflets, events) is running in order to encourage
citizens to participate to the recycling program of batteries
|
|
Selected chemical contaminants
|
High
|
o
Common Ministerial Decision 8668/2007 “Acceptance of the National Plan for the Management of Hazardous Waste”,
o
Ministerial Decision
13588/725/2006 “Measures, terms
and limitations for the management of hazardous waste in compliance with Council Directive 91/689 “for the
hazardous waste” of 12th
December 1991”.
o
Presidential Degree
116/2004 “Measures, terms and program for the alternative management of vehicles
at the end of life in compliance with the Council Directive 2000/53 “for vehicles
at the end of life (ELV)” of 18th September 2000”
Alternative Management Vehicles Hellas - AMVH is an
approved and licensed collective system (resolution number 105136/GG
907B/17-06-04) for the alternative management of ELV's, in Greece. AMVH is a
non-profitable organization established in January 2004 by the 33 official
importers of vehicles, according to law 2939/01 about recycling.
o
Especially for the
management of Hospital Waste it has been approved the Common Ministerial
Decision 37591/2031/2003.
In compliance with the above Decision, hospitals have
to be obtained with the appropriate equipment for the management of their
waste. Moreover, they have to organise courses in order to educate their
personnel in handling hazardous medical waste. Also, hospitals are obliged to
use different waste bins, for each kind of biologic waste, marked with
defined colours
It is remarkable, that the last few years, more and
more hospital managers are trying to implement the Environment Management
System ISO 14000 / ISO 14001.
|
|
|
Use of pesticides
|
high
|
|
|
|
Food safety
|
high
|
o
Law 2741/1999
concerning the establishment and the operation of the Hellenic Food Authority
(EFET)
o
Common Ministerial
Decision 487 (published in 2000) concerning the hygiene of foods in
compliance with the EU Directive 93/43. According this regulation all food
industries are obliged to be certified with HACCP
o
Common Ministerial
Decision 588 (published in 2000) concerning the establishment of a Scientific
Committee for monitoring and controlling the circulation of foods which
contain genetic modified organisms.
o
Ministerial Decisions
34258 and 100 (published in 2002) concerning the determination of additional
measures for food control in compliance with the E.U Regulation 93/99.
o
Common Ministerial
Decision 245090/11.1.2006 for determining additional measures for the
implementation of the Council Directive 2092/91 concerning the biological
production of agricultural products.
|
In Greece, the main authority for food safety is the Hellenic Food Authority (www.efet.gr). The
principal aim of EFET is to take all reasonable steps to ensure that food
produced, distributed or marketed in Greece meets the highest standards of
food safety and hygiene reasonably available and to ensure that food complies
with legal requirements, or where appropriate with recognised codes of good
practice.
EFET has national responsibility for co-ordinating
the enforcement of food safety legislation in Greece. This is achieved by
applying an integrated and coherent official food control system after
primary production, enforced by the local authorities and supervised by
EFET's regional directorates, so as to amplify its efficiency and to ensure
its consistency. At the same time, EFET takes all the necessary steps to protect
consumers' from misleading practices and food fraud.
EFET is also established as the national contact
point of the European Union for the management of the Rapid Alert System of
Food (RASFF) and for Codex Alimentarius.
Also, on the EFET site there are lists of approved
food establishments such as:
Approved meat and meat products
establishments
Approved milk and dairy products
establishments
Approved fishery products establishments
Approved egg products establishments
Finally, the General Consumer Secretary (www.efpolis.gr) is organizing plenty of
campaigns in order to provide information to citizens on food safety matters
and to encourage the public to accuse any case of low and improper quality
food, either to EFET or to Consumer Secretary
|
|
Physical stressors
|
intermediate
|
|
|
|
Human settlements
|
intermediate
|
|
|
|
Transportation including road safety
|
high
|
Law 3542/2007 Code about road safety
|
o
Law 3542/2007 (in
comparison with the previous code 2696/1999) makes stricter the regulations
about the use of helmets and seat belts, by expanding their obligatory use to
the passengers of the vehicles. Moreover the recent law doubles or even
triples the pecuniary offences and the point system penalties for the violation
of the regulations.
o
TV spots are used by
the Ministry of Transportation in order to improve the citizen’s compliance
with the above mentioned regulations
|
|
Extreme weather events and health
|
high
|
o The direction 1299/2003 of the Ministry of
Interior approved the General Plan for Citizen’s Protection with the code
name “Xenokratis”, which among others determines the means and the acting
plan to encounter with the consequences of extreme weather conditions
(floods, thunderstorms, snowfall, frost, heat, etc.)
|
The General Secretariat for Citizen’s
Protection provides print outs with instructions concerning protection
against the natural hazards. The same instructions are available through the
website of the authority (www.civilprotection.gr).
Online there are also available instructional games for children, which
provide useful instructions concerning the prevention of the consequences of
the extreme weather conditions.
|
|
Socio-economic determinants
|
|
Poverty
|
high
|
o Recently (15/1/2008) the Greek Parliament
approved a fund by the Ministry of National Economy and Economics concerning
the establishment of a National Fund of Social Solidarity. The aim of the
under approval regulation is to enhance the income of natural entities and
households in Greece, which their annual income is below the national per
year estimated limits of poverty.
o Law 2434/1996 established the Benefit of Social Solidarity for Pensioners (EKAS); law 2556/1997 enlarged
the group of the eligible pensioners, while law 2676/1999 increased the
amount of the benefit by 50% and readjusted the financial criteria for its
dispensation. Nowadays the Benefit of Social Solidarity for Pensioners is
dispensed to 360.000 eligible pensioners.
o The Greek State provides free medical and pharmaceutical care to uninsured citizens with low income in the public hospitals and other health
institutions of the National Health System.
|
|
|
Gender issues
|
high
|
o
Law 1329/1983: Modernization of the Domestic Law and adjustment to
the principle of gender equality.
o
Law 1414/1984: Gender
equality in the labour market and labour relations, according to the
directions 75/117 and 76/207 of the EU.
o
Law 2839/2000:
Balanced participation of men and women in decision-making centers.
o
Law 3488/2006: Enforcement for the equal
treatment of men and women, concerning their access to employment, to
vocational training and elevation and to the working conditions.
o
Law 3500/2006: Encounter of the domestic
violence and other regulations.
|
The General Secretariat for Gender Equality developed TV spots and
informational leaflets on issues concerning domestic violence and human
trafficking. Additional informational sources on gender issues are available
through the website of the authority (www.isotita.gr).
The General Secretariat also plans to operate a call center for the
information of the citizens. Counseling Centers in the capital provide
psychosocial support and legal advices to abused women and a hostel is
available for their lodging.
|
|
Work-related health issues
|
high
|
o
Law
1568/1985 “Health and Safety of employees”
o
Presidential
Degree 105/1995 “Minimum standards for safety or/and health signals at work
in compliance with the Council Directive: 92/58
o
Presidential
Degree 16/1996 “Minimum standards for safety and health at work in compliance
with the Council Directive 89/654’’.
o
Presidential
Degrees 88/1999, 76/2005 ‘Minimum standards for organizing working time in
compliance with the Council Directives 93/104, 2000/34’’
o
Presidential
Degrees 17/1996, 159/1999 “Measures for improving safety and health of
employees at work in compliance with the Council Directives: 89/391 and
91/383
o
Presidential
Degrees 396/ 1994, 89/1999, 155/2004 Concerning directions for using self protection
means at work by the employees in compliance with the Council Directives:
89/656, 89/655, 89/655 respectively.
o
Law
3227/2004 Concerning the duties of Occupational Physician and the
Re-organization of the General Direction of Conditions and Health at Work (of
the Ministry of Employment and Social Protection)
|
o
The Greek Ministry of
Employment and Social Protection is an active member of the European Agency for Safety and Health at
Work. So, every year the
Ministry participates in the European Campaign for Safety and Health at Work.
It organizes actions in order to communicate
information in a variety of ways (leaflets, internet, radio, TV, conferences
etc) to reach workers and workplaces. Also, the Ministry participates in the European Week for Safety and Health at
Work, which focuses on different themes, every year.
o
Especially concerning
work-related issues in hospitals in 1998 was founded the Hellenic Network of
Health Promoting Hospitals
(HNHPH-www.neahygeia.gr/foreas.php?IssueID=8&lang=en). It enumerates 23
member-hospitals (18 from the major Athens area, 4 from the rest of the
country) and is member of the European Network of Smoke Free Hospitals. It
aims to:
-
Health
promotion and education of hospitals employees
-
Improvement of the
hospital’s physical and organizational environment
-
Diffusion of evidence
based best practices and policies
-
Cooperation and
networking with local community
-
Health
promotion and education of hospitalised patients
|
|
Deprivation factors
|
high
|
|
The Greek Ministry of Employment and
Social Security (www.ypakp.gr)
participates actively in the EQUAL program, which is funded partly by the
European Union and by the European Social Fund.
The program has been designed to support a
horizontal approach of policies and services to which multiple categories of
groups-excluded or threatened with exclusion from the labor market-will have
access, and to tackle the piecemeal and uncoordinated nature of the policies
currently being implemented
It has been constructed on the basis of
nine thematic fields-measures. Eight of these are based on the four pillars
of the European Employment Strategy, while the ninth covers the needs of
asylum –seekers.
Objectives of the Program:
o
Improving
employability by:
1.
facilitating access
and return to the labor market for groups suffering discrimination
2.
combating racism and
xenophobia in relation to the labor market
o
Developing
entrepreneurship by:
3.
improving access to
the process of setting up a business
4.
strengthening the
social economy
o
Encouraging
adaptability of businesses and employees by:
5.
promoting lifelong
learning and inclusive work practices
6.
supporting the
adaptability of firms and employees
o
Strengthening the
equal opportunities policies for men and women by:
7.
reconciling the
demands of family and professional life
8.
supporting job
desegregation
9.
Supporting the social
and vocational integration of asylum-seekers
|
|
Others: Voluntarism actions
|
High
|
The
Ministry of Health and Social Solidarity is now preparing the regulations for
the establishment and the function of the “Community of Volunteers”
|
In May 2007 the Ministry of Health and
Social Solidarity announced the foundation of the National Organization
“Community of Volunteers”. Aim of the national organization is to provide
counseling services for the Non-Governmental Organizations and to interconnect the acts of
social voluntarism. It’s also responsible to highlight the voluntary acts in
order to stimulate the public opinion and to recruit new volunteers.
“Community of Volunteers” adjusts the rules and the procedures for the
certification of the Non-Governmental Organizations in health and social
solidarity and develops educational programs for the members of the
non-governmental organizations and their volunteers.
|
|
Psychosocial health determinants
|
high
|
In
1999 a major Psychiatric Reformation took place in Greece with the law N.
2716/99 and the national program entitled “Psychargos”, which was planned
both for the psychosocial rehabilitation of the mental ill (1st
phase 2000-2001) and the development of social-civic psychiatric and
psychotherapeutic services (2nd phase 2002-2006)
In addition the Psychiatric reformation allowed
non-Governmental and Voluntary Organisations to develop private
non-commercial structures for mental health care and emergency phone numbers
for immediate psychological support (under the supervision of “Psychargos”
program). Recently the majority of the Greek Universities developed
counseling centers for their students that they support for studies and student life (e.g.
test-anxiety, academic difficulties, adjustment to student life),
relationship problems (e.g. friends, fellow students, family, companion) and
other personal problems and anxiety manifestations (e.g. under-achievement,
lack of interest, bodily manifestations of psychological origin, isolation
problems).
|
Concerning the mental health of the general
population, “Psychargos” established various types of psychosocial
interventions such as:
Institutes for Mental Health and Psychosocial Support
for adults and children
Municipal bureaus of social supportive services: They
support and treat members of social groups vulnerable to psychoemotional
conflicts, such as single-parent families, abused women, refugees etc
Mobile Units for Mental Health: prevention, diagnosis
and treatment of mental and affective disorders for infant and adult
residents of inaccessible areas of the country.
|
|
Personal determinants
|
|
Obesity
|
High
|
Food industry is obliged to mention the ingredients
of packed food. Also, some regulations are applied for determining the
accepted limits of some food ingredients (e.g salt, fat, etc)
|
The Ministry of Health and Social Solidarity
(www.mohaw.gr) runs a dynamic campaign program in order to familiarize
citizens with the obesity problem and to reduce the prevalence of obesity.
Also, the
Hellenic Medical Association for Obesity (www.eiep.gr)
has a dynamic site providing citizens with information about obesity. It is a
non-governmental scientific association, operating on a non-profit basis in
Athens, Greece. According to its mission statement, its aim is to promote
"the scientific research and study of obesity and the metabolic diseases
in Greece" as well as "the scientific research in the field of
healthy nutrition of the contemporary individual".
Finally, the Association Against Nutrition Disorders
(email: anasa2007@mail.gr) is a non-governmental association. Its aim is to
familiarize citizens with nutrition disorders (through special events and
campaign programs) and to support people with such problems.
|
|
Genomics and public health
|
Low
|
|
|
|
Hypertension
|
Intermediate
|
|
A campaign program is running from the Greek Ministry
of Health in order to familiarise public with hypertension and the measures
for the prevention and control of hypertension
|
NATIONAL HEALTH STRATEGIES AND REPORTS (GREECE)
o
The Law 3370 on 11th
July 2005, concerning the organization and function of Public Health
Services in Greece (www.mohaw.gr/gr/theministry/nomothesia/dhmosia_ygeia)
has set up a new frame for public health policy in Greece. According to the
Law, a General Secretary and a General Direction of Public Health, have been
established in the Ministry of Health and Social Solidarity. They are
responsible for the implementation of public health measures, in the frame of
the National Plan for Public Health, for the audit of public health services
and for the supervision of the implementation of public health politics,
mentioned by the European Union and the WHO.
o
The Ministry of Health
and Social Solidarity runs nowadays a major prevention campaign with the title:
“Prevention Now, Problem Never” In the frame of this program there are
actions for: Hypertension, Obesity, Cholesterol, Cancer, AIDS, Diabetes
mellitus, Sun radiation.
As regards reports, we
mention diseases specialised reports issued by the Hellenic Center for
Infectious Diseases Control (www.keel.org.gr/en)
COUNTRY: FRANCE
A) Prevention and control instruments and initiatives
adopted at national or local level on major health determinants
NATIONAL HEALTH STRATEGIES AND REPORTS (FRANCE)
The public health law on 9th august 2004 (http://www.legifrance.gouv.fr/affichTexte.do?idSectionTA=JORFSCTA000000895120&cidTexte=JORFTEXT000000787078&dateTexte=29990101)
has set up a new frame for public health politics in
France. It stipulates that each five years the nation sets its objectives in
the field of the public health with the main plans and actions to achieve them.
The objectives and programs are defined by state and are implemented at
regional level.
The law has set up new advisories councils independent
from the government for preparing and assessing the public health goals: the
Health National Conference and the High Council of Public Health. The High
Council setq up a report about health needs and suggests new targets. On this
basis the government introduces a new bill.
The High Council is in particular in charge of
assessment of achievement of the objectives
The 2004 law has set up 100 objectives in the various
fields of public health: determinants, main diseases, work related health, age
and gender health issues…each objective is a quantitative one. So indicators
have been drawn up to follow them: http://www.sante.gouv.fr/htm/dossiers/losp/rapport_indicateurs_drees.doc
and yearly reports are issued on this basis :
http://www.sante.gouv.fr/drees/santepop2006/santepop2006.htm
http://www.sante.gouv.fr/drees/santepop2007/santepop2007.htm
These documents provide a sheet with data for each objective
and a summary about the main health issues on the basis of general and
synthetic indicators.
The High Council of Public health was installed in
March 2007. So it’s beginning the assessment of the objectives of the 2004 law
and on this basis it will set up the report about health needs with proposal of
new objectives/
The 2004 public health law includes strategic programs:
cancer, health and environment, rare diseases, quality of
life of patients with chronic diseases, health and violence (this plan isn’t
yet in place). A set of other plans are running: health and nutrition
(2001-2005 and a second one is starting) cardiovascular diseases, asthma,
diabetes, health of youth, aids…see: http://www.sante.gouv.fr/cdrom_lpsp/pdf/661_672.pdf
As regards reports, we can also mention diseases
specialised reports issued by the French Institute for public Health
Surveillance and at regional level theses ones issued by the regional health
observatories.
COUNTRY: ITALY
A) Prevention and control instruments and initiatives
adopted at national or local level on major health determinants
B) Actions adopted in relation with EU
initiatives to improve public health
COUNTRY: Latvia
A) Prevention and control instruments and
initiatives adopted at national or local level on major health determinants
|
Determinants
|
Level of Priority for Public Health Interventions
|
Main regulations adopted
|
Main programmes on citizen empowerment
|
|
Health-related behaviours
|
|
www.sva.gov.lv
|
|
|
Smoking and tobacco snuff use
|
high
|
Law on Restrictions regarding
Sale, Advertising and Use of Tobacco Products
Adoption of WHO framework convention on tobacco
control
|
National Program on Tobacco Control, 2005-2010
Special target “Reducing harm from alcohol, drugs and
tobacco” in national Public Health Strategy
|
|
Alcohol consumption
|
intermediate
|
Law On Handling of Alcoholic Beverages
|
Programme for Reduction of Alcohol Consumption
and Restriction of Alcohol Addiction for 2005-2008
Special target “Reducing harm from alcohol, drugs and
tobacco” in national Public Health Strategy
|
|
Physical activity
|
low
|
Sports Law
|
Framework of Sports Policy, 2004 – 2009
Special target “Healthier Living, incl. Physical
activity” in national Public Health Strategy
|
|
Drugs and substance abuse
|
intermediate
|
Law On procedures for the Legal Trade of Narcotic and
Psychotropic Substances and Medical Products
|
State Program on drug Control and Drug
Addiction Restriction 2005-2008
Special target “Reducing harm from alcohol, drugs and
tobacco” in national Public Health Strategy
|
|
Sexual behaviour
|
High for HIV and intermediate for other things
|
Law on Sexual and Reproductive Health
|
Programme for Limiting the Spread of Human
Immuno-deficiency Virus (HIV) and AIDS for 2003-2007
Special target “Reducing communicable diseases, incl.HIV/AIDS”
in national Public Health Strategy
|
|
Personal hygiene
|
Intermediate for public hygiene, low for personal
hygiene
|
Different regulations on requirements of hygiene of
public institutions, places (as from schools, finish with working places)
|
|
|
Safety awareness
|
low
|
|
|
|
Environmental determinants and settings
|
|
www.vidm.gov.lv
|
National Environmental Policy Plan, 2004 - 2008
|
|
Air pollution
|
intermediate
|
Law on Safety of Environment
Regulation on Air Quality
|
National Environmental Policy Plan, 2004 – 2008
Special target “A healthy and safe environment” in
national Public Health Strategy
|
|
Drinking and recreational water
|
high
|
Water Management Law
Different regulations on requirements for Drinking and recreational water
|
National Environmental Policy Plan, 2004 - 2008
Special target “A healthy and safe environment” in
national Public Health Strategy
|
|
Soil contamination and waste disposal
|
intermediate
|
Law On Waste Management
Different regulations on this field
|
Special target “A healthy and safe environment”
in national Public Health Strategy
|
|
Selected chemical contaminants
|
intermediate
|
Law on
Chemical Substances and Chemical Products
Different regulations on this field
|
National Environmental Policy Plan, 2004 - 2008
|
|
Use of pesticides
|
intermediate
|
Different
regulations on this field
|
National Environmental Policy Plan, 2004 - 2008
|
|
Food safety
|
high
|
Law on the Supervision of the Handling of Food
Different regulations about specific food products
and restrictions
|
Special target “Healthier Living, incl. Healthy food”
in national Public Health Strategy
|
|
Physical stressors
|
low
|
Different regulations on this field
|
National Environmental Policy Plan, 2004 – 2008
Special target “A healthy and safe environment” in
national Public Health Strategy
|
|
Human settlements
|
low
|
|
|
|
Transportation including road safety
|
high
|
Roads Traffic Regulations
Different regulations on this field
|
Road Traffic Safety Program 2007-2013
Special target “Reducing health disorders from
violence and accidents” in national Public Health Strategy
|
|
Extreme weather events and health
|
low
|
|
|
|
Poverty
|
intermediate
|
|
National Action Plan for Limitation of Poverty
and Social Exclusion, (2004-2006)
Special targets (“Equity and Solidarity in health”
and “Healthy adulthood, healthy and active ageing”, includes poverty problem)
in national Public Health Strategy
|
|
Gender issues
|
intermediate
|
|
|
|
Work-related health issues
|
high
|
Labour Protection Law
www.vdi.gov.lv
Different regulations on this field
|
|
|
Deprivation factors
|
low
|
|
Special targets “Equity and Solidarity in health” in
national Public Health Strategy
|
|
Psychosocial health determinants
|
low
|
|
Special targets “Improving mental health ” in
national Public Health Strategy
|
|
Personal determinants
|
low
|
|
|
|
Obesity
|
intermediate
|
Law on the Supervision of the Handling of Food
Different regulations about specific food products
and restrictions
|
Framework „Healthy Diet, 2003.–2013"
Action Programme for Implementation of framework „Healthy Diet (2003-2013)”
Special target “Healthier Living, incl. Healthy food”
in national Public Health Strategy
|
|
Genomics and public health
|
intermediate
|
Law on research of human genome
|
|
|
Hypertension
|
high
|
|
Special target “Reducing non-communicable diseases,
incl. cardiovascular diseases” in national Public Health Strategy
WHO CINDI programme activities
|
|
Interactions amongst determinants
|
intermediate
|
|
Public Health Strategy of Latvia (2001.-2010.)
Action Programme for Implementation of the Public
Health Strategy 2004-2010
|
COUNTRY: Lithuania
A) Prevention and control instruments and initiatives
adopted at national or local level on major health determinants
|
Determinants
|
Level of Priority for Public Health Interventions
|
Main regulations adopted
|
Main programmes on citizen empowerment
|
|
Health-related behaviours
|
|
|
The preventable nature of these problems, their
manifestations and their tendency to rise in frequency in the population,
justify priority in the formulation and development of action programmes to
stimulate the adoption of healthy lifestyles and reinforce the structural
and environmental conditions favourable to health.
|
|
Smoking and tobacco snuff use
|
High
|
Ratification of the Framework Convention on Tobacco
Control (FCTC) – Decree 25/A of 8th November 2005.
Law 37/17 August 2006 entered into force on the first
of January 2008.
Reinforces public health protection from passive
smoking, reinforces measures against tobacco sales to minors of 18 years,
creates consultations for smoking cessation in the National Health Service.
|
Information Campaign of the new law.
TV campaign on prevention of passive smoking;
Training courses for health professionals on smoking
cessation (last 3 years);
Co-operation with the mass media on this topic –
information to the public
Awareness Days – No tobacco Day (every year) and Non
Smokers Day celebrations (every year)
Co-operation with NGO and civil society in several
initiatives.
|
|
Alcohol consumption
|
High
|
|
|
|
Food choices and nutrition
|
High
|
Food regulation for schools and orientations
for health departments
|
National Platform against obesity
Health Determinants Programme
|
|
Physical activity
|
Intermediate
|
Low VAT for health clubs
|
National Platform against obesity
Health Determinants Programme
|
|
Drugs and substance abuse
|
High
|
National level
|
|
|
Sexual behaviour
|
High
|
National level
During the last year there were considerably changes
in the legal context so as in what concerns sexual health agenda. In February
2007 was approved in a national referendum the decriminalisation of the
voluntary interruption of pregnancy within the first 10 weeks, by woman’s
choice and in authorised establishments. The vaccine against the human
papilloma virus was incorporated in national vaccination programme. Also, it
is a political priority for 2008 to promote and assure the access to assisted
reproduction technologies, namely by providing financial support to
infertility treatments.
|
National Programme of Reproductive Health has five
main areas of intervention: planned parenthood, preconception and pre-natal
care, pre-natal diagnosis, voluntary interruption of pregnancy and assisted
reproduction technologies.
|
|
Personal hygiene
|
High
|
National level
|
|
|
Safety awareness
|
High
|
National level
|
|
|
Air pollution
|
High
|
National level
|
|
|
Drinking and recreational water
|
High
|
National and local level
Drinking water – Decree-Law 306/2007 of 27 August;
Recreational water – Directive 2006/7/EC of the
European Parliament and of the Council of 15 February 2006concerning the
management of bathing water quality and repealing Directive 76/160/EEC –
being transpose.
|
- Development of surveillance system of
swimming-pools and recreational waters;
- Development of surveillance system of drinking
water.
|
|
Soil contamination and waste disposal
|
High
|
National level
Decree-Law nb 178/2006 of 5 September;
Decree-Law nb 85/2005 of 28 April;
Decree-Law nb 152/2002 of 23 May;
Portaria nb 174/97 of 10March
Despacho nb 242/96 of 13 August
|
-PERH – implementation of clinical waste plan
|
|
Selected chemical contaminants
|
|
|
- Evaluation of biocides
|
|
Use of pesticides
|
High
|
National level
CE1907/2006 (REACH)
|
|
|
Food safety
|
High
|
National level
|
|
|
Physical stressors
|
High
|
National level
|
|
|
Transportation including road safety
|
High
|
National level
|
|
|
Extreme weather events and health
|
High
|
National and level
|
- Heat waves contingency plan
|
|
Poverty
|
High
|
National level
|
|
|
Gender issues
|
High
|
Health sector start to acknowledge the relevance of
putting sex and gender issues into health agenda. Besides focusing on sex
differences and specificities, health policies begin to integrate a gender
sensitive approach, namely in highlighting how socially constructed
asymmetrical conduct patterns shape men and women’s health condition. It is a
priority to call attention to the need to diminish gender iniquities in
health.
|
The project “PROSASGE” (Project about Health, Sex and
Gender) intend to attend jointly to epidemiological data and planned courses
of action in order to assemble gendermainstream in Portuguese health
policy. Recently, Directorate-General of Health published the report “Health,
Sex and Gender: Facts, Representations and Challenges” (December 2007).
Also, there is an effort to explore more deeply the
results of National Health Interview Survey in a gender perspective (results
are now in final analyses).
|
|
Work-related health issues
|
High
|
National level
|
|
|
Deprivation factors
|
|
|
|
|
Others
|
|
|
|
|
Psychosocial health determinants
|
|
|
|
|
Personal determinants
|
|
|
|
|
Obesity
|
High
|
Revision of the codes of practice for foods
products mkt to children is panned. Improving self-regulation is expected.
Mandatory regulation is an option is planned is self-regulation doesn’t work
|
National Platform against obesity
|
|
Genomics and public health
|
High
|
Not yet adopted.
|
Draft programm on rare diseases
is presently under public discussion.
|
|
Hypertension
|
High
|
Circular letter on diagnosis, treatment and control
of AHT (Arterial Hypertension).
|
National Programme for the Prevention and Control of
Cardiovascular Diseases
|
|
Interactions amongst determinants
|
High
|
Approval of the National Programme on Integrated
Action on Health Determinants related with Lifestyles, in 2005. Under this
Programme several initiatives has been undertaking regarding healthy
nutrition, tobacco and physical activity.
|
Dissemination of several informative materials
to the public TV campaign. Co-operation with the mass-media and TV,
Co-operation with Civil society and the NGO working in this area.
|
B) Actions
adopted in relation with EU initiatives to improve public health
COUNTRY: Romania
A) Prevention and control instruments and initiatives
adopted at national or local level on major health determinants
|
Determinants
|
Level of Priority for Public Health Interventions
|
Main regulations adopted
|
Main programmes on citizen empowerment
|
|
Health-related behaviours
|
|
|
|
|
Smoking and tobacco snuff use
|
high
|
Ministry of Public Health Decision 1438/11/2006 to
approve the Program for reduction of tobacco use and for smoking cease;
Law 433/11/2006, harmonizing law 349/06/2002 with
Directive 2001/37/CE;
Law 332/11/2005, ratifying FCTC of WHO (adoption of
WHO framework convention on tobacco control);
Law 349/06/2002, for prevention and control of the
side effects of tobacco consumption;
Increasing price of cigarettes
|
Many prevention campaign
|
|
Alcohol consumption
|
Intermediate
|
|
Prevention campaigns
|
|
Food choices and nutrition
|
Intermediate
|
|
National health nutrition objective within the Public
Health Sub-program
|
|
Physical activity
|
Intermediate
|
Law 195/04/2002
|
Were built sports halls in most of high schools;
Specific objective of the national health nutrition
programs
|
|
Drugs and substance abuse
|
High
|
Decision 1654/11/2006 for approval of National
strategy 2006-2010 against human trafficking
Law 350/07/2006 for socio-professional integration of
young people
National HIV/AIDS strategy
|
Media campaign
|
|
Sexual behaviour
|
High for HIV, STI and abortion
|
Special target of public health law about effective
access at contraception and abortion, for prevention of STI, including HIV
|
HIV/AIDS and STI prevention
campaign;
Family planning campaign and services
|
|
Personal hygiene
|
Intermediate
|
Law 221 2006/05/31 Avian flu prevention and control
plan
|
Avian flu prevention
Diarrhoea prevention during floods or other severe
weather conditions
|
|
Safety awareness
|
Low
|
|
Home and leisure accidents (fire, severe weather
conditions, etc.)
|
|
Air pollution
|
High
|
Decisions 346-352/03/2007 regarding the list of
localities within Romania regions, according with Decision 96/62/EC on
air quality.
|
national plans on environmental health
|
|
Drinking and recreational water
|
High
|
Law 458/2002 regarding drinking water modified and
completed by Law 311/2004 (according to Drinking Water Directive 98/83)
GD 459/2002 approve the quality norms for bathing
waters from natural zones according to the directive 76/160/EEC
|
national plans on environmental health
|
|
Soil contamination and waste disposal
|
High
|
GD 195/2005 regarding the environment protection
|
Media campaign for children
http://www.mmediu.ro/ape/flopi_si_apa.pdf
|
|
Selected chemical contaminants
|
intermediate
|
GD 956/2005 concerning the placement on the market of
biocide products according with Directive 98/8/EC of the European
Parliament and of the Council of 16 February 1998 concerning the placing of
biocide products on the market
|
National registry of biocide products: http://www.ms.ro/abilitari-notificari.php
|
|
Use of pesticides
|
high
|
Law 89/2006 and decisions on maximum admitted levels
of residual pesticides in vegetables, fruits, plants and animals
|
Media campaign for decreasing use of pesticides
|
|
Food safety
|
high
|
The Romanian legislation in the field of
food safety is accordingly to the European Directives and regulations.
|
Media campaigns
|
|
Physical stressors
|
intermediate
|
Decision 1830/11/2007 Noise maps
Occupational health regulations
|
Noise: public health law regarding occupational
health
|
|
Human settlements
|
intermediate
|
|
|
|
Transportation including road safety
|
intermediate
|
|
Media national campaigns on road safety on high
traffic
|
|
Extreme weather events and health
|
high
|
Decision 1877/12/2005 National plan of action for
climate changes
|
Media campaign
|
|
Socio-economic determinants
|
|
|
|
|
Poverty
|
high
|
Government decision 1217/09/2006 for the setting-up
mechanism for the | |
|
|
