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

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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 “Troikamechanism, 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

 

Determinants

Level of Priority for Public Health Interventions

Main regulations adopted

Main programmes on citizen empowerment

Smoking and tobacco snuff use

High 

National/Regional

Yes

Alcohol consumption

High 

National/Regional

 Yes

Food choices and nutrition

High 

National/Regional

 Yes

Physical activity

High 

Regional

 Yes

Drugs and substance abuse

High 

National/Regional

 Yes

Sexual behaviour

High

Regional

 Yes

Personal hygiene

Intermediate

National/Regional

 

Safety awareness

High 

National/Regional

Yes

Air pollution

High 

National/Regional

 Yes

Drinking and recreational water

Intermediate for Flanders

 

High for Wallonia

Regional

 Yes

Soil contamination and waste disposal

High

Regional

 Yes

Selected chemical contaminants

High 

National/Regional

 

Use of pesticides

Intermediate

National/Regional

 Yes

Food safety

High

National

 Yes

Physical stressors

Low

Regional

 

Human settlements

Intermediate

Regional

 

Transportation including road safety

High

National/Regional

 Yes

Extreme weather events and health

High

National/Regional

 Yes

Poverty

High

National/Regional

 Yes

Gender issues

High 

National/Regional

 Yes

Work-related health issues

High

National/Regional

 Yes

Deprivation factors

Intermediate

/Regional

 Yes

Psychosocial health determinants

Intermediate

National/Regional

 Yes

Obesity

High 

National/Regional

 Yes

Genomics and public health

Intermediate

Regional

 

Hypertension

High 

National/Regional

 

Interactions amongst determinants

Intermediate

National/Regional

 

 

 

B) Actions adopted in relation with EU initiatives to improve public health

 

EU Initiative

Level of initiative (National or Local)

Main regulations adopted

Main programmes on citizen empowerment

European strategy for health

Intermediate

National/Regional

Yes

European public health programme

Intermediate

National/Regional

Yes

Health information

High

National + Regional

Yes

European cooperation on health services

High

National/Regional

Yes

European Union directive proposal on “safe, high-quality and efficient cross-border health care

High

National

--

Public health forum

Low

--

--

Human therapeutic substances: quality, safety and ethics

High

National

Yes

Pharmaceuticals

High

National

Yes

International pharmaceutical harmonisation

High

National

Yes

Framework programme priorities of relevance to health and public health (Life science and biotechnology)

High

National/Regional

Yes

Environment and health

High

National/Regional

Yes

 


 

COUNTRY: DENMARK

 

 

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

MMain programmes on citizen empowerment

Health-related behaviours

 high

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

 2002-2010: Healthy throughout Life

– the targets and strategies for public health policy of the Government of Denmark, 20022010 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.

Smoking and tobacco snuff use

 high

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

 

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

Alcohol consumption

 

 high

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

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.

Food choices

and nutrition

 

 

 high

 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.

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.

 

Approximately2.5 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.

 

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.

 

 

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.

 

 A.        The largest national initiative is calledAlt 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.

 

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.

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

Drugs and substance abuse

 high

 

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

Sexual behaviour

 High

 

 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.

Personal hygiene

 

 

 

Safety awareness

 

 

 

Environmental determinants and settings

 high

 

 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

Air pollution

 High

 

Drinking and recreational water

 High

 

Soil contamination and waste disposal

 High

 

Selected chemical contaminants

 High

 

Use of pesticides

 High

 

Food safety

 High

 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

 

Physical stressors

 High

 

  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.

Human settlements

 High

 

Transportation including road safety

 

 

 

Extreme weather events and health

 

 

 

Socio-economic determinants

 high

 

  2002-2010: Healthy throughout Life

– the targets and strategies for public health policy of the Government of Denmark, 20022010 http://www.folkesundhed.dk/media/healthythroughoutlife.pdf

Poverty

 

 

 

Gender issues

 

 

2004: Young and pretty: National campaign fostered by the department of gender equality on young people and health issues

Work-related health issues

High

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.

 

 

Deprivation factors

 

 

 

Others

 

 

 

Psychosocial health determinants

 High

 

  2002-2010: Healthy throughout Life

– the targets and strategies for public health policy of the Government of Denmark, 20022010 http://www.folkesundhed.dk/media/healthythroughoutlife.pdf

Personal determinants

 High

 

  2002-2010: Healthy throughout Life

– the targets and strategies for public health policy of the Government of Denmark, 20022010 http://www.folkesundhed.dk/media/healthythroughoutlife.pdf

Genomics and public health

 

 

 

Hypertension

 

 

 

 

 

 

 

Interactions amongst determinants

 

 

 

 

 

COUNTRY: Germany

 

 

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 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.

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 environment5 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).

  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 smartdont start” (see www.ift-nord.de/ift/be), smoke-stop competitions for general population (WHO-initiativeQuit & Win”, see www.rauchfrei2008.de), basic life skills training for children (“Kinder stark machensee 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.deGerman 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)

 

Alcohol consumption

High priority, policy mix approach according to European guidelines.

Legal requirements aimed at prevention of alcohol abuse among young people: Prohibition of selling alcohol to underage and youth drinking alcohol in public9 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).

 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

ProjectHaLTHart 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.

 

Food choices and nutrition

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.

§ 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).

 

Nutritional advice is part of many rehabilitation/secondary prevention programs as well (legal basis: § 43 SGB V and SGB IX).

National health targetGrowing 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 planGermany 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).

 

Physical activity

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

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).

 Selected activities:

National campaignExercise and health” (“Bewegung und Gesundheit”, see www.die-praevention.de) – promotes3000 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).

 

Drugs and substance abuse

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.

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).

 

 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).

JESjunkies, 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 seeDrugs 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).

Sexual behaviour

High priority

 

 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 Chancecampaign, campaign started in 1987

Personal hygiene

Intermediate

 

§ 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

www.die-praevention.de:Website hosted by the Ministry of Health, Special topicfit durch den Winter’ (Being fit in winter) offers practical advices how to strengthen the immune system (Stand: Dezember 2006)

 

Safety awareness

High priority given the many laws, institutions, and activities concerning safety/risk.

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 reportingvoluntary 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 21aim 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 PracticeExamples 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 topicMoving 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 calledCheck-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

 

EU Initiative

Level of initiative (National or Local)

Main regulations adopted

Main programmes on citizen empowerment

European strategy for health

 

 

 

European public health programme

 

 

 

Health information

Health information is regarded as an important tool in the process of health policy making on both national and local level. In addition health reporting on the community level becomes increasingly important.

Federal State legislation related to the preparation of health reports have been integrated in the Federal State law on Public Health Services. A law on prevention currently under negotiation defines the scope and purpose of the Federal Health monitoring and reporting system established at the Robert Koch-Institute.

Reliable and comprehensible information is a prerequisite for informed individual decision making. This applies in particular to health information.

Health Information is published by a number of Federal agencies. The Robert Koch-Institute (www.rki.de) is in charge of the federal health monitoring and reporting activities. It regularly publishes global health reports and thematic health reports, addressing policy makers as well as other stakeholders and the interested public. Regional health reports are published by the Federal State authorities. The Federal Centre for Health Education (BZgA) publishes information on health education and health promotion for specific populations groups such as children and adolescent. Specific Information on selected conditions and their treatment is offered by the Institute for 

 

 

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 (19982000). 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 20072009.

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 ChangeReport 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

(ongoinglaunched 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 campaignLittle 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

 

EU Initiative

Level of initiative (National or Local)

Main regulations adopted

Main programmes on citizen empowerment

European strategy for health

High

National Health Strategypublished in 2001, set out key objectives and an Action Plan for the health services up to 2010

http://www.dohc.ie

 

 

European public health programme

High

In line with the EU Drugs Action Plan

developments include the following:

 

Under 18s - A Report of the Working

Group on Treatment of Under 18

year olds Presenting to Treatment

Services with Serious Drug Problems

was published in September 2005

The Report is based on a 4-tier model

of service delivery and  is being

implemented  on a phased basis.

 

Cocaine - Implementation is ongoing

of the recommendations of the

National Advisory Committee on Drugs

(NACD) Report An Overview of Cocaine

Use in Ireland: II published in march 2007

http://www.nacd.ie

 

The Health Service Executive (HSE)

is re-orientating its addiction services

to meet changing patterns of drug use

particularly regarding polydrug usage

(including alcohol, cocaine and prescribed

drugs).  The HSE is up-skilling its staff via

a National Addiction Training Programme

which is concentrating initially on cocaine

misuse.  The HSE is aiming to deliver a

community based response  to addiction via

the emerging Primary Care Teams and

Social Care Networks.

 

Rehabilitation - The report of the working

group on Drugs Rehabilitation was

published in May 2007 (www.pobail.ie).

 

National Drug-Related Deaths Index (NDRDI)

Statistics in the General Mortality Register

are collected by the Central Statistics Office

which measures direct drug-related deaths

based.  These figures do not include deaths

which are indirectly related to drug use

To remedy these limitations, the

Department of Health and Children and

the Department of Justice, Equality and

Law Reform jointly asked the Alcohol and

Drug Research Unit of the Health

Research Board to establish and maintain

a National Drug-Related Deaths Index

The NDRDI was established in September

2005.  The first report from the NDRDI is

scheduled for publication in autumn 2008.

 

NACD - The National Advisory Committee

on Drugs in September 2007 published

on its website (www.nacd.ie) the baseline

data from the ROSIE (Research Outcome

Study in Ireland - Evaluating Drug Treatment Effectiveness) study.

 

Population Prevalence Study - A follow

up to the 2002/2003 Drug Prevalence Study

was carried out in 2006/2007.  The study

which was published in January 2008

examined drug use in Ireland & Northern

 Ireland

http://www.nacd.ie/publications/prevalence_bulletin1_results.html

 

 

 

Intermediate

A letter of intent issued in April 2007 signalling Ireland’s intention to participate in a European Human Bio Monitoring Pilot Project. Human Bio Monitoring is one of the elements of the European Environment and Health Action Plan.  However this project has not begun as yet.

 

Health information

High

Developing a Public Health common dataset, based on the system of European Community Health Education (ECHI)

 

European cooperation on health services

Intermediate

Specific specialities within the Irish health services would have formal and informal contacts with similar services in other EU member states through research projects, formal and informal networks.

 

European Union directive proposal on “safe, high-quality and efficient cross-border health care

High

The National Treatment Purchase Fund (NTPF) which is funded by the State, purchases services either at home or abroad, for patients who are on waiting lists at hospitals beyond a specific length of time. Formal arrangements are also in place with Northern Ireland and England for the delivery of some hospital based services to Irish citizens.

Patients can contact the NTPF directly.

Only very limited numbers seek services

abroad outside of these arrangements.

http://www.ntpf.ie

 

Public health forum

High

National Health Forum. The Health Act 2004 provides for Regional Health Forums to be established by regulation to allow for the sharing of views with the Health Service Executive (HSE) on how health services are been delivered and managed.

 

 

 

C) OTHER INFORMATION ON NATIONAL HEALTH POLICIES AND REPORTS (IRELAND)

National Health Strategy

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.

Establishment of Health Service Executive (HSE)

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 approvalArrangements 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

Restructuring of the Department of Health and Children:

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 HSEAdditionally, 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.

 

Establishment of Health Information and Quality Authority (HIQA): www.hiqa.ie

HIQA was established in 2007 under the Health Act 2007HIQA 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

Legislation

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;

Health and Social Care Professionals Act 2005

http://www.dohc.ie/legislation/acts/?year=2005&number=27

Pharmacy Act 2007:

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 Health Service

Investment in the health sector has increased significantly since 1997 from €3.67 billion to over €16 billion in 2008.

 

Modernisation and Improvement of health services

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.

 

Primary Care

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 careCentral 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.

 

Cancer Control

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

 

Acute Hospitals

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

 

Disability and Mental Health

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.

 

Older People

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 increasingEnsuring 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 schemeA 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 titleSatellites 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 concerningThe 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 50910/2727/2003Measures 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  8668/2007Acceptance of the National Plan for the Management of Hazardous Waste”,

o         Ministerial Decision 13588/725/2006Measures, terms and limitations for the management of hazardous waste in compliance with Council Directive 91/689 “for the hazardous wasteof 12th December 1991”.

o         Presidential Degree 116/2004Measures, 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 nameXenokratis”, 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 1568/1985Health and Safety of employees

o         Presidential Degree 105/1995Minimum standards for safety or/and health signals at work  in compliance with the Council Directive: 92/58

o         Presidential Degree 16/1996Minimum standards for safety and health at work in compliance with the Council Directive 89/654’’.

o         Presidential Degrees 88/1999, 76/2005Minimum standards for organizing working time  in compliance with the Council Directives 93/104, 2000/34’’

o         Presidential Degrees 17/1996, 159/1999Measures 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 asylumseekers.

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 OrganizationCommunity 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 Volunteersadjusts 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 entitledPsychargos”, 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 “Psychargosprogram). 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, “Psychargosestablished 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

 

Determinants

Level of Priority for Public Health Interventions

Main regulations adopted

Main programmes on citizen empowerment

Smoking and tobacco snuff use

 high

 Law 31/7/2003 aiming to limit the tobacco consumption by young people

Decree 15/1/2006 banning smoking in public place

Increasing price of cigarettes

Adoption of WHO framework convention on tobacco control

 

Many prevention campaign of Inpes  (French  Institute For Health Prevention and Training)

 

Alcohol consumption

 high

 

 Many prevention campaign of Inpes (French  Institute For Health Prevention and Training)

Food choices and nutrition

 high

 

National health nutrition programs 2001-2005 et 2006-2010 http://www.sante.gouv.fr/htm/pointsur/nutrition/1nbis.htm

http://www.sante.gouv.fr/htm/actu/pnns_060906/plan.pdf

 

 

Physical activity

 intermediate

 

Specific objective of the national health nutrition programs

Drugs and substance abuse

 high

2006Setting up of new medical and social places for reducing risks for drugs users

2007: inside prevention of crime law

articles  concerning cure obligation and awareness training for drugs users

 Permanent campaign of French  Institute For Health Prevention and Training

Special campaign about cannabis

and  traffic security

Sexual behaviour

 High for HIV and abortion

 Special target of public health law about effective access at contraception and abortion

2007 campaign on contraception

2005- 2008 : plan against AIDS and sexual communicable diseases: prevention part

Personal hygiene

low

 

Campaign for oral hygiene in particular for children : free visits at dentists

Safety awareness

Intermediate 

 

Common campaign of French  Institute For Health Prevention and Training

( home and leisure accidents in particular for falls in elderly)

 

Environmental determinants and settings

Air pollution

 high

 “environment Grenelle24-25-26 October 2007:

http://www.legrenelle-environnement.fr/grenelle-environnement/spip.php?rubrique5

Adoption of  the Charter of environment (constitutional text) 29 April 2005 http://www.ecologie.gouv.fr/Le-texte-de-la-Charte-de-l.html

 

national plan on health and environment 2003-2008 http://www.sante.gouv.fr/htm/dossiers/pnse/resume_en.pdf

 

Drinking and recreational water

 high

Articles about drinking water  in 2004 public health law

Law 2006.1772 about water and aquatic environment:

http://www.ecologie.gouv.fr/ecologie/IMG/pdf/loi_eau_milieux_aquatiques_301206.pdf

 

 national plan on health and environment 2003-2008 http://www.sante.gouv.fr/htm/dossiers/pnse/resume_en.pdf

 

Soil contamination and waste disposal

 high

 

 national plan on health and environment 2003-2008 http://www.sante.gouv.fr/htm/dossiers/pnse/resume_en.pdf

 

Selected chemical contaminants

 high

 REACH in force since 1st June 2007

 national plan on health and environment 2003-2008 http://www.sante.gouv.fr/htm/dossiers/pnse/resume_en.pdf

Use of pesticides

 high

 “environment Grenelle24-25-26 October 2007:

http://www.legrenelle-environnement.fr/grenelle-environnement/spip.php?rubrique5

 

 Plan for decreasing use of pesticides:

http://agriculture.gouv.fr/sections/presse/communiques/michel-barnier-installe/

 

Food safety

 high

 

 Permanent activity of the French food Safety Agency

national plan on health and environment 2003-2008 http://www.sante.gouv.fr/htm/dossiers/pnse/resume_en.pdf:

objective of cutting the frequency  of “ legionairesdisease by 50% by 2008

 

Physical stressors

 intermediate

 Noise: Decree 2004/1051 of 28/09/2004 for transposition of UE directive 26/03/02 about air traffic:

http://www.legifrance.gouv.fr/affichTexte.do?oldURL=true&cidTexte=JORFTEXT000000443732&dateTexte=

 

 Noise: special objective of public health law

Radon: objective of national plan on health and environment 2003-2008

Human settlements

 intermediate

 

 See air pollution and  physical stressors . We can add here the fight against lead in blood in children

Transportation including road safety

 high

 Jun-July 2003: setting up automatics means for control of speed

 Important national campaigns on this topic

Extreme weather events and health

 high

 Decree 2005-768 concerning elderly houses http://admi.net/jo/20050709/SANA0522348D.html

 

 Heatwave Plan 2007:

http://www.sante.gouv.fr/canicule/doc/pnc_2007_vf.pdf

 

Poverty

 high

Insurance public law  13 august 2004 : institution of a money assistance to get a supplementary insurance :

http://www.legifrance.gouv.fr/affichTexte.do?oldURL=true&cidTexte=JORFTEXT000000625158&dateTexte=

 

 Regional programmes for care access:

http://www.sante.gouv.fr/htm/pointsur/praps/sommaire.htm

 

Gender issues

 intermediate

 

Specialised programmes of French  Institute For Health Prevention and Training

 

Work-related health issues

 high

 Decree 2004/760 28 July 2004 reform of work medicine http://www.legifrance.gouv.fr/affichTexte.do?oldURL=true&cidTexte=JORFTEXT000000419260&dateTexte=

 

 Part of the national plan on health and environment 2003-2008: reduce occupational exposure to CMRs

Special work-related health plan  February 2005:

http://www.travail.gouv.fr/IMG/pdf/20050217_dp_plan-sante-travail_dossier-presse.pdf

 

Deprivation factors

 high

 

 See poverty also: special attention in national health nutrition program

2006-2010

Psychosocial health determinants

 high

 

 Plan psychiatry and mental health

http://www.sante.gouv.fr/htm/actu/pnns_060906/plan.pdf

 

Personal determinants

Obesity

 high

 Law about public health policy

Article 30 banning  food and drink distributors in schools

 national health nutrition programs http://www.sante.gouv.fr/htm/pointsur/nutrition/1nbis.htm

http://www.sante.gouv.fr/htm/actu/pnns_060906/plan.pdf

 

 

Genomics and public health

 

 Law 2004-800 6 August 2004 concerning the bioethics

http://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000000441469&dateTexte=

 

 

Hypertension

 high

 

 During each consultation the GP examines the blood pressure

Decreasing the intake of salt is a objective  of the public health law

 

 

 

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 isnt 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, aidssee: 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

 

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

Law 3/2003 Art. 51 (implemented in January 2005): smoking ban in all public places.

ProgrammeGain Health” (Guadagnare Salute) promoted with a decree of the Prime Minister on 04.05.2007 (www.ministerosalute.it/stiliVita/stiliVita.jsp)

Alcohol consumption

 High

 Law 30.03.2001 n. 125 (Framework law on alcohol and alcohol related problems)

Agreement between State and Regions (16.03.2006): work activities at risk in case of alcohol consumption.

ProgrammeGain Health” (Guadagnare Salute) promoted with a decree of the Prime Minister on 04.05.2007 (www.ministerosalute.it/stiliVita/stiliVita.jsp)

Food choices and nutrition

High

 

National Prevention Plan 2005-2007, promoted by an agreement between the central State and the regional Governments (Intesa Stato-Regioni 23.3.2005)

 

ProgrammeGain Health” (Guadagnare Salute) promoted with a decree of the Prime Minister on 04.05.2007 (www.ministerosalute.it/stiliVita/stiliVita.jsp)

Physical activity

High

 

National Prevention Plan 2005-2007, promoted by an agreement between the central State and the regional Governments (Intesa Stato-Regioni 23.3.2005)

 

ProgrammeGain Health” (Guadagnare Salute) promoted with a decree of the Prime Minister on 04.05.2007 (www.ministerosalute.it/stiliVita/stiliVita.jsp)

Drugs and substance abuse

 High

 Decree of the President of the Republic n. 309/1990 and following modifications (1999; 2006).

 

Sexual behaviour

 High

 Main regulation for HIV/AIDS: Law 135/1990.

 

Food safety

 High

 EC Regulation 178/2002

 

Gender issues

 High

Project for Motherhood and ChildhoodDecree 24.04.2000

 

Obesity

 

ProgrammeGain Health” (Guadagnare Salute) promoted with a decree of the Prime Minister on 04.05.2007

 

Hypertension

 

Law 138/2004 established the Italian Centre for Disease Control (CCM) which started the “Progetto Cuore” to address the prevention of cardiovascular risk.

National Prevention Plan 2005-2007.

 

 

 

B) Actions adopted in relation with EU initiatives to improve public health

 

EU Initiative

Level of initiative (National or Local)

Main regulations adopted

Main programmes on citizen empowerment

European public health programme

National

ProgrammeGain Health” (Guadagnare Salute) promoted with a decree of the Prime Minister on 04.05.2007

 

Health information

National

ProgrammeGain Health” (Guadagnare Salute) promoted with a decree of the Prime Minister on 04.05.2007

 

Pharmaceuticals

 

National Drugs Agency (Agenzia Italiana del FarmacoAIFA) established in 2003.

 

International pharmaceutical harmonisation

 

National Drugs Agency (Agenzia Italiana del FarmacoAIFA) established in 2003.

 

 

 

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 targetReducing 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 targetReducing harm from alcohol, drugs and tobacco” in national Public Health Strategy

Physical activity

low

 Sports Law

 

 Framework of Sports Policy, 20042009

 

 Special targetHealthier 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 targetReducing 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 targetReducing 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, 20042008

 

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 targetHealthier Living, incl. Healthy food” in national Public Health Strategy

 

Physical stressors

low

 Different regulations on this field

National Environmental Policy Plan, 20042008

 

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 targetReducing 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 targetsEquity and Solidarity in health” in national Public Health Strategy

Psychosocial health determinants

low

 

 Special targetsImproving 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

FrameworkHealthy Diet, 2003.–2013"

 

Action Programme for Implementation of frameworkHealthy Diet (2003-2013)”

 

Special targetHealthier Living, incl. Healthy food” in national Public Health Strategy

 

 

Genomics and public health

 intermediate

 Law on research of human genome

 

Hypertension

 high

 

Special targetReducing 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

 

 

COUNTRYLithuania

 

 

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 topicinformation 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 interventionplanned 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 waterDecree-Law 306/2007  of 27 August;

Recreational waterDirective 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/EECbeing 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

 -PERHimplementation 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 projectPROSASGE” (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 reportHealth, 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 doesnt 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

 

EU Initiative

Level of initiative (National or Local)

Main regulations adopted

Main programmes on citizen empowerment

European strategy for health

 

 

 

European public health programme

 

Ratification of the Framework Convention on tobacco law (1st  of January 2008)

 

Pharmaceuticals

National

- Decree Law 307/2007 that establishes the legal regime for pharmacies (31/08/07);

- Decree Law 102/2007, that transposes into national law Commission Directive 2005/28/EC, laying down principles and detailed guidelines for good clinical practice as regards investigational medicinal products for human use, as well as the requirements for authorisation of the manufacturing or importation of such products (02-04-2007);

- Decree Law 176/2007: New medicines Act, that transposes into national law Directive 2001/83/EC of the European Parliament and of the Council, on the Community code relating to medicinal products for human use as well as Directives 2002/98/CE, 2004/24/CE and 2004/27/CE, of the European Parliament and of the Council and Commission Directive 2003/63/CE(30-08-2006);

- Decree Law 92/2005, that transposes into national law Commission Directive 2003/94/EC, laying down the principles and guidelines of good manufacturing  practice in respect of  medicinal products for human use and investigational medicinal products for human use (07-06-2005).

- Portaria142/2007 establishes the conditions and requirements for the dispensing of medicines for home delivery  and through the internet.

- decree Law 238/2007 allowing for over the counter medicines to be sold outside pharmacies (16-09-2007);

- 2 campaigns for the promotion of Generic Medicines (2004&2007);

- Campaign on medicines and driving (2004).

Environment and health

National and local

 

- Housing and Health Action Plan;

- Environment and Health Indicators;

- POPs in Human Milk;

- Implementation of National Environment and Health Action Plan (NEHAP);

- Health Impacts of ionization and non-ionization radiation.

 

 

 

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 productshttp://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

 

See air pollution and physical stressors. We can add here the fight against lead in blood in children

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 promotion of social inclusion