Spausdinti

Project “Development of a Model for the Strengthening of the Capacities to Identify and Reduce Health Inequalities”

 

 

 

 

LithuanianUniversityofHealth Sciences (hereinafter – LSMU) and its partnersInstituteofHygiene(hereinafter – HI), KlaipedaUniversity(hereinafter – KU) andVilniusUniversity(hereinafter – VU) are implementing the project No. NOR-LT11-SAM-01-TF-02-001 “Development of a Model for the Strengthening of the Capacities to Identify and Reduce Health Inequalities” funded by the Norwegian financial mechanism 2009–2014 programme No. LT11 “Public Health Initiatives”.

     

 

Project’s duration – from16/06/2014 until31/01/2017

Total value of the project – 613.160,85 Eur

Essence of the project. The understanding of health in the modern world is based not only of the absence of disease, but has a much broader social concept in which health is understood as a social process with a significant impact for the quality of life. In this concept health is important for well-being of individuals and society and a healthy population is a necessary condition for each state’s economic productivity and prosperity. In general, health is one of the main indicators reflecting socio-economic changes in the society. The global tendencies show improvement in socio-economic situation and health of residents, however different groups have different improvement rates, which create significant health inequalities. Such social differences are one of the major issues in bothEurope and the world. The clear social separation is formed, while the health care services in the regions differ by their quality and accessibility. The project is meant to solve the problems of Lithuanian health inequalities through development of administrative capacities to identify, evaluate and reduce health inequalities on national and regional (municipal) level with regard to the employees participating in the policy making and implementation in different sectors (health and other sectors contributing to health) and with regard to the employees of public health offices. Special attention is given to induce the inter-sectoral cooperation in order to secure complex reduction of socio-economic, as well as health-related inequalities. Here the key role is played by cooperation withNorway, as its experience in the field of identification and reduction of social inequalities in health and the practice of implementation of the Norwegian National Strategy to Reduce Social Inequalities in Health which is recognised by the World Health Organisation as a model for other European countries, is of great importance. This project will be sought to develop the respective fields intended for the improvement of public health and reduction of health inequalities inLithuania by maintaining cooperation with the respective Norwegian institutions and strengthening bilateral relations. LSMU, VU, KU and HI will use the good foreign material for this project in order to achieve their goal – to develop a model for the strengthening of the capacities to identify and reduce health inequalities that will be prepared according to the international and national experience in the area of identification, evaluation and reduction of health inequalities, analysis of legal documentation (national or regional), evaluation of human potential and its competences, and upon preparation of the related recommendations and training programmes for national and regional employees. This model for the strengthening of the capacities to identify and reduce health inequalities created during the project will be regularly used by the specified target groups thereby improving public health and reducing health inequalities inLithuania.

Purpose of the project – to create the model for the strengthening of the capacities to identify and reduce health inequalities according to the international and national experience in the area of identification, evaluation and reduction of health inequalities, analysis of legal documentation (national or regional), evaluation of human potential and its competences, and upon preparation of the related recommendations and training programmes for national and regional employees.

Project’s activities and sub-activities and their progress:

1.1.1.Preparation of methodical recommendations to identify, evaluate and reduce health inequalities (implementation period 06/2014-04/2016):

1.1.1.1 Analysis of international and national experience in identification and reduction of health inequalities:

  • Period: 07/2014– 11/2014;
  • Responsible institution – LSMU;
  • Person in charge – Dr. Kastytis Smigelskas;
  • Status – done;
  • The report on sub-activity was prepared and sent to the programme’s operator Ministry of Health of the Republic of Lithuania (hereinafter – LR SAM). Summary of the sub-activity 1.1.1.1.:

Summary of the sub-activity 1.1.1.1 “Analysis of international and national experience in identification and reduction of health inequalities”

According to the list of indexes formed with regard to the goals of the Lithuanian health policy and examples of monitoring of health inequalities in the European countries, the analysis of present situation of health inequalities inLithuaniaandEuropewas done. The statistical indexes (demographical, social, economic, mortality, morbidity, lifestyle, accessibility to health care, environment), which illustrate the distribution of health inequalities and their determinants inLithuaniaand abroad, were taken into account. The results manifest that the major health inequalities inn Europe were determined in theBaltic States, includingLithuania. Moreover, the international and systematic review of national experience in monitoring and reduction of health inequalities was carried out. The systemic analysis was used to analyze the publications of scientific researches and international organizations, as well as methodological guidelines for monitoring and reduction of health inequalities. The Master Theses and doctoral dissertations related to health inequalities inLithuaniawere also reviewed.

1.1.1.2    Analysis of strategic documents, which regulate the correctness of health relations in various political sectors:

  • Period: 07/2014– 11/2014;
  • Responsible institution – LSMU;
  • Person in charge – Prof. Skirmante Sauliune;
  • Status – done;
  • The report on sub-activity was prepared and sent to LR SAM. Summary of the sub-activity 1.1.1.2

Summary of the sub-activity 1.1.1.2 “Analysis of the strategic documents (national and municipal), which regulate the correctness of health relations in various political sectors”

When the international systemic monitoring of health inequalities in the European countries with experience in public health practice was reviewed, the review on the legal acts regulating public health monitoring and the authorities implementing such monitoring in Lithuania and other European countries was prepared. It introduces to the main subjects monitoring public health and the data they collect inLithuaniaand inEurope. The search for reports on activities, publications, descriptions of the institutions’ functions and other documents related to monitoring of health inequalities was carried out in the publications and websites of the Lithuanian, Latvian, Estonian, Norwegian, Finnish and Slovenian public authorities responsible for health care and its monitoring. In order to evaluate the correctness of health relations in various political sectors, the content analysis of strategic and normative acts of various Lithuanian political sectors was carried out. The analysis was used to evaluate what tools reducing the health inequalities are included in the municipal and national legal and strategic documents. Besides, the SSGG analysis of strategic and normative acts regulating correctness of health relations in various Lithuanian political sectors was carried out in cooperation with experts during the project. The goal of that analysis was to identify weaknesses, strengths, possibilities and threats of strategic documents and legal acts (national and municipal), which regulate correctness of health relations, and to prepare suggestions for various political (economic) sectors, how to improve the legal basis in the area of correctness of health relations.

1.1.1.3 Evaluation of administrative capacities to identify and reduce health inequalities on the national and municipal level:

  • Period: 12/2014– 03/2015;
  • Responsible institution – LSMU;
  • Person in charge – Dr. Jurgita Vladickiene;
  • Status – done (the municipal doctors were questioned additionally);
  • The report on sub-activity was prepared and sent to LR SAM. The article was prepared and delivered, and three theses for EPH 2015 conference were prepared. Summary of the report on sub-activity 1.1.1.3:

Summary of the sub-activity 1.1.1.3 “Evaluation of administrative capacities to identify and reduce health inequalities on the national and municipal level”

The quantitative and qualitative researches were performed. The data of qualitative research were collected using the method of focus group, when the participants (respondents) were asked the open-type questions leading to discussion. 8 heterogenic groups of discussions took part in the research: 6 groups of municipal level (Vilniuscity,Kaunascity,Klaipedacity, Utena region, Vilkaviskis region, andKlaipedaregion) and 2 groups of national level. The size of the groups of municipal level varied from 7 to 14 persons, the average number of persons in the group was 10. In total 58 persons representing sectors and organizations of different character took part in the group discussions. The discussions of focus group of national level were carried out in two groups: a) group of professionals, working in the health system, and b) group of professionals, who do not belong to the health system. 13 professionals of health sector took part in the first discussion, and 11 representatives of other sectors participated in the second one. All the group discussions were conducted on the basis of interview protocol. The group discussions were moderated by researchers representingVilniusUniversity,LithuanianUniversityof Health Sciences,KlaipedaUniversityandInstituteofHygiene. The inductive method of qualitative content analysis was applied to the data analysis. The interpretations and insights were discussed and considered in cooperation of all the researchers. The municipal doctors, employees of health departments, administrators of public health offices and professionals from the units of public health monitoring, public health strengthening, children and youth health were invited to take part in the quantitative research. The invitations to participate in the research were sent to each respondent by e-mail. The purpose of research was explained and there was indicated the website, where the questionnaire that had to be completed online, was. If the needed answer was not received, the invitations were sent repeatedly. The invitations to the municipal employees were sent twice, to the employees of public health offices – three times. As the answers of the respondents were anonymous, the repeated invitations were sent to all the respondents with the warning not to pay attention to them if the questionnaire had already been completed. The survey procedure lasted 30 days (March 2015). In total 150 completed questionnaires were received (total response frequency made 47,2 percent). According to the jobs of the respondents, the number of answers was distributed as follows: municipal employees (doctors and employees of health units) – 34 questionnaires (response frequency made 25,4 percent), employees of public health offices – 116 questionnaires (response frequency made 63,1 percent). 236 respondents working in various national institutions were questioned in the national quantitative research (where 131 representatives were from the health sector and 105 – from other sectors).

Published results:

  • Vladickiene J, Kalediene R, Zaborskis A, Smigelskas K, Stankunas M. Attitudes of public health professionals’ towards monitoring health inequalities in Lithuania. Eur J Public Health 2015, 25 (suppl. 3): ckv176.146. Reference: http://eurpub.oxfordjournals.org/content/25/suppl_3/ckv176.146
  • Berzanskyte A, Jakubauskiene M, Butkeviciene R, Stepukonis F, Butikis M, Kalediene R. Health policy strategy in local level: experience from the country with high health inequalities. Eur J Public Health 2015, 25(suppl. 3): ckv176.019. Reference: http://eurpub.oxfordjournals.org/content/25/suppl_3/ckv176.019
  • Petronyte G, Aguonyte V, Valinteliene R, Jociute A, Vladickiene J, Stankunas M, Jankauskas R, Kalediene R. The capacities of the health and non-health sectors in identifying and reducing health inequalities. Eur J Public Health 2015, 25(suppl. 3): ckv176.150. Reference: http://eurpub.oxfordjournals.org/content/25/suppl_3/ckv176.150
  • Jociute A, Aguonyte V, Valinteliene R, Petronyte G, Vladickiene J, Stankunas M, Jankauskas R, Kalediene R. Challenges in tracking health inequalities from perspective of stakeholders in national level. Eur J Public Health 2015, 25(suppl. 3): ckv175.062 Reference: http://eurpub.oxfordjournals.org/content/25/suppl_3/ckv175.062

1.1.1.4 Study of collection of the indexes stored in the information systems of various sectors necessary to monitor health inequalities and their usage possibilities with preparation of conclusions:

  • Period: 01/2015-05/2015
  • Responsible institution – HI;
  • Person in charge – Eimante Zolubiene;
  • Status – done;
  • The report on sub-activity has been prepared and discussed at the Project event on 08 April 2015, in Vilnius. The final version of the e-recommendations were discussed by LUHS and HI representatives in a meeting on 01 June 2015. Results of this sub-activity will be included in the recommendations for monitoring health inequalities. Recommendations should be issued in the second half of 2016.

1.1.1.5 Preparation, issuance and distribution of methodical recommendations about monitoring of health inequalities, interpretation and application of results:

  • Period: 06/2015 – 10/2015;
  • Responsible institution – HI;
  • Person in charge – Eimante Zolubiene;
  • Status – under implementation (the pilot research was carried out in the selected municipalities; the results of pilot research were discussed in the conference on27/08/2015; the preparation of the illustration platform of health inequalities is coming to an end);
  • On this sub-activity from June to August (2015), pilot studies were carried out in 4 municipalities (Molėtai, Visaginas, Kalvarija, Alytus) which voluntarily expressed their willingness to participate in activity. The studies tested health behavior research methodology prepared in 1.4 sub-activity. The results were presented and discussed at the debate with the public health offices, held on 27 August 2015 in Vilnius. Also, the process of this sub-activity has been discussed at the meeting in the Ministry of Health (on 17 September 2015). Guidance on inequalities in health monitoring electronic version (pdf) is available in Hygiene Institute’s web site: http://www.hi.lt/uploads/pdf/projektai/Modelis%20Norway%20Grants/Rekomendaciju%20projektas%20_1.1.1.5.pdf. Results of this sub-activity will be included in the recommendations for monitoring health inequalities. Recommendations should be issued in the second half of 2016.

1.1.1.6 Preparation, issuance and distribution of recommendation for evaluation and reduction of health inequalities:

  • Period: 05/2015 – 10/2015;
  • Responsible institution – LSMU;
  • Person in charge – Prof. Aurelijus Veryga;
  • Status – under implementation;
  • On this sub-activity developing recommendations for excluded six groups: alcohol (organizer HI), tobacco (organizer LUHS), nutrition (organizer VU), physical activity (organizer HI), suicide (organizer VU) and health care (organizer KU). December 15 (2015) was the day of all the project partners and the Ministry of Health representatives meeting in which it was discussed the initial versions of the recommendations. It was noticed that the recommendations are to be developed and to be closer to practical use. Therefore, it was decided to revise the recommendations and to develop a detailed implementation plan for a single measure (from each group of recommendations). On 13-14 January 2016 a seminar was held in Druskininkai, in which developed recommendations were presented and discussed in conjunction with the Ministry of Health, local public health offices and members of the municipal administrations. During the seminar received suggestions and comments were used to improve health disparities reduction recommendations Revised recommendation presented to selected Druskininkai, Plunge district Klaipeda district municipalities and analyzed the situation of these recommendations application in practice. Recommendations are forthcoming and will be released in the second half of the year 2016.

1.1.2. Strengthening of administrative capacities (implementation period 05/2015 – 01/2017):

1.1.2.1.Preparation of training programmes meant for the subjects of national and municipal authorities (health and other sectors), including professionals;

1.1.2.2.Strengthening of administrative capacities of the subjects of national and municipal authorities (health and other sectors), including professionals;

1.1.2.3.Strengthening of administrative capacities of the subjects of national and municipal authorities (health and other sectors).

In this activity, there is already prepared an initial plan of training programs and delivered for the Ministry of Health. There are also almost finalized tutorial / teaching tool. The training of municipal public health office staff (4 events) as well as the national and municipal level employees who are concerned with the problem of health inequalities (5 events) are planned to carry out in September 2016 - January 2017.

Project’s events and results:

The project’s discussion "Health inequalities monitoring and reduction" was organized on 08 January 2015 in Vilnius, during which the data of sub-activity 1.1.1.3 qualitative research were collected.

The conference"Health inequalities monitoring and reduction" was organized on 29 January 2015 in Vilnius (Karolina Hotel), where the results of the sub-activities 1.1.1.1 and 1.1.1.2 were presented, the recommendations, how to improve the legal basis in order to achieve correctness of health relations in various sectors were discussed. 92 participants representing the project’s implementers (LithuanianUniversity of Health Sciences,Institute ofHygiene,VilniusUniversity andKlaipedaUniversity), Ministry of Health, municipal health units, public health offices and other institutions took part in the conference.

The project’s discussion “Monitoring of Health Inequalities” was organized on 08 April 2015 in Vilnius, during which the existing health monitoring practices in different public health offices were discussed and there were presented the list of indexes necessary for health monitoring, their illustration possibilities, and methodical recommendations of lifestyle monitoring of children and adults. The representatives of theInstitute ofHygiene,LithuanianUniversity of Health Sciences, Ministry of Health, and public health offices of different municipalities took part in that discussion.

The representatives of the institutions implementing the project – Lithuanian University of Health Sciences and the Institute of Hygiene – visited Norway on 28-30 April 2015,where they tried to get familiar with the Norwegian good practice in the area of monitoring and reduction of health inequalities. They went toLillehammer, where the meeting with “Sunne kommuner” was held. This meeting was beneficial because it allowed seeing how the communities are involved in various wellness activities, how such processes are organized, and what experience could be applied to solve the problem of health inequalities in the Lithuanian regional level. The meeting with the representatives of the Norwegian Public Health Institute was held inOslo. The following persons participated in the meeting: Bjørn Gunnar Iversen, Jon Ivar Elstad, Heidi Lyshol, Bjørn Heine Strand, Marte Kvernland and Andrej M Grjibovski. The major attention during the meeting was given to the Norwegian experience in organization and implementation of monitoring of health and health inequalities. This visit allowed making closer relations with the Norwegian colleagues and getting familiar with good practice in the area of monitoring and reduction of health inequalities. The trip was funded by the Norwegian financial mechanism 2009–2014 programme No. LT11 “Public Health Initiatives”.

On 10 June 2015 the article of the project’s manager Prof. Mindaugas Stankunas “Norway is Investing to Reduction of Health Inequalities: what could Lithuania learn?” was published in the magazine “Valstybė” (State) (available at: https://www.facebook.com/Sveikatosvadybosklubas/posts/1601349273480438)

The annual conference of European Health Management Association was held on 15-17 June 2015 in Breda (Netherlands), where the project’s representatives from theLithuanianUniversity of Health Sciences also took part. Besides, the stand presentation “Capacity building for bringing more evidence based decisions for monitoring and reducing health inequalities inLithuania” was prepared and presented during the conference. It introduced the conference’s participants to the problem of health inequalities inLithuania, the project under implementation, and expected results. 

The public discussion “Determination of health inequalities in health behaviour research” was organized in Vilnius on 27 August 2015.Its purpose was to discuss the methodical recommendations for monitoring of health inequalities and researches of lifestyle of children and adults. Besides, the testing results of pilot methodologies in the municipalities of public health offices (Moletai regional municipality, Visaginas municipality, Rietavas municipality, Alytus city municipality) were presented.

On 15-17 October 2015 the European Public Health Conference was held in Milan (Italy). It is the major event of such character on the old continent that is visited by more and more participants from such remote corners of the world asAustralia andNew Zealand. The representatives of the LithuanianUniversity ofHealth Sciences and theInstitute ofHygiene took part in that conference. They are actively participating in the project of health inequalities. Four reports were presented during the conference. They were based on the research, during which the representatives of municipal public health offices and national health policy (e.g., Ministry of Health), and other sectors related to health inequalities were questioned. In order to get familiar with the present situation and possibilities of its improvement better, the quantitative and qualitative research methods were used. List of prepared and presented reports:

  • Vladickiene J, Kalediene R, Zaborskis A, Smigelskas K, Stankunas M. Attitudes of public health professionals’ towards monitoring health inequalities in Lithuania. Eur J Public Health 2015, 25(suppl. 3): ckv176.146.
  • Berzanskyte A, Jakubauskiene M, Butkeviciene R, Stepukonis F, Butikis M, Kalediene R. Health policy strategy in local level: experience from the country with high health inequalities. Eur J Public Health 2015, 25(suppl. 3): ckv176.019.
  • Petronyte G, Aguonyte V, Valinteliene R, Jociute A, Vladickiene J, Stankunas M, Jankauskas R, Kalediene R. The capacities of the health and non-health sectors in identifying and reducing health inequalities. Eur J Public Health 2015, 25(suppl. 3): ckv176.150.
  • Jociute A, Aguonyte V, Valinteliene R, Petronyte G, Vladickiene J, Stankunas M, Jankauskas R, Kalediene R. Challenges in tracking health inequalities from perspective of stakeholders in national level. Eur J Public Health 2015, 25(suppl. 3): ckv175.062

Health inequalities imaging/ portrait system “SveNAS”. During the project, in the Institute of Hygiene was created health inequalities imaging/ portrait system “SveNAS”. In this system, it is available to see Lithuanian’s in mortality, per 100 000 inhabitants, imbalances. This system “SveNAS” is available in Lithuanian language at: http://www.svenas.lt/.

 

On 13-14 January 2016 the two-day seminar - discussion on “Reducing health inequalities” was held in Druskininkai. The seminar was attended by the Ministry of Health, Lithuanian University of Health Sciences, Institute of Hygiene, University of Vilnius and Klaipeda, municipal administrations and public health office representatives. The main objectives of the seminar were:

1. To get acquainted with the proposed recommendations on reducing health inequalities.

2. Identify the most appropriate / effective recommendations designed to reduce inequalities of health.

3. Share best practices to reduce health inequalities in Lithuania.

During the seminar-discussion the main groups of the recommendations were discussed, such as recommendations focused on alcohol and tobacco consumption reduction, nutrition and physical activity in improving access to health care and suicide prevention. Recommendations are developed using science-based knowledge and good practices. The most highlighted activities are at the municipal level. The seminar participants gave a very interesting measures to reduce health inequalities. It was also prepared detailed action plans for selected recommendations.

 

 

 

 

 

 

 

On 18 March 2016 in Klaipėda, on 8 April 2016 in Šiauliai, on 13April 2016 in Kaunas and on 15 April 2016 in Druskininkai were held discussions on “Health inequalities. Lifestyle research organization and realization in municipalities”. In different regions of Lithuania organized discussion - workshops aimed at municipal public health office's preparation of lifestyle research. More information about events and their material can be found at: http://www.hi.lt/index.php?mact=News,cntnt01,detail,0&cntnt01articleid=1045&cntnt01returnid=503.

 

   
   

 

On 23-25 May 2016 in Jerusalem (Israel) was held the 6th International Conference on Health Policy in Jerusalem. The event attracted over 500 participants from 40 countries. During the event, the project leader, Professor Mindaugas Stankūnas made a report, which briefly introduced the health inequalities situation in Lithuania and the ongoing project and its results.

 

 

 

 

 

 

 

More information about the Project:

 

News about the Project in social network „Facebook“:

https://www.facebook.com/SveikatosNetolygumai/?fref=ts

 

Information about the Project in scientific publications:

About the Project also writes LUHS newspaper „Ave Vita“:

03 October 2014, No. 33: http://lsmuni.lt/media/dynamic/files/5140/2014_av33--8pslweb.pdf

23 January 2015, No. 3: http://lsmuni.lt/media/dynamic/files/5961/2015_av3--8pslweb.pdf

30 April 2015, No. 17: http://www.lsmuni.lt/media/dynamic/files/6804/2015_av17--8pslweb.pdf

04 December 2015, No. 40: http://www.lsmuni.lt/media/dynamic/files/8376/2015_av40--6pslweb.pdf  

22 April 2016, No. 16: http://www.lsmuni.lt/media/dynamic/files/9292/2016_av16--4pslweb.pdf

10 June 2016, No. 23: http://www.lsmuni.lt/media/dynamic/files/9739/2016_av23--10pslweb.pdf

Articles in English are available here.

 

About the Project also writes (in Lithuanian language):

Contact data of the project’s administration group:

  • Mindaugas Stankunas – LSMU Professor, project’s manager. E-mail: mindaugas.stankunas@lsmuni.lt, phone: 8-37-327325.
  • Egle Rimaviciene – LSMU projects’ coordinator, project’s administrator. E-mail: egle.rimaviciene@lsmuni.lt, phone: 8-37-409746.
  • Rolanda Valinteliene – head of HI Centre of Public Health Technologies, project’s manager in the Institute of Hygiene. E-mail: rolanda.valinteliene@hi.lt, phone: 8-5-261 8390.
  • Ausra Berzanskyte –VU lecturer, project’s coordinator at Vilnius University. E-mail: ausra.berzanskyte@mf.vu.lt, phone: 8-5-2398735.
  • Arnoldas Jurgutis – head and professor at KU Department of Public Health, project’s coordinator at Klaipeda University. E-mail: arnoldas.jurgutis@ku.lt, phone: 8-46-398561.