Gaining health : analysis of policy development in European ...

Lithuania
Anna Ritsatakis
1. Country profile
Lithuania is situated on the eastern Baltic coast. It is
bordered by Belarus to the east, Latvia to the north and
Poland to the south. In March 1990, Lithuania declared its
independence from the USSR.
Lithuania is divided into 10 regions and 56 municipalities.
There are 56 local self-governing councils elected every
two years, and 10 district advisory councils comprising the
mayors of the local councils. In 2005, the population was 3.4
million, about 67% of whom lived in urban areas.
The national language is Lithuanian. Lithuania joined the EU
in May 2004.
1.1. Socioeconomic development
At the beginning of the 21st century Lithuania had an
unemployment rate of over 12%, but by 2004 this had
fallen to around 6%. During the same period, per capita
gross national income doubled from US$ 3170 in 2000 to
US$ 7210 in 2005. Indeed, this period may be considered
as one of solid economic growth, stable currency, healthy
public finances, low budget deficit and successful structural
reforms.
Despite these significant improvements, however, inequalities
remain. Although the proportion of those living in
absolute poverty decreased considerably during the 1990s,
income inequalities are greater in Lithuania than in EU15
countries. Eurostat reports that, in 2002, 17% of Lithuanians
had incomes below 60% of the national median disposable
income (after social transfers), compared to an average of
14% in the EU countries in 2001 (1).
1.2. The people and their health
Between 1970 and 1990, the population of Lithuania increased
from 3.1 million to around 3.7 million. Since the political
changes in eastern Europe, there has been a gradual
but continuous decrease to around 3.4 million. Natural
growth of the population has been negative since 1994.
World Bank forecasts (2) indicate a continuing decrease
over the coming years, reaching 3.2 million by 2020.
As the birth rate has continued to fall (around 15 live births
per 1000 population in 1980 to just below 9 in 2005) and
young people seek jobs abroad, there has been a rapid
ageing of the population. The proportion of people aged
65 years and over rose from around 11% in 1980 to 15% in
2005, and this is estimated to reach 22% by 2030 (1).
Overall life expectancy at birth increased from 70.3 years
in 1996 to 72.3 years in 2000, falling again to 71.3 years in
2005. This hides a large and increasing gender gap. In 2005,
life expectancy for males was 65.4 years while that for
females reached 77.4 years. According to WHO estimates
(1), Lithuanians spend on average about 11.9% of their life
with illness.
The overall rates also hide considerable regional differences,
there being a twofold difference between the regions with
the highest and lowest mortality rates. Life expectancy
between these regions differs by almost seven years (3).
The number of infant deaths per 1000 live births has been
gradually falling, reaching 6.8 in 2005. This is still higher than
in western European countries and its further reduction is
one of the aims of the current health programme.
More than half of all deaths in Lithuania are caused by CVD.
They are also the cause of 30% of disabilities and 15–20%
of all referrals for health care. Within total cardiovascular
mortality, ischaemic heart disease and stroke constitute
the greatest proportions. Although mortality from CVD
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases