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

as wide an understanding as possible of the determinants
of health and potential for intersectoral action. The Conference
recommended that comprehensive public health
reports be prepared regularly.
2.1. Broad public health programme
The Lithuanian Health Programme 1998–2010 (11) is the
current “umbrella” policy for health. It is clearly based on
the principle of equality in health, although at the time
when it was written this was still understood mainly in
terms of equality in access to care. The programme covered
the prerequisites for health, lifestyles conducive to
health, appropriate health care, the environment, and the
structures, training and monitoring system necessary for
implementation and evaluation of outcomes. It was seen
as a continuation of the National Health Concept and as a
national adaptation of the WHO Health for All Policy.
Its main objectives are:
• a reduction in mortality rates and an increase in average
life expectancy;
• equality in health and health care; and
• improvement in the quality of life.
Quantified targets were set to reduce, by 2010, mortality
rates from accidents (30%), CVD and cancer in those under
65 years of age (15%) and infant mortality (30%), and
to increase life expectancy to 75 years. Explicit targets were
set for reducing health risks such as smoking and alcohol
and fat consumption and for increasing physical activity.
In relation to tackling inequalities in health, reference was
also made to addressing the determinants of health, such as
reducing income differences, improving living and working
conditions, promoting healthy lifestyles (with specific attention
to high-risk groups) and to improving access to health
care.
2.1.1. How things started
At the time when Lithuania gained its independence, there
was already a firm evidence base and a critical core of highly
skilled experts intent on utilizing their skills to improve
health. These experts provided clear leadership, notably the
Rector of Kaunas University of Medicine, Professor Vilius
Grabauskas, who was also President of the National Board
of Health and team leader for the CINDI programme. They
were widely respected and their guidance sought by politicians
across political parties. With the evidence they provided,
consensus was reached on the priority areas needing
urgent attention, which included tackling CVD, cancer and
diabetes and their related health risks. The overwhelming
nature of the transition period, however, when every sector
was bringing up urgent legislation, meant that health joined
a long waiting list of issues coming to Parliament.
A Health Reform Management Group was established
in 1993, providing leadership not only for health system
reform but also for the development of policies for disease
prevention and health promotion. The 1994 Lithuanian
Health Law provided the necessary legislative background,
and the following year a task force was charged with preparing
a situation analysis and action plan to address the
major problems. To continue the building of intersectoral
understanding and support, the challenges outlined in the
analysis were discussed in a full-day parliamentary session,
broadcast on national radio, with four ministers and a large
number of members taking part.
The ensuing Lithuanian Health Programme was approved
by the Collegium of the Ministry of Health in July 1996 and
by the Government in October of that year. The following
spring, it received wide publicity when it was discussed at
the Second National Conference on Health Policy. Experts
from other countries and from WHO were asked to comment
on the draft, which was reviewed by Parliament in July
1998.
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases