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

Chapter 4
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Lithuania reports regularly to WHO (and more recently
to the EU) and participates in certain Nordic monitoring
exercises. Collaboration with the other Baltic countries is
particularly close. The Baltic ministers of health meet on a
regular basis and there are agreements in certain areas for
an exchange of expertise and knowledge. A report on the
health status in the Baltic countries (15) is produced on a
regular basis (now every three years) and a healthy competition
creates peer pressure for improvements in public
health policy formulation and monitoring.
Research policy tends to be driven mainly by the interests
of researchers and does not necessarily reflect the needs of
public health policy development.
2.2. Health promotion strategy
Lithuania does not have a separate health promotion strategy,
health promotion being seen as part of the overall public
health policy. Health promotion and health education were
included among the state health programmes approved by
the Government in 1996. This programme no longer exists,
however, and health promotion has apparently come under
the general umbrella of the state public health office. There
is some concern among public health experts that health
promotion is not given sufficient visibility under this large
umbrella, and that consequently the Public Health Bureaux,
which are gradually to be operated at municipal level, may
not receive the necessary technical support from the central
level.
The 5th National Health Policy Conference held in November
2006 focused on improving health system performance
and taking multisectoral action to tackle NCD. Both the
CINDI vision (16) and the European strategy (17) documents
were presented, and the Conference recommended
that these documents be translated into Lithuanian, a task
that is now under way.
In November 2006, by a joint decision of the Ministry of
Health and the National Board of Health, a National Task
Force for NCD policy formulation was established. Owing
to changes in the top administration of the Ministry of
Health and municipal elections in March 2007, submission of
the draft policy document was postponed but is expected
early in 2008.
2.3. Health system policy
Soon after independence, Lithuania passed a comprehensive
Law on the Health System (6). The opening paragraph
makes clear reference to the WHO Health for All policy,
the Ottawa Charter, the need to tackle the determinants
of health and to the provisions of the Lithuanian National
Health Concept. It is a widely embracing legal document,
giving a decisive impression of a country making a new
beginning.
Article 7 of Chapter 2 clearly sets out the principles of
equality and social justice, the need for intersectoral action,
and for the health system to contribute to the implementation
of national objectives and priorities.
The structure of health care and its management at national
and local levels is outlined, and the responsibilities of the
national and municipal levels defined. PHC is defined for
the first time as a separate activity. Public health care is
given considerable prominence and is defined (in the English
translation) as having a “universal character”, stating that it
is the duty of all natural and legal persons to take responsibility
for public health and health promotion. The control of
risk factors such as alcohol, tobacco and drugs, environmental
health and safety at work are defined as being the responsibility
of the state and the municipalities. The intention
to prohibit the advertising of alcohol and tobacco products
through further legislation is mentioned.
Prominence is given to the need for public health information
and its monitoring and that “Information concern-
Case studies: policy development in countries for tackling noncommunicable diseases