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

ing public health must be available to the public without
restriction and it may not be considered a state secret”.
Long-term planning (10 years) is also provided for (Article
88), including the need to define objectives and to set “the
indices of health level to be achieved”.
In relation to intersectoral action for health, Article 109 sets
out the joint responsibilities of the Ministry of Health and
other ministries.
Provision is made for the establishment of a National Health
Board with responsibility for coordinating health promotion
policy, for alcohol, tobacco and drug control policy; for
public health protection and the relevant policy formulation,
and for setting up a State Health Commission at government
level to coordinate intersectoral action for health. At
the municipal level, Community Health Boards are provided
for. Article 117 provides for the establishment of a State
Tobacco and Alcohol Control Agency.
The 1994 law not only outlines the responsibilities of the
state but also those of individuals, stating that residents
of Lithuania must take care of under-aged children and of
elderly parents, should refrain from violating the healthrelated
rights of others, and should protect the environment
from harmful effects. Those who do not will be held
legally liable for their actions. The responsibilities of private
enterprises and other institutions in relation to health are
also outlined.
The training of health personnel for health promotion in
PHC has begun but still has some way to go. It still has a
low social status and financial benefits are being considered
to motive personnel in this direction.
2.4. Policies for specific NCD
Policy documents for individual NCD have not been formulated
in Lithuania, the objectives and targets for tackling
these diseases being included in the umbrella policy for
public health. There are, however, approved government
action programmes.
2.4.1. Heart health
More than half of all deaths in Lithuania are caused by
CVD, with ischaemic heart disease causing almost 28% of
all deaths in 2003. There has, however, been considerable
improvement in mortality rates from CVD in those aged
15–74 years, but for older people the rates began to deteriorate
in the 1980s and continue to do so.
The broad health policy sets targets to reduce, by 2010,
mortality rates from ischaemic heart disease and stroke
for those under 65 years of age by 15% and for those
aged 65–74 years by 10%. Linked to implementation of
the overall strategy, the prevention of CVD is one of the
programmes approved by the Government in 1996. As part
of this effort, screening for high cardiovascular risk has been
initiated in some regions of the country.
As in many countries, influential cardiologists tend to exert
strong pressure for improved technology in their field,
and there is some concern that investments in diagnostic
technologies for cardiologists through the heart health programme
has been to the detriment of investment in health
promotion and health education. Consequently, critics of
the programme feel that the heart health programme has
not been as effective as it might have been.
One of the changes brought about by the regaining of independence
was the establishment of numerous new NGOs.
In1994, the Lithuanian Heart Association was established,
and now has seven branches throughout the country. The
web site of the Association (www.heart.lt) states that,
owing to the level of CVD in Lithuania, heart health is “not
only a medical but also a social problem” and the leading
cause of incapacity to work. One of the main aims of the
Association is to improve doctors’ professional skills, and
guidelines and protocols for tackling CVD and their main
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Case studies: policy development in countries for tackling noncommunicable diseases