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

Chapter 4
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risk factors have been developed. Seminars for physicians
are organized several times a year, including teleconferences
in collaboration with the Mayo Clinic in the United States,
and the Association’s regular periodical brings the latest
information to its members. The Association also organizes
television programmes and articles in popular newspapers
and journals.
The Lithuanian Society of Cardiology was established much
earlier in 1964 and works in collaboration with similar societies
in Estonia and Latvia. It appears, however, to have a
rather smaller membership.
2.4.2. Cancer
Cancer causes every fifth death in Lithuania (1) and is
relatively high compared with other European countries,
particularly in the middle-aged. Among older people, both
men and women, cancer death rates (as for CVD) have
increased constantly since the 1980s. The broad health plan
sets quantified targets to reduce death rates from breast
cancer and lung cancer, and to reduce the number of cancer
cases with a late diagnosis by 20% by 2010.
Linked to implementation of the overall health strategy,
the prevention of cancer was one of the programmes
approved by the Government in 1996. National screening
programmes for cervical and breast cancer have been
initiated, and the government programme for 2006–2008
(18) stipulated that these should be free of charge for all
women in the 30–65-year age group. There is also to be
free screening for prostate cancer for men aged 60 years
and over. Key to the success of efforts to get the necessary
infrastructure in place for early detection/screening will be
the way in which family physicians are introduced into the
health system.
2.4.3. National demonstration projects – CINDI
Lithuania’s collaboration with the WHO started in the
early 1970s with a classical epidemiological study, the
Kaunas –Rotterdam Intervention Study (KRIS). In 1981
WHO headquarters and the Regional Office for Europe
convened a meeting to discuss the development of a more
integrated approach to the prevention and control of NCD
This meeting was held in Kaunas, and databases in North
Karelia (Finland) and Kaunas were used to demonstrate the
commonality of lifestyle-related risk factors to a number of
NCD. An outcomes of these discussion was the establishment
of WHO’s CINDI programme, of which Lithuania
became a founding member in 1983 (19).
One of the special contributions that CINDI made to
the enhancement of the national information system for
health policy development was that national statistics were
merged with characteristics of major health determinants
derived from population surveys (20). The CINDI system
allows for monitoring and evaluation of changes in morbidity
and its determinants at national, regional or local levels,
and for monitoring the impact or effect of specific health
interventions.
Participation in CINDI involves mandatory surveys of
health behaviour every second year. Seven national health
behaviour surveys were carried out in Lithuania between
1994 and 2006 among the population 20–64 years old. The
reports were published in collaboration with the Finnish
National Public Health Institute.
The CINDI programme in Lithuania was designed to cover
two levels: demonstration areas and national actions. There
are now six CINDI demonstration areas in the country,
covering 15% of the population. The urban population is
represented by Kaunas city and there are five rural areas
in the project. Organized health interventions are carried
out by teams of researchers and local health staff in the
demonstration areas, to act as pilots. At the national level,
CINDI acts as a strong advocate for intersectoral action to
promote health.
Case studies: policy development in countries for tackling noncommunicable diseases