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

Chapter 4
204
of industrial diseases and accidents rather than on utilizing
the workplace as a setting for health promotion and the
prevention of NCD.
2.6.3. Schools
In 1994, Lithuania joined the long-standing (from
1983/1984) WHO project for surveying the health behaviour
of schoolchildren, and since then has carried out the
survey every four years. The results of the 2002 survey
gave cause for concern, as eating habits were unsatisfactory,
physical activity was inadequate and smoking was increasing.
Lithuania has also been an active member of ENHPS since
1993, when there were 10 schools in the national network.
By 2007, there were 180 certified schools in the network:
primary and secondary schools and gymnasiums plus an
additional 205 kindergartens. There are also five local networks,
at municipal level, of schools working towards the
Health Promoting Schools concept. These local networks
cover 20–100% of the schools in their area and are associate
members of the national network.
At the beginning of the project in Lithuania, the focus was
mainly on basic hygiene issues, such as achieving a clean
learning environment and topics related to personal hygiene.
Since then, the scope has broadened to encompass
lifestyle issues, with a focus on physical activity in recent
years. Information is easily available and, in the Lithuanian
tradition, strong efforts are made to monitor and evaluate
activities.
Public health specialists and community nurses are being
trained to work in schools.
2.6.4. Hospitals
Although there is no legislative basis for the implementation
of a health promotion strategy in hospitals, a network
of health promoting hospitals was established in 1996.
There are now ten hospitals in the network, coordinated by
Kaunas Medical University Hospital, which is also a WHO
collaborating centre for CVD and other NCD. The network
collaborates with other settings networks, with CINDI and
with NGOs dealing with heart disease, hypertension and
diabetes. The main aim of the network, which is funded by
the Ministry of Health and fees from member hospitals, is
to incorporate the concepts, values and standards of health
promotion into the organizational structure and culture of
the hospital. For example, in 2002, a focus of the network
was to create smoke-free hospitals, for which a guide and
training were provided. Five of the hospitals in the network
are already implementing this programme.
2.7. Policies for specific population groups – older
people
The period of socioeconomic transition was considered to
be “especially painful for the elderly”. 16 Although there is
no separate policy document related to the health of older
people, in recent years special attention seems to have
been paid to certain of their needs. For example, the law
regarding compulsory health insurance provides for insurance
contributions for pensioners to be paid by the state.
There is also a national strategy on ageing, covering the
fields of family welfare, public health and migration.
Also, from 1998, when a three-year social services infrastructure
development programme (SSID) was initiated,
priority was given to funding projects at the local level
that aimed to provide services for people in their homes
and communities (25). Some 37% of the SSID projects
were aimed at older people. When SSID was renewed for
2004–2006, the community focus was further strengthened
and more attention paid to rural areas where services were
practically nonexistent.
Older people appear to have been particularly active in
establishing NGOs to deal with their concerns. In 2001,
Gabija, a nationwide network of NGOs working with and
16
Statement by the Minister of Social Security and Labour at the 2nd
World Assembly on Ageing, Madrid, 11 April 2002.
Case studies: policy development in countries for tackling noncommunicable diseases