INFORMED AND HEALTHY

Project BG051PO001-5.3.01 “Informed and Healthy” is implemented within the 2007 – 2013

Human Resource Development Operational Program, Priority Axis 5 “Social Inclusion and Promotion of Social Economy”, Operation 5.3.

“Employability through Better Health”

• Total project amount: BGN 4,692,754.30 • Project duration: 48 months; launched on 21

May 2009 and planned to end until 21 May 2013

• The project general goal is to enhance the population’s employability, extend its active labor life and maintain healthy workforce by enhancing the knowledge, skills and motivation needed for healthy lifestyles.

Project specific goals include:

1. Enhance the awareness, especially among vulnerable groups, about behavioral risk factors related to excessive table salt intake, psychotropic drug abuse among young people, smoking, occupational, everyday and transport traumatism.

2. Incept a change in behavior in relation to the aforementioned risk factors by enhancing the knowledge of healthy lifestyles and opportunities for curbing traumatism among target groups.

Forthcoming Activities:

• Compile handbooks and manuals of good practices:

• Methodological manual of successful approaches and good practices to be used by practitioners in the area of psychotropic drug abuse prevention;

• Manual of good practices for medical specialists on risk assessment and control for smokers;

• Manual of good practices for medical specialists on risk assessment and control of occupational traumatism;

• Methodological manual of successful approaches and good practices for producers of low-salt foods.

• National health information campaigns aiming to curb:

- table salt intake - psychotropic drugs abuse among

young people - smoking - occupational traumatism - everyday traumatism - transport traumatism

 - Conduct a final study of knowledge,

attitudes toward behavior change and healthy lifestyle skills and opportunities for curbing the risks of occupational, everyday and transport traumatism among target groups.

• Expected results include:

-  quality of human capital improved through an improved health status and curbed unhealthy habits;

- expanded knowledge, skills and attitudes toward healthy lifestyles and curbing the risks of occupational, everyday and transport traumatism;

- established new values of responsible behavior to people’s own health, other people and the environment;

- The project is managed and administered by the Ministry of Health.

ANALYSIS

The global prevalence of chronic non-infectious diseases, the various mortality reasons and their development models in the individual countries prove that people’s living conditions, their attitude toward their own health, habits and behavior can prevent their appearance or accelerate the process of high morbidity rate.

Social chronic non-infectious disease

morbidity in the Republic of Bulgaria shows a growth tendency which will probably persist in the following decades of this century. One reason for that is the nation’s demographic status: the long-term negative population growth and the ageing of the population.

A significant part of our country’s population is a bearer of serious behavioral risk factors corresponding mostly to blood circulation organ diseases, respiratory system diseases, cancer neoplasm, traumas, etc. In 2006, the WHO presented a new strategy for health improvement and enhancement and countering chronic non-infectious diseases based on the theses below:

• Each widely spread social disease is caused (completely or partially) by social and behavioral processes that can facilitate its dissemination and treatment.

• All behavioral and social processes are subject to potential change.

• Successful interventions aiming to bring about social and behavioral changes can alleviate significantly the global burden of diseases, disability and premature death.

This strategy finds its implementation

in health promotion methods including enhancement of individuals’ health awareness and self-motivation for control of their own health behavior as a chance for better health.

• Health in all its aspects is a cross-cutting point for solving problems like life expectancy and quality, employability, healthy offspring, economic prosperity, etc. These are also the reasons why health related issues and the bridling of some risk behavior factors are in the spotlight of INFORMED AND HEALTHY project activities.

Research, Analyses and Campaigns

Conducted over the Past Three Years • Cardiovascular diseases rank among

Bulgaria’s number one reasons for morbidity and mortality. Bulgaria is one of the countries in Europe with the highest morbidity and mortality rates caused by cardiovascular diseases which show a tendency to increase or persist, unlike Western European countries’ tendency to curb this rate.

• According to National Statistical Institute data, the main mortality reason among Bulgaria’s population are blood-circulation organ diseases - 66.4% of overall mortality in 2006 and 65.8% in 2007. The high cardiovascular mortality rate in Bulgaria corresponds to the high arterial hypertension rate in our country – 40.1% of people aged 25 – 64 years; and 50.3% of people aged 45+.

• Arterial hypertension is a paramount and highly widespread risk factor for cardiovascular and kidney diseases, including stroke, coronary disease, cardiac and kidney disorders, and ranks as a mortality risk factor number one globally.

• The excessive table salt (sodium chloride) intake increases arterial pressure values.

• The reduced table salt intake at the population level contributes to the reduction of cardiovascular morbidity and mortality rates, thus resulting in significant saving of health expenses. The World Health Organization and the World Cancer Research Fund recommend a daily salt intake of 5 g.

• Main sources of salt in the diet of Bulgaria’s population include: industrially processed food – bread and bakery products, meat products, cheese and ready to cook food (soups, broths, etc.).

• The excessive salt intake affects more than 70% of Bulgaria’s population.

• The excessive table salt intake correlates to the high rates of arterial hypertension, myocardial infarction and brain stroke in our country.

• The “2006 Recommendations for Healthy Diet of the Population” include a recommended daily sodium intake of less than 2,000 g which can be found in 5 g of salt – a quantity that complies with the WHO recommendation; practical approaches to reducing salt intake are also proposed.

DISSEMINATION OF DRUGS

Over the past three years, research and analyses were conducted on the issue of dissemination of drugs among both active age population (18 – 65 years) and school goers.

• Cannabis is the most commonly used illegal drug.

• The second largest group of illegal drugs is the group of stimulants, including synthetic ones (amphetamines, ecstasy, cocaine).

• The comparatively common use of sleeping drugs and tranquilizers, mostly by the more elderly population, is also alarming.

Summing up, we need to say that in 2007 33.2% (one-third) of Bulgaria’s 9th to 12th graders had tried at least once in their lives some type of illegal drug. Translated into absolute numbers, this means that about 115,000 – 120,000 of today’s secondary school students have some experience in using illegal drugs.

The same research employed indicators for

tracing the influence of 3 main aspects of young people’s lives: family, school and friends. Some elements were identified that could be defined as risk factors at the social level. Within the family, these include for example insufficient contacts with parents and control by parents (different from total or police-like control).

Data show that the percentage of

young people, who have used some kind of drugs in their lives and almost never spend their free time with their parents on off-school days, is almost three times higher than the same percentage among school goers who frequently share their leisure time with their families.

As to the school, young people’s dissatisfaction with studying and the lack of understanding with their teachers can qualify as such risk factors; for example, the percentage of young people who have used some drugs and say that studying is useless is two times and a half higher than the same number among school goers who do not share the same opinion.

In friends’ circles, the most influential

risk factor is the use of psychoactive drugs by friends – for example, the percentage of school goers who have tried some drug is six times higher among those whose friends smoke marijuana.

SMOKING

Smoking has unique significance because of its present and prognosticated future influence on global mortality rates. If the current ascending tendency persists, the number of smoking victims will grow several times and will reach 10 million per year.

Smoking is a behavioral factor causing extremely unfavorable health consequences. Accumulated scientific information indicates that smoking and passive smoking are a direct or indirect factor for morbidity and mortality caused by more than 25 types of diseases. It is essential for the origin and the graver course of the most serious and widely spread diseases of social significance like:

• oncologic diseases and in particular lung, mouth, mouth cavity, pharynx, esophagus, larynx, trachea and bronchial cancer;

• cardiovascular diseases: hypertension, ischemic heart disease, brain vascular disease and atherosclerosis. The risk of heart diseases among smokers is 1.5 – 3 times higher and brain stroke incidence among smokers is 2 – 4 times higher. The risk gets higher as smoking intensity increases;

• chronic non-specific lung diseases

(chronic bronchitis, chronic obstructive lung disease, asthma, etc.) and emphysema where smoking causes 75% of morbidity rates and 80% of all lethal cases associated with these diseases.

• Smoking causes economic losses for both smokers and their families and society as a whole. The percentage of lethal cases among men caused by all smoking factors is highest at the age of 45 – 64 years and accounts for 44%.

• Quitting smoking results in longer life expectancy in good health which gives vital importance to all programs and activities in support of smokers’ efforts to quit smoking.

OCCUPATIONAL TRAUMATISM

Occupational traumatism is a combination of occupational traumas resulting from employment injuries that can cause temporary incapacity for work, disability or death. As per Article 55 of the Social Insurance Code “employment injury is any sudden impairment of health occurred during and in connection with or because of the work performed, as well as during any work performed in the interest of the enterprise where the said impairment has resulted in incapacity for work or death”.

Employment injury shall furthermore be any injury of a person insured under Article 4 (1) and (2) herein during the usual commuting to or from the working place to: 1. the principal place of residence or to another additional place of residence of a permanent nature; 2. the place where the insured person customarily takes his or her meals during the working day; 3. the place where a remuneration is received. Employment injury shall not be the case where the insured person has deliberately impaired his or her health. Occupational traumatism causes human suffering, material and social losses affecting not only injured persons but also their employers and society as a whole.

• The reasons for occupational traumatism are numerous: technical (e.g. lack of fencing of rotating and moving parts, machine and equipment failure); technological (using dangerous technology or dangerous work practices); organizational (lack of company policy on health and safety at work, inadequate organization of work, lack of technical safety training and control;

insufficient in-house risk control; lack or inadequate use of protective means and gear; work performed by unauthorized persons; lack of established and clear instructions on safety at work; lacking or insufficient safety and security instructions and training; poor maintenance of workplaces).

Information materials – with the support of the Working Conditions Fund, a number of brochures on safe and healthy working conditions in construction were published: “Safety and Security Coordinator in Construction”; “Openings and Contours: Working up High”; Risk of Falling from Height. Protection”; “Movable Scaffolding”; “Roof Works”; “Wheel Loaders, Dumpers and Dump Trucks”; “Loading and Unloading Works”.

There is a separate group of occupational traumatism related to people with impaired hearing and disabled people.

ROAD TRAFFIC

Road traffic is a process incorporating at any time the driver, the vehicle and the road infrastructure. Each one of these elements has certain influence on road traffic safety, the dominating one, at a certain stage, being the behavior of road traffic participants which is also reflected by the statistics on road traffic accidents and their consequences. People of all ages, mostly young people in good health, die as a result of road traffic accidents.

In 2008, 74 (7%) children aged up to 18 years, 187 (17.6%) young people aged 18 – 24, 601 (56.6%) people aged 25 – 64 and 199 (18.8%) elderly people aged 65+ died because of road accidents. The number of children victims – 48 killed and 655 heavily injured – is the highest. 521 children, of whom 12 dead, were injured as pedestrians. 14 drivers were killed and 209 were injured.

More than 92% of young people aged 18 – 24 injured in road accidents were drivers of and passengers in motor vehicles. 601 people aged 25 – 64 years died because of road accidents. Of the 199 dead people aged 65+, pedestrians account for 129 (64.8%), passengers – 44 (22.1%) and drivers – 26 (13.1%).

Reasons for Road Accidents:

• More than 94% of road accidents are caused by motor vehicle drivers and high and inappropriate speed.

• Incapable and unauthorized drivers.

• Other factors influencing drivers’ capability of adequate driving: fatigue, depression, various health disorders, natural disasters, etc.

• Insufficient usage of safety tools (seatbelts, helmets and children’s car seats) by passengers and drivers injured in road accidents.

• Pedestrian traumatism levels – among the highest in European countries.

• Road accidents during the dark part of the day.

The gravest road accidents occur due to front crashes caused by unsafe overtaking and entry in the opposite lane resulting from loss of car control due to insufficient qualification or falling asleep, entry in the opposite lane horizontal curves because of higher speed, etc.

Road traffic traumatism is a serious public health problem because it results in premature death, permanent disability and long-term illness of healthy people.

TRAUMATISM Traumatism in Europe is the third mostsignificant reason for death after cardio-vascular and oncologic diseases. Traditionally, everyday trauma isclassified according to the intention factor. The main reasons forunintentional trauma include falling,poisoning, drowning, burning, etc.

• Reasons for intentional trauma include some types of violence (e.g. threat). Violence is defined as an intentional use of physical power or threat against people’s own lives (suicide or self-injury) or against other persons (interpersonal – violence of children, partners, elderly people, acquaintances, strangers), groups or communities of people which leads to physical or psychological trauma, death, developmental deviation or deprivation.