r e 1 public health status and forecast reporting in the netherlands augustinus e.m. de hollander...

Public Health Status and Forecast Reporting in the NetherlandsAugustinus E.M. de HollanderDepartment for Public Health Forecasting, National Institute of Public Health and the Environment (RIVM)

2Health Reporting in the Netherlands, Guus de Hollander

In 1991 the Ministry of Health requested the RIVM to:

“present an overview and systematic analysis of the available information on public health in The Netherlands

every 4 years”

For the:

• assessment of current health policy

• preparation of new health policies

A Dutch national public health report


Definition of Health Reporting

Health Reporting is:

A system of different products and measures aiming at creating

knowledge and awareness of important Public Health problems and

their determinants (in different population groups) among policy-

makers and others involved in organisations that can influence the

health of the population.

Mans Rosen ,Sweden


Key features of health reporting

policy-oriented clear central questions for health policy support

conceptual start conceptually, not just from available data

integrative interrelate health, determinants, care and costs

collaborative based on expert opinions; broad acceptance

quantitative whenever possible: based on data and research

consistent handle data uniformly (maximum comparability)

prospective looking towards future (trend, scenario, model)

evaluative relating past policy to current trends

comparative regional, international differences, special groups

comprehensive health is a broad issue; many data are relevant


Conceptual model for Public Health (1)


Conceptual model (2): determinants


Short history of the Dutch public health reports

1993:• first report, one book, 800 pp (“the bible”)

• no direct support for health policy measures• followed by policy-document in 1995: ‘Healthy and Well’

1997:

• second report, eight books, 2500 pp (“the library”)

• fragmented policy measures• not followed by integrative policy document


Design of PHSF-2002: three parts• Websites

– basic information in the Atlas, Compass, and Costs of Illness websites (e.g. www.nationaalkompas.nl)

– for short-term policy questions

• Theme reports– in depth studies of concrete policy topics of present interest, e.g.

health in large cities, healthy behaviour etc. – for mid-term policy

• Summary report VTV-2002, 250 pp– draws the outlines – for long-term policy– brochure with key-messages– aimed at ministry of Health and other actors– clear policy recommendations– followed by integrative policy-document “Living longer in good

health”, 2003


Public Health Status and Forecasts

2002

Health oncourse?


Summary Report PHSF-2002Starting points• continuation of the PHSF-1993 and 1997 reports• provide information about current Public Health situation

– How is our health?– What factors determine our health?– What is the significance of prevention and care?– How much care is used, for what and by whom?– Are costs and benefits in balance?– What will the future bring?– What does it mean for health policy?

• provide information from different policy relevant angles– international and regional differences– trends and developments– socio-demographic differences– costs of illness


Important messages from the 2002-report as seen by the Dutch Ministry of Health

• Our life expectancy is stagnating compared to other EU countriesThe Netherlands has lost its historical, favorable, position

• Considerable part of mortality and morbidity is caused by unhealthy behaviourYouth is investing in ‘unhealthiness’

• Investing in prevention is essentialMuch health can be gained by prevention, rather than by healthcare

• Prevention is often the cheaper way


The Netherlands drops towards the European average and lower


Considerable part of mortality is related to behaviour

Smoking: 15% Saturated fat: 5%Fruit/vegetables: 5% Physical activity: 6%Overweight: 6% Blood pressure: 6%


Youth is investing in future ‘bad health’

Present levels of unhealthy behaviour:smoking (15-19) 45%alcohol use 50-59% physical activity 49%vegetables and fruit 85-95%overweight 7-16%

Trends are unfavourable: smoking unfavourablealcohol use unfavourablevegetables and fruit unfavourableoverweight unfavourable


Overweight becomes more prevalent and in younger age-groups


Europe as a source of inspiration:there still is much health to be gained

factor life-expectancy men life-expectancywomen

worst mortality rates in EU (14 causes) 4.6 4.1

average mortality rates +0.4 +0.3

best mortality rates +6.0 +3.8

worst risk factor prevalence (6 factors) 2.8 3.0

best risk factor prevalence +1.4 +1.2


Prevention often more cost-effective(in Euro per added quality-adjusted life-year)cost-saving: vaccination several diseases (measles, polio,

influenza), stop-smoking-programs, smoke

detector, ban on lead in paint and gas

0-1000 euro: safety belt, screening chlamydia, moped

exams, asthma coping courses

1000-10.000 euro: chlorination drinking water, pacemaker,

screening breast cancer, meningococcus C

vaccination, Viagra, mamma screening

10.000-100.000 euro: screening cervical cancer, traumahelicopter,

heart transplant, statins for CHD-patients, air bags

100.000-1.000.000 euro: neurosurgery brain tumour, Legionella control,

EPO for dialysis patients

> 1.000.0000 euro: benzene, dioxin emission control, earth-quake

proof homes


Prevention often more cost-effective

• Costs per QALY of different interventions show large variations

• Preventive interventions often more cost-effective, but not always

• But it is not only about cost-effectiveness, but also about solidarity,

and the right to protection, cure and care for everybody


New prevention strategies are necessary

Furthermore health profits by:• Implementation of locally successful initiatives• Stimulating of prevention within health care

New prevention strategies include: • Prevention ‘fitted’ to target groups:

- youngsters, elderly

• Prevention within existing settings: - school, work, leisure time

• Prevention by combining methods: - health education, laws and regulations, etc.

• Structural prevention:- no project financing, but structural budgets


Significance of the findings for policy

Prevention is everybody's concern:– national and local authorities

– healthcare providers, consumers, health-insurance

Prevention asks for long-term vision and investment:– investments necessary

– structural financing

Investment in: – existing preventive interventions

– development and evaluation of new interventions

– nation-wide implementation of effective interventions

– intersectoral health policy

– prevention within health care


Policy-response on the report

Ministry of Health– integrative policy document “Living longer in good health”– Minister and Secretary of State (and PM) underlined

importance of prevention in election campaign– prevention and public health higher on internal agenda– internal discussion on cost-effectiveness of interventions

Public health sector– took opportunity to re-address the issue of prevention – it’s now or never


How has our health reporting become effective?

• Trustworthy ( both documents and organisation)RIVM (independent institute), good PHSF-team, use other experts, scientific supervisory committee

• Build networksExpert involvement (250), partnerships (experts and institutes)

• Political and management supportMinisterial supervisory committee

• Local data creates local involvementRegional comparisons (Atlas website and Summary report)

• Adjust language (media) to the target groupsKEY MESSAGES for policy makers; WEBSITES

• Concentrate marketing efforts to a few messages


What features does our Ministry of Health like in the PHSF system?

• Authority (increases their knowledge)• Independence • Policy relevance (answers and new questions)• Flexibility • User orientation

– broad audience– easy access– well-communicated

• Regional and international comparisons

Statement by Secretary General Bekker at the Bielefeld Conference (Feb. 2003)


Evolution behind Health ReportingTrends• Epidemiological transition

– Attention shift from Infectious to Chronic Diseases

– From physical environment to life-style and behaviour

• Political attention dominated by Health Care– Increasing Costs of Healthcare

– Population Ageing, Growing influence of Medical Technology

• Globalisation, Open borders, Growing importance of EU– Emerging infections; Food safety; EU-regulations

– Cross-border care; Exchange of Best Practices

– Growing importance of International Comparative Data

• From Public Health plus Health Care to Health Systems– International perspective (WHO, OECD): Benchmarking


NPHSF Report 2006

• The same questions as in 1993, 1997 and 2004

• New topics– Performance indicators for prevention, cure and care– Integrated Cost-effectiveness analyses– Regional comparisons (“best practises”) – International comparison (public health policies)– Scenario based Public Health Forecasts


Future of Dutch Health Reporting

Integrate

Public Health reports

and

Health Care reports

into

Health System Performance reports


Health is distributed unequally and socioeconomic differences are persistent

Difference in life expectancy: 5 yrs (m) and 2,6 yrs (f)Differences in years without disabilities: 10 yrsDifferences did not decline in recent years


The Dutch are living longer

2000

Life- Healthy Trend life expectancyexpectancy life expectancy 1980-2000

Men 75.5 61.3 +3.1

Women 80.6 60.8 +1.4

Life-expectancy Dutch men: 5 years shorter than women

Healthy life expectancies are about equal


The Dutch are living longer in good health

Trend 1980-2000

Life Years in good Years withoutexpectancy health disabilities

men +2.7 +2.4 +5.8

women +1.1 -1.2 +5.5

r e 1 public health status and forecast reporting in the netherlands augustinus e.m. de hollander...

Documents

ministry of health

good health

public health forecasting

hollanderpublic health

actorsclear policy

swedenhealth reporting

relevanthealth reporting

determinantshealth reporting