On Approval of the National Public Healthcare Development Programme for 2016-2023


Published: 2015-09-12

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Government of the Republic of Lithuania
 
 
 
RESOLUTION NO 1291
 
ON
 
APPROVAL OF THE NATIONAL PUBLIC HEALTHCARE
 
DEVELOPMENT PROGRAMME FOR 2016–2023
 
 
 
9 December 2015 Vilnius
 
 
 
In accordance with paragraph 2 of Article 10 of the Law of the Republic of Lithuania on Public Health and in order to implement subparagraph 4 of the section “The Ministry of Health” of the chapter “Planning Documents Drafted or Implemented during the Implementation of the Programme of the Government of the Republic of Lithuania” of the priority instruments of the programme of the Government of the Republic of Lithuania for 2012–2016 that were approved by Resolution No. 228 of 13 March 2013 of the Government of the Republic of Lithuania “On Approval of Priority Instruments of Implementing the Programme of the Government of the Republic of Lithuania for 2012–2016”, the Government of the Republic of Lithuania hereby decides:
 
To approve the National Public Healthcare Development Programme for 2016–2023 (as appended).
 
 
 
 
 
Prime Minister                                                                                 Algirdas Butkevičius
 
 
 
Minister of Health                                                                           Rimantė Šalaševičiūtė
 
 
 
 
 
APPROVED by Resolution No. 1291of 9 December 2015 of the Government of the Republic of Lithuania
 
THE NATIONAL PUBLIC HEALTHCARE DEVELOPMENT PROGRAMME FOR 2016–2023
 
 
 
CHAPTER I
 
GENERAL PROVISIONS
 
1. The National Public Healthcare Development Programme for 2016–2023 (hereinafter referred to as the Programme) shall set the goals, tasks, assessment criteria and anticipated values of national public healthcare.
 
2. The Programme was prepared in order to ensure the implementation of public healthcare goals and tasks set in the Lithuanian Health Programme for 2014–2025, which was approved by Resolution No. XII-964 of 26 June 2014 of the Seimas of the Republic of Lithuania “On Approval of the Lithuanian Health Programme for 2014–2025” (hereinafter referred to as the Lithuanian Health Programme for 2014–2025).
 
3. The following sources were used to prepare the Programme: the experience of implementing public health strategies and programmes in the member states of the European Union (hereinafter referred to as the EU), studies of the recommendations of the World Health Organisation (hereinafter referred to as the WHO) regarding public health development, studies of the health status of the Lithuanian public, its determinants, and their changes, experience of implementing legal acts that regulate public health and public health interventions, and the results of public discussions.
 
4. Concepts used in the Programme are defined in the Law of the Republic of Lithuania on the Health System, the Law of the Republic of Lithuania on Healthcare Institutions, the Law of the Republic of Lithuania on Public Health, the Lithuanian Health Programme for 2014–2025 and other laws of the Republic of Lithuania regulating health promotion activities and resolutions of the Government of the Republic of Lithuania.
 
5. The Programme includes the following chapters: “General Provisions”, “Analysis of the Situation”, “Goals, Tasks, Assessment Criteria and Values thereof of the Programme”, “Implementation and Funding of the Programme”, and the Annex “List of Assessment Criteria and Values thereof of the Implementation of Goals and Tasks of the National Public Healthcare Development Programme for 2016–2023”.
 
 
 
 
 
CHAPTER II
 
ANALYSIS OF THE SITUATION
 
 
 
SECTION ONE
 
GENERAL PART
 
6. Health is an asset, which is vitally important in the life of every person, family and the entire community and is essential for economic and social development. Poor public health has a negative impact on the overall productivity of the country, on workforce, human capital and public expenditure. Public health depends on biological, chemical, economic, ergonomic, physical, social, and psychological factors, which are managed not only by the healthcare sector, but also by other sectors. Therefore, one of the most important conditions of implementing the Programme is the leadership of the healthcare sector and the involvement of other sectors.
 
The strategic goal of the Programme was determined by the public health status of the Lithuanian  residents. Life expectancy indicators increase in Lithuania as well as in most member states of the EU; however, preserving the health of the population for longer is crucial as well. According to Eurostat, the healthy life years indicator that had been increasing till 2010 for Lithuanian men as well as women decreased in 2011–2013. The healthy life years indicator of Lithuanian women in 2013 (61.6 years) was one tenth higher that the average of EU member states (61.5 years); however, Lithuanian men are distinguished from the men of other EU member states by a particularly low healthy life years indicator – 56.8 years, that is, 4.6 years lower than the average of EU member states (Fig. 1).
 
 
 
 
 
EU average (28 countries) (women)                            EU average (28 countries) (men)
 
Lithuania (women)                                                      Lithuania (men)
 
 
 
Fig. 1 Healthy Life Expectancy of Women and Men in Lithuania and in EU Member States in 2010–2013 (Eurostat Data).
 
 
 
SECTION TWO
 
Physical and Mental Public Health
 
7. Scientific studies have shown and EU and international strategic documents have stated that unhealthy lifestyle, that is, unbalanced diet, physical inactivity, obesity, constant stress, smoking, abuse of alcohol, and other factors are the main risk factors for the development of chronic non-infectious diseases, such as circulatory system diseases, malignant tumours, and diabetes mellitus, which are the main cause of death of the residents of Lithuania.
 
7.1. Unbalanced diet. Most residents of Lithuania do not follow healthy diet principles, that is, their diet is unbalanced and does not comply with the norms; consumption of vegetables, fruits, whole grain products, fish and fish products is insufficient, while consumption of fat, salt, and sugar is excessive. Such a diet is reflected in the health indicators of the residents’ morbidity and mortality (for example, mortality rates for cardiovascular diseases are the highest in the EU). Fifty-four point seven per cent of Lithuanian residents are obese or overweight (body mass index is higher than 25). Obese individuals are at a higher risk of cardiovascular diseases, cancer, and diabetes mellitus.
 
The Lithuanian food industry and trade pay too little attention to offering more healthy food products on the market. The Ministry of Health of the Republic of Lithuania (hereinafter referred to as the Ministry of Health) legalised international healthier foods criteria and voluntary labelling of such foods with the “Keyhole” symbol in 2014; however, there are few such products on the market as yet because producers have little interest in changing the composition of the foodstuffs, in reducing their fat, sugar or salt content, or in increasing the dietary fibre content.
 
Human development and health risk factors are highly dependent on childhood diet, particularly during the first year. For children to acquire a solid basis for health, during early childhood, for at least 6 months, they should be exclusively breastfed. The Baby-friendly Hospital Initiative of the WHO and the United Nations Children’s Emergency Fund (UNICEF) is one of the most suitable ways of improving the health of the mother and child by encouraging breastfeeding. Only 8 hospitals out of 32 have this status in Lithuania; only about a quarter of all babies are born in these hospitals. Only a third of all mothers exclusively breastfeed their babies for the first six months. The development of baby-friendly hospitals is hindered by a lack of knowledge about the benefits of breastfeeding, by widespread advertisements of breast-milk substitutes. The Ministry of Health, in order to protect the health of older children, as of 2010 introduced the advanced healthy diet organisation procedure in child education and care institutions of all levels: these institutions no longer offer unhealthy food and sweet soft drinks. However, this procedure cannot protect from the negative influence of external advertising and advertising in the media. This is demonstrated by the eating habits of children – according to the data of a study carried out in 2013, 57 per cent of pupils eat confectionery products every day; of these, only 68 per cent eat vegetables every day (the WHO recommends eating fruits and vegetables 5 times a day), half of the children choose fast food from kiosks or buy sweet or salty snacks instead of hot meals in schools.
 
Statistics show that the rates of tooth decay of Lithuanian adults and children are the highest in Europe, while our teenagers brush their teeth less frequently than teenagers in other countries. In Lithuania, 52 per cent of boys and 48 per cent of girls under 3 years of age are already affected by tooth decay. Tooth decay affects as many as 94 per cent of six-year-olds and from 84 to 100 per cent of twelve-year-olds and older children. In the Nordic countries, as many as 63 per cent of twelve-year-olds do not have a single tooth damaged by tooth decay, while in Germany, only 38 per cent of three-year-olds are affected by tooth decay. Although the programme of coating the molar teeth of children with sealant materials that was approved in 2005 is a successful initiative of tooth decay prevention in children, it is obvious that integrated measures of improving the oral health of children have to be implemented. Early oral health prophylaxis and proper hygiene can prevent most subsequent health problems.
 
7.2. Low physical activity. Contemporary industrialisation, urbanisation, and rapid development of transportation reduced the physical activity of individuals. Young people, elderly people and people whose work is sedentary do not engage in enough physical activity to maintain well-being. Lack of physical activity in young people hampers body development and increases the risk of obesity, while elderly people face the threat of osteoporosis, bone fractures, obesity, cardiovascular diseases and early disability.
 
Particularly distressing is the lack of physical activity in children – on average, only every other boy (45 per cent) and only one in five girls (20 per cent) may be considered sufficiently physically active. Physical activity of young people is similar to the physical activity of the elderly (people over 65 years old).
 
According to Eurobarometer data from 2013, approximately 46 per cent of adults do not engage in sports activities and do not exercise (the EU average is 39 per cent). The WHO recommends that adults engage in regular moderate-intensity physical activity for at least 150 minutes per week, while children should engage in vigorous physical activity for 60 minutes per day. According to the GPAQ method recommended by the WHO (data of the Health Education and Disease Prevention Centre from 2014), it was determined that 19.6 per cent of adults in Lithuania belong to the group of low-intensity physical activity. Although over 80 per cent of individuals are sufficiently physically active, almost 50 per cent of them engage in vigorous-intensity or moderate-intensity physical activity by doing hard physical work as part of their jobs.
 
Lithuania lacks sufficient infrastructure for physical activity; the existing infrastructure is not accessible to everyone, there are too few practical initiatives, and there is very little social advertising proving the benefits of physical activity.
 
7.3. Poor public mental health. Public mental health is a crucial factor for creating a healthy, socially responsible and creative society. Enhancing mental health and preventing mental disorders is vitally important for the person, family, community, and society as a whole. Mental disorders are one of the main disease groups that have the most significant economic and social impact on EU states.
 
One of the most important indicators reflecting public mental health status is the number of suicides. Although the suicide rate in Lithuania has been decreasing every year since 2000, according to this indicator Lithuania still significantly exceeds the EU average and is the last of 28 EU states. According to the data of the Health Information Centre of the Institute of Hygiene, there were 31.7 suicides per 100,000 population in Lithuania in 2014; according to Eurostat, in the EU (average of 28 countries), there are 11.7 suicides per 100,000 residents. Suicides are a social problem that may only be solved after analysing all social, economic, psychological, medical and other reasons that cause a person to take his or her own life.
 
Rapid technological changes allow transferring huge amounts of information, but there is also a negative side. Negative information in the media promotes violence, affects sexual behaviour, and encourages interest in pornography. Violence in video games changes behaviour and makes it more aggressive; other negative trends are on the rise (Dill E., Dill C. Video game violence: a review of the empirical literature. Aggression and Violent Behavior, 1998; 3 (4): 407–428). Due to aggressive marketing that encourages purchases and consumption there are more young people who use psychoactive substances; therefore, there are more mental disorders (World Health Report 2001. Mental Health: A New Understanding, a New Hope. The State Mental Health Centre, 2002).
 
For a child to live successfully in modern society, he or she receives insufficient knowledge about various areas of life: family, work, learning, the ability to solve problems independently, to think critically, to communicate effectively and constructively, to manage conflict situations, and to deal with stress; therefore, educational establishments play a crucial role in preparing the child for successful socialisation. High levels of vulnerability of young people are demonstrated by various risky behaviour types and indicators of violence, suicides, and other mental health problems. The overall child well-being indicator, which is determined on the basis of 5 dimensions, namely child prosperity, health and safety, education, behaviour and risk factors, living conditions, was very poor in 2013 – Lithuania was in the 27th position among 29 states (Unicef Office of Research ‘Child Well-being in Rich Countries: A comparative overview’. Innocenti Report Card 11, UNICEF Office of Research. Florence, 2013). In Lithuania, over 50 per cent of children of 11–15 years of age have experienced bullying over the last few months. And, although the indicators of this phenomenon are slowly going down, in 2009–2010 Lithuania was among the countries with the largest numbers of teenagers who are bullies or victims of bullying when indicators of 38 countries were compared (The Problem of Bullying in Schools and Prevention, September 2014, No. 7 (112) ISSN 1822-4156, the Ministry of Education and Science).
 
According to statistical data, in 2012 50 per cent of all cases of violence against children were cases of physical violence and 44 per cent of cases were psychological violence (The 2012 Activity Report of the State Child Rights Protection and Adoption Service under the Ministry of Social Security and Labour. Vilnius, 2013).Children who are victims of violence have a higher risk of psychological and behavioural problems. Depression, anxiety, abuse of addictive substances, unsafe sexual behaviour, and lack of social competence are identified in children who are victims of violence more often than in their peers (Studying the Risk Factors of Public Mental Health and Determining the Directions of Preventive Measures Planning. The State Mental Health Centre. Vilnius, 2013).
 
Psychosocial risk factors and stress at work are major challenges to the mental health of employees. Work-related stress and mental health problems lead to more frequent cases of absence from work, unemployment, and long-term disability. According to research data of the European Agency for Safety and Health at Work (EASHW), 51 per cent of working individuals in Lithuania indicate that their work conditions are the main reason for deteriorating health. According to Eurostat data from 2009, a third of employees are confronted with factors at work that may negatively influence their mental health. Consequences of poor mental health are also linked to most factors that are harmful to organisations, such as worse work results of employees and lower productivity, poor motivation, and high employee turnover rates.
 
Mental disorders are especially prevalent among the elderly. The mental health of these individuals deteriorates not only as a result of physiological ageing-related reasons and inherited risk of disease, but also because of social environment (loneliness, lack of safety, emotional distress, financial problems, etc.). Senility (dementia) and emotional problems are the most frequent disability reasons in elderly people. The number of people over 65 years of age who suffer from dementia and Alzheimer’s disease constantly increases: in 2010, there were 1,102.73 cases, while in 2014, there were 1,575.81 cases per 100,000 individuals (The System of Health Indicators of Lithuania, the Institute of Hygiene). It is believed that in 20 years the number of people with dementia will double.
 
 
 
SECTION THREE
 
Environmental Risk Factors and Safety of Products and Services
 
8. The main goal of the environmental protection policy is to make Lithuanian environment healthy, clean and safe, and to ensure that it meets the needs of the public, environmental protection and economy in a harmonised manner; priority environmental protection areas and long-term goals are set in the National Environmental Protection Strategy, which was approved by Resolution XII-1626 of 16 April 2015 of the Seimas of the Republic of Lithuania “On Approval of the National Environmental Protection Strategy” (hereinafter referred to as the National Environmental Protection Strategy); implementing the strategy will undoubtedly contribute to reducing the negative effect of environmental risk factors on the Lithuanian public.
 
8.1. Unhealthy risk factors of the living environment. According to the WHO, air pollution reduces the life expectancy of every EU citizen by 8.5 months on average. Environmental air quality has a direct impact on individuals’ health: data of epidemiological scientific research show that environmental air pollution increases the incidence of various diseases of the respiratory system (tracheitis, bronchitis, asthma, flare-ups of other chronic diseases of the respiratory system) and the circulatory system (cardiovascular diseases, diseases of blood vessels); it is also harmful to the nervous, reproductive and immune systems. According to the data of the Environmental Protection Agency, over the course of the last several decades, concentrations of most air pollutants in Lithuania, for example, sulfur dioxide (SO2), carbon monoxide (CO) and nitrogen oxides (NOx), have decreased. However, concentrations of air pollutants are still too high: environmental air contains many solid particles (SP10, SP2.5) and ozone (O3), the concentration of the polycyclic aromatic hydrocarbon benzo(a)pyrene is high. Many residents live in areas, particularly in cities, where concentrations of air pollutants pose a serious threat to health. According to the WHO, approximately 20–30 per cent of EU households have problems related to moisture, while people who live or work in humid, mouldy rooms, are 75 per cent more likely to develop respiratory diseases or allergies.
 
Too little attention is paid to healthy spatial planning. Currently in Lithuania, according to the requirements of legal acts, sanitary protection areas of only 8 per cent of economic operators have been set and recorded in the Real Property Cadastre and Register; sanitary protection areas of 5 per cent of economic operators have been recorded only in some documents of land plots belonging to such areas. If spatial planning is carried out, structures are built and economic activity is planned and performed without setting these areas, it is not guaranteed that a healthy residential environment will be created; therefore, risk factors caused by economic activity (for example, chemicals, noise, non-ionising radiation, smells) may have a negative impact on the residents’ health.
 
According to the data of the Institute of Hygiene, injuries are one of the most frequent causes of death in Lithuania. In 2014, there were 67.7 cases of death caused by accidents per 100,000 residents. Non-lethal injuries become more frequent: in 2009, there were 9,313.49 cases, in 2012 – over 10,000, while in 2014 – 14,175.1 cases per 100,000 residents. The most frequent causes of injuries are traffic accidents, drownings, and falls. A major part of various injuries, traffic accidents and other accidents happen during free time.
 
Attention has been paid to the problem of traffic accidents for a long time, while the main goals and tasks of road safety are enshrined in the National Road Safety Development Programme for 2011-2017, which was approved by the Resolution No. 257 of 2 March 2011 of the Government of the Republic of Lithuania “Approving the National Road Safety Development Programme for 2011-2017” (hereinafter referred to as the National Road Safety Development Programme for 2011-2017). However, too little attention is paid to other accidents and injuries.
 
The majority of various accidents, such as injuries, drownings, poisonings, which are frequently fatal, happen as a result of unsafe living environment: improperly installed stairs, slippery floors, unsecured carpets, disorderly electrical wiring, unsafe kitchen equipment, easily accessible household chemicals and medication, etc. House yards may be dangerous because of unsafely built children's playgrounds and pools and ponds without fences. Unsafe living environment particularly often poses a threat of injury to young children left without adult supervision, to elderly and disabled people. A frequent cause of injuries is unsafe games, extreme sports, which are particularly popular among teenagers, other leisure activities when individuals overestimate their abilities and do not use protection measures. Many accidents happen under the influence of alcohol or drugs.
 
In 2014, 229 people drowned in Lithuania. The indicator of mortality due to drowning is 7.8 cases per 100,000 residents, although it has slightly decreased over the past few years. Most people drown in natural bodies of water.
 
Many fatalities are caused by falls. Elderly people are particularly in danger because their bones are fragile, so falls often become the cause of fractures or even death. In 2014, 12 fatalities caused by falls were identified per 100,000 residents. Falls also cause many injuries among children under 5 years of age. The data of the research carried out in 2015 by the Health Education and Disease Prevention Centre and the Public Health Institute of Vilnius University Faculty of Medicine show that 34 per cent of children in this age group were injured during falls at playgrounds or yards, 28 per cent of children injured by falls needed medical attention, while 3.6 per cent of children had to spend at least one night in hospital.
 
8.2. Threat posed by chemicals. The National Chemicals Database in 2014 contained over 19,000 chemical mixtures, over 2,000 chemicals, and 1,475 suppliers of chemicals and mixtures. The national database of data about commercially available chemicals (mixtures), their properties, effect, and proper protection measures must meet the needs of market supervision and the needs of the healthcare sector to obtain information in order to handle medical emergencies promptly and to ensure that poisoned patients are treated properly. If a consistent and rational view of human biological media monitoring is adopted as an additional tool in a collection of evidence-based measures of protecting public health and the environment, targeted biological supervision must involve the assessment of contamination of human bodies with chemicals. The Eurobarometer study “Attitudes of European citizens towards the environment” carried out in 2014 demonstrates that the use of hazardous substances in products is one of the most important and worrying environmental problems pointed out by the residents of the Baltic states. Over 60 per cent of Lithuanians (the highest indicator in Europe; there is an observable increasing trend: from 51 per cent in 2011 to 63 per cent in 2014) are worried about the effect of chemicals that are used in products on their health. Surveys show that citizens of the Baltic states are prepared to pay slightly more for nature-friendly products (this was stated by almost two thirds of the residents of these states); however, so far residents of Lithuania have not been particularly eager to follow through with their stated intention to purchase an eco-labelled product, compared to the European average where one in five residents chooses a green product.
 
The public lacks the skills to properly handle chemicals that are located in the immediate environment – at home. Especially worrisome are cases of poisoning with chemical mixtures, particularly medicines. Consequences may be very severe because children may find these substances. The Poison Information Bureau held consultations on the phone in 2014: on poisoning with medicines – 801 times (473 adults, 328 children), on poisoning with household chemicals – 269 times (130 adults, 139 children). Not enough attention is paid to the responsible management of chemicals, including waste. Seven per cent of Lithuanian residents do not sort any waste at all (3 per cent of Europeans), which creates the conditions for polluting the living environment with chemicals.
 
8.3. The negative impact of noise on health. According to the WHO, as a result of harmful effect of environmental noise (roads, railroads, aircraft traffic and major industrial activities) 1–1.6 million of healthy life years are lost in Europe every year. Environmental noise is considered a health hazard because of its effect on the cardiovascular system. It has been calculated that the social costs of noise caused by EU railroad and road traffic comprise EUR 40 billion per year, that is, 0.4 per cent of the overall EU gross domestic product.
 
The main sources of environmental noise in the living environments in Lithuania are roads, railroads, aircraft traffic and industrial activities. Traffic noise affects the most residents. According to the aggregated data of strategic noise maps for agglomerations of EU member states as of 10 June 2014, 67.51 per cent of residents of Lithuanian agglomerations live in buildings whose façades are affected by road traffic noise exceeding 55 decibels (dB) of the average annual day noise level (Lden noise indicator), while 18.65 per cent of residents are affected by noise exceeding 65 dB. Only in agglomerations in Luxembourg (90.92 per cent), Bulgaria (84.44 per cent) and Belgium (77.22 per cent) residents are more affected by traffic noise that exceeds 55 dB Lden than residents in agglomerations in Lithuania.
 
Statistical Eurostat data of public surveys confirm that the problem of noise caused by domestic activities is important: In 2014, 14.4 per cent of Lithuanian residents claimed that they suffer as a result of noise caused by neighbours or coming from the outside. Since 2012, the number of Lithuanian residents complaining about noise has been increasing (13.3 per cent in 2012; 14.1 per cent in 2013). The number of infringements of Article 183 (disturbance of public tranquillity) of the Code of the Republic of Lithuania on Administrative Offences increases as well (approximately 8,300–9,200 infringements per year recorded in 2007–2009, approximately 12,900 such infringements in 2014).
 
8.4. Health risks associated with ionising and non-ionising radiation. According to the State Register of Ionising Radiation Sources and Occupational Exposure, over 16,000 sources are constantly in use in Lithuania. In recent years, sufficiently increase number of medical radiodiagnostic technique as well as radiodiagnostic procedures. Approximately 3 million radiodiagnostic examinations are performed in Lithuania every year. Medical radiation exposure makes up about a third of the all residents’ exposure.  The highest radiation exposure patients get during the computed tomography examinations and interventional radiology procedures, which is not only becoming more frequent, but also comprises 53 per cent of total medical exposure. Therefore, it is crucial to constantly monitor and evaluate exposure caused by the radiodiagnostic procedures because current observations and assessments are not sufficient. Cardiologists and interventional radiology specialists, particularly their eyes, are affected by occupational exposure the most.
 
Radon is also relevant as a source of natural radiation in Lithuania (approximately 32 per cent of total exposure). Environmental contamination due to emissions caused by economic operators’ activity involving sources of ionising radiation and due to previous nuclear and radiation accidents and nuclear explosions in the atmosphere also contributes to the residents’ exposure and must be monitored (the contamination of food must be monitored as well).
 
Within the last two decades, the number of devices that emit non-ionising radiation in the living environment has increased rapidly. Exposure to non-ionising radiation is not as dangerous as ionising radiation exposure, but it affects more people, so the importance of its effects on humans increases. According to the classification of the International Agency for Research on Cancer of the WHO, electromagnetic fields of the radio spectrum band are classified as possibly carcinogenic to humans (group 2B). Although the treatment of electromagnetic fields of the radio spectrum band as carcinogenic factors is based on the effect of electromagnetic radiation emitted by mobile phones, the potential risk of carcinogenicity allows taking precautionary measures ensuring high-level public health protection not only from the already acknowledged negative thermal effect of electromagnetic radiation of the radio spectrum band, but also from the potentially harmful non-thermal effect of low-level electromagnetic fields of the radio spectrum band.
 
The thinning ozone layer and increasing quantities of ultraviolet radiation that reaches the Earth's surface are undoubtedly harmful to people's health. The negative health impact of ultraviolet radiation involves the risk of skin cancer and other malignant skin changes, premature skin ageing, eye conditions (photokeratitis, photoconjunctivitis, cataract), weakened immune system and increased risk of infectious diseases. According to the data of the Institute of Hygiene, the incidence of  malignant neoplasms of skin in Lithuania increases – from 6.42 cases of skin melanoma and 56.27 cases of other types of malignant neoplasms of skin per 100,000 residents in 2001 to 10.48 cases of melanoma and 94.38 cases of other types of malignant neoplasms of skin per 100,000 residents in 2012. Over the last decade, the number of men as well as women suffering from skin melanoma has almost doubled.
 
In 2009, the International Commission for Non-ionising Radiation Protection recognised sunbeds and other sources of ultraviolet radiation as definite causes of cancer, same as tobacco and plutonium, and included them in cancer risk factors of the highest category. According to the WHO, 4 out of 5 cases of cancer could have been avoided by using the simplest means of protection from ultraviolet radiation.
 
8.5. The health impact of unsafe products and services. In the EU, particular attention is paid to the safety of products; however, the safety of services is less regulated at EU level. The safety of services is usually ensured via the safety of products, which are subject to requirements, and liability is prescribed for supplying dangerous products to the market. Lithuanian legal acts provide for certain requirements for the safety of services as well as for liability for harm done to consumers via unsafe services; however, this regulation is insufficient.
 
Only 67 per cent of Lithuanian consumers think that non-food products (and services) are safe. Lithuanian consumers are not sufficiently protected and informed yet, too little attention is devoted to health safety and the protection of legal and economic interests. The annual index of consumer conditions, which is measured according to the status of all major areas of consumer protection (consumer trust in authorities, in associations that protect their rights, and in businessmen, cases of misleading advertising on the market, consumer activity to protect their rights, effectiveness of mechanisms for protecting consumer rights, the quantity of unsafe services and products supplied to the market, and other aspects that must be controlled to ensure an effective system for protecting consumer rights), comprised 56 per cent in Lithuania in 2012 and did not reach the EU average – 62 per cent.
 
Since new products and services are constantly introduced to the market and no criteria are set for them, services (products) are not evaluated in terms of safety to consumers; the service provider cannot ensure the safety of services (products), they constitute a health hazard for consumers, and the control of these services (products) is insufficient and ineffective.
 
 
 
SECTION IV
 
SUSTAINABILITY OF THE PUBLIC HEALTHCARE SYSTEM
 
9. Sustainability of the public healthcare system in modern society is a very important goal of the public healthcare policy that is based on a holistic approach to health, looks for new high-quality accessible and evidence-based forms of service provision and cooperation that meet the needs of the public, helps to prepare for possible threats to public health and to contain them, and uses resources rationally.
 
9.1. Insufficient access to high-quality and acceptable public healthcare services. Lithuanian society is ageing rapidly – one in five residents is older than 60. Health inequalities between city residents and residents of rural areas are increasing. As the population gets older, incidence of chronic non-infectious diseases and multiple morbidities increases, so the need for healthcare and related expenses increases as well and new public healthcare services are constantly needed. Emphasis on treatment of diseases rather than on prevention and prophylaxis thereof is still prevalent. Doctors in primary personal healthcare establishments who provide personal healthcare services do not have time to educate patients on healthy lifestyle principles, health promotion and disease prevention. Personal as well as public healthcare services are usually provided in an isolated manner, without coordinating primary, secondary and tertiary prophylactic actions and health literacy promotion actions. Therefore, disease prophylaxis and health promotion services that are provided to individuals are insufficient and the necessary availability of services to people at risk of chronic non-infectious diseases is not ensured.
 
Often public healthcare services are organised for certain groups, individualised health promotion services (individual consultations) intended for a particular person both in the case of healthy people and people with health problems are lacking.
 
The fulfilment of state (transferred from the state to municipalities) public healthcare functions (hereinafter referred to as delegated functions) is interpreted in various municipalities differently and sometimes in a fragmented manner; unified descriptions, algorithms and recommendations regarding activity implementation and service provision are lacking, proper planning of resources (human and financial) and assessment of functions are lacking as well. Municipalities insufficiently focus on results when they plan the fulfilment of delegated functions, and evaluation criteria do not correspond to the objective. One public healthcare professional who works in the sphere of health promotion in schools and pre-school education establishments has to take care of too many pupils. In 2014–2015, one public healthcare professional provided public healthcare services to 1,000 pupils in cities and 500 pupils in rural areas (including pre-school education establishments). According to the data of 2013 provided by Statistics Lithuania, one pre-school education establishment was attended by 168 pre-school children on average. Thus, one public healthcare professional has to work in 6 pre-school education establishments on average, devoting to each of them 297 hours per year or one day per week on average. It is obvious that, in the presence of the aforementioned standards, it is difficult to perform delegated functions properly and to ensure the necessary availability of public healthcare services to pupils.
 
The incidence of tuberculosis in Lithuania is the highest among EU states. The overall EU incidence rate is 12 cases per 100,000 individuals, while in Lithuania the incidence is 61 cases per 100,000 individuals; the rate is higher only in Romania (79 cases per 100,000 individuals). Approximately 90 per cent of new cases of pulmonary tuberculosis are detected late, when lungs are already severely affected and infection has spread outside the lungs, causing multiple lesions. This is caused by patients being very reluctant to go to personal healthcare establishments.
 
Incidence of sexually transmitted infections in Lithuania has been on the decline for the last 10 years; however, incidence of syphilis in 2011 was 1.6 times the average incidence in EU states. Within the last 5 years (in 2010–2014), incidence of chlamydia infection, which, if left untreated, may cause infertility, increased in one third. Sexually transmitted infections are most prevalent among young persons 20–34 years of age. The spread of sexually transmitted infections is related to risky sexual behaviour. The number of people who contract HIV through sexual intercourse grows every year, while the number of people becoming infected through the use of intravenous drugs is decreasing in relation. Every year, more and more women contract this infection. It is believed that HIV may spread in the general population through the sexual partners of intravenous drug users. Although HIV detection improves every year and the number of HIV tests has increased 20 per cent in the recent years, in order to implement international recommendations, it is expedient to increase the availability of these tests at all healthcare levels and to ensure that the newest HIV treatment recommendations are implemented in Lithuania. HIV treatment becomes HIV prevention, so optimising the treatment of this disease would contribute to stabilising the incidence of AIDS and reducing mortality caused by AIDS in Lithuania.
 
Every other resident of Lithuania has accurate knowledge about 5 of 8 ways of transmission of sexually transmitted infections. The knowledge of the remaining individuals is insufficient, which may lead to risky behaviour and contribute to the spread of these infections. Minors and pupils who contract sexually transmitted infections are registered every year, which demonstrates their vulnerability and shows that youth-friendly services are needed.
 
Occupational healthcare infrastructure in Lithuania is not fully developed, availability of occupational healthcare services to employees of all companies is not ensured. Occupational healthcare is a part of healthcare that includes the creation of safe and healthy working environment that would ensure optimal work-related physical and mental health of employees, the adjustment of work to workers’ capabilities according to their physical and mental health status, prevention, detection, registration, examination, treatment, nursing, and rehabilitation in case of health damage caused by occupational hazards, and the application of health promotion measures. Occupational healthcare is a part of the occupational safety and health system. In Lithuania, companies that employ fewer than 100 or 200 people (depending on the type of economic activity) are not obligated to hire an occupational health professional. According to a study carried out in 2012 by the Institute of Hygiene, actual availability of occupational health services is only 2–4 per cent and occupational health professionals work in only 18.8 per cent of companies that are obligated to hire such professionals; usually (83.1 per cent of cases) occupational health professionals are nurses. According to Eurostat data of 2011, Lithuania is among the last in the EU according to the number of occupational physicians per 100,000 residents. International organisations note that occupational healthcare services must be provided to every working person, irrespective of sector, company size (small and medium enterprises need assistance), geographical location or type of employment agreement.
 
Lithuania, unlike most EU countries, does not have a sufficient legal basis for ensuring effective occupational healthcare; there is no national occupational health authority that would evaluate, according to its area of expertise, occupational healthcare activity in companies.
 
According to a study carried out in 2012 by the Institute of Hygiene, employee health promotion and disease prevention programmes are implemented by only a third (34.1 per cent) of larger companies. Offices of public health in municipalities and non-governmental organisations have potential in this area because they can cooperate with companies regarding the matters of employee health promotion; however, they need constant methodological assistance. International employee safety and health organisations note that workplaces should be used for health promotion and disease prevention (promotion of nutritional health and physical activity, prevention of alcohol and tobacco use, improvement of mental health).
 
Diagnosis of occupational diseases in Lithuania in ineffective. According to the State Registry of Occupational Diseases of the Republic of Lithuania, preventive health examinations find only 6–15 per cent of all cases of occupational diseases recorded every year. Most often (87 per cent in 2013) occupational diseases are diagnosed when persons seek medical advice themselves, when the disease is already advanced and the person is already fully or partially incapable of working. According to a study carried out in 2012 by the Institute of Hygiene, 19.3 per cent of general practitioners perform prophylactic tests without proper occupational medicine training, and 32.5 per cent of them have not improved their occupational medicine knowledge in five years.
 
Lithuanian employers lack motivation to take care of the employees’ health. The industrial sector, in order to preserve employees’ loyalty to the company, tends to allocate funds for the improvement of the employees’ social well-being and working conditions, to health promotion and the availability of psychological help, to the improvement of skills and promotion of life-long learning, to leisure organisation and healthy lifestyle encouragement. Therefore, it is important to encourage the companies’ social initiatives aiming at improving the safety and health of employees (statutory tax reliefs, financial support and (or) other state aid).
 
9.2. The management of the public healthcare system should be improved. Implementation of the “health in all policies” approach is particularly important in Lithuania, whose national strategies focused for a long time on a more sector-based, not integrated, approach to solving health problems. Therefore, conditions for developing an efficient, interdisciplinary and integrated public health policy and management were rather unfavourable. Frequently, healthcare sector leadership is still insufficient, other ministries, institutions and municipalities are slow to get involved in the process of implementing the public health policy, coordinated cross-sectoral cooperation is lacking, non-governmental organisations and communities do not actively participate in the formation of this policy, do not represent the public properly, and lack expertise in this area. The role of municipal doctors as coordinators of health promotion activity is too insignificant, the activity of municipal community health councils is often merely formal.
 
Health policy makers and specialists frequently lack detailed information based on scientific research about effective interventions intended for improving public health and developing disease prevention. Lithuania is still in the process of creating a system for evaluating public health technologies intended for supporting decisions on the public health policy and possible intervention alternatives, while abandoning old public health technologies and implementing new ones, as well as likely consequences for the public with objective information. Most public health initiatives in Lithuania are implemented on the basis of intuition or examples of other countries. According to a study carried out by the Institute of Hygiene, unevaluated public health technologies are used in Lithuania most often.
 
The public healthcare system still lacks results-oriented management, information on solving public policy problems and achieving better results is missing, efficient cross-sectoral cooperation is insufficient, and funds are used in an unreasonable manner.
 
Although the Lithuanian health indicators monitoring system is rather advanced compared to some EU countries, it is, however, obvious that today it lacks information necessary for the creation of an efficient health policy. The health disparity identification and display system that is currently used by the Health Information Centre of the Institute of Hygiene was created in the 1980s by using the instruments that were available at that time and according to the requirements that existed then; in addition, it was intended for meeting the needs of that period. The system is fragmented, rigid and incomplete; sending data to modern data exchange formats is impossible. In addition, decision-making institutions need more and more detailed information that this system is unable to provide. This problem is being solved by an expensive highly qualified workforce, which sets up conditions for unreasonable use of financial and human resources.
 
In Lithuania, at the moment there is no national system for registering and preventing undesirable incidents, which is used by most EU and other countries. Epidemiological surveillance of hospital-acquired infections and monitoring of the use of antimicrobial medicines are carried out in a non-automated and inefficient manner that does not ensure the collection of quality data and proper feedback; therefore, making decisions on control and prevention measures on time is difficult.
 
Hospital-acquired infections seriously harm the patients, health institutions, and the entire healthcare system. As a result, treatment results worsen, short-term and long-term negative consequences emerge, the duration of hospitalisation is extended, treatment costs rise, and public trust in the healthcare system is undermined. Hospital-acquired infections affect one in 20 hospitalised patients on average, that is, 4.5 million patients across the EU every year. According to the European Centre for Disease Prevention and Control, hospital-acquired infections cause 37,000 additional deaths in the EU, approximately 16 million days are added to the patients’ treatment duration, and hospitals incur about EUR 7 billion of additional costs per year.
 
According to population mortality statistics of Lithuania and neighbouring countries, a country’s statistical indicators may be distorted by a flawed main cause of death identification and coding system, the application of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), and high likelihood of systemic encoding errors.
 
In Lithuania, insufficient attention is paid to the assessment of the results and effect of health programmes, there is no encouragement to improve the quality of programme management, and the effect of programmes on long-term goals stipulated in strategic documents is not evaluated.
 
Public health professionals are taught in four universities in Lithuania; however, according to the research data on the status of graduates on the labour market, only a quarter of graduates who completed the public health programme start working in public healthcare establishments. Research and studies carried out according to the EU assistance project “Creation of the System for Training and Professional Development of Public Healthcare Professionals as well as for Planning the Demand” (for 2009–2015) revealed that professionals working in public healthcare institutions lack knowledge and skills, professional improvement is imbalanced, the supply of training activities does not correspond to existing demand, and professional development of specialists is mainly done by implementing EU assistance projects. There is no information on human resources in the public healthcare system, therefore, the demand for professionals and professional development directions that match market demands cannot be adequately planned.
 
Currently, in 10 counties of public health centres public healthcare functions are decentralised, different counties do not ensure the same procedure of public administration and administrative services, the administrative burden imposed on economic operators by the system of supervisory institutions is being reduced too slowly, the use of funds of the state budget of the Republic of Lithuania as well as of human resources of institutions is inefficient because general functions (finances, human resources, information technologies, law, document management, planning and reporting) have been distributed.
 
Public administration institutions in the sphere of public healthcare do not have uniform automated systems for assessing economic operators’ activity; currently, only some risk and danger criteria of the activity of an economic operator are assessed. There is no consultation system for economic operators; therefore, provisions and some implementation aspects of legal acts may be interpreted differently, mistakes are not avoided, and legal certainty is not ensured.
 
Incidence of communicable diseases comprises 10 to 20 per cent of all cases registered in the country every year. According to the WHO, vaccination is the most successful and cost-efficient public health intervention that helps to fight communicable diseases. Vaccines save the lives of 2–3 million people per year, they protect newborn children as well as the elderly from diseases, complications, disability, and death. The scope of vaccinations in Lithuania has always been large; however, over the last few years it has been slowly decreasing; therefore, the threat of outbreaks of infectious diseases will inevitably arise in the future.
 
In the recent years, the WHO and the Council of Europe adopted several strategic documents and specified that antimicrobial resistance is one of the main threats to public health. Infections caused by bacteria that are resistant to medications cause approximately 25,000 patient deaths in the EU, while related healthcare costs amount to more than EUR 1.5 billion. In Lithuania, the antimicrobial resistance situation is alarming: resistance rate of gram-negative bacteria are among the highest in Europe, the resistance of gram-positive bacteria is stable and lower than EU averages; however, there are no downward trends observed in other EU countries. Total consumption of antimicrobial medications in Lithuania is close to the EU average; however, the situation in outpatient and in-patient fields is vastly different (in the in-patient field, consumption is among the highest in Europe). Disparities in the use of antibiotics in regions and in different personal healthcare establishments are significant; more broad-spectrum antibiotics are used, self-medication is quite widespread, and the public has too little knowledge of antimicrobial resistance and antibiotics.
 
Another important feature of a sustainable healthcare system is the ability to respond to threats to society and emergencies properly and in a timely manner. Mass disturbances, natural disasters, accidents caused by more hazardous sources, military conflicts, potential outbreaks of infectious diseases as a result of migration, catastrophic natural phenomena and other emergencies must be managed in such a way as to ensure that the provision of health services to the population is not interrupted and is capable of meeting the challenges presented by the respective situation. In terms of public health, it is important to prevent emergencies from becoming complicated and to eliminate the consequences of civil protection events as adequately and as promptly as possible. It is crucial to ensure that if there is a threat of emergencies or if actual emergencies take place the continuity of the national health system of Lithuania is preserved.
 
 
 
CHAPTER III
 
GOALS, TASKS, ASSESSMENT CRITERIA AND VALUES THEREOF OF THE PROGRAMME
 
10. The strategic goal of the Programme is to extend the healthy life years of Lithuanian residents.
 
11. The first goal of the Programme is to promote physical and mental health, to encourage healthy living and culture, to promote health literacy.
 
12. Tasks for achieving the first goal of the Programme:
 
12.1. To develop healthy eating habits of the residents, to improve opportunities for all population groups to choose healthy food. During the fulfilment of this task, it is planned:
 
12.1.1. To create a healthy diet environment in educational, healthcare, and social care establishments as well as at the workplace;
 
12.1.2. To spread scientifically proven information on healthy diet and lifestyle; to organise training for various population groups (particularly children, pregnant women, breastfeeding women, and persons who are at risk of developing chronic non-infectious diseases) and to use social advertising;
 
12.1.3. To increase the quantity of healthy food products (that contain little saturated fat, trans-fatty acids, sugar and salt, but much fibre) on the market, to improve their availability and recognisability, to change the composition of other food products accordingly and to implement economic instruments of encouraging healthier choices;
 
12.1.4. To encourage the breastfeeding of babies until the age of 6 months, to mitigate the effect of marketing aimed at children that promotes unhealthy food (that contains much energy, saturated fat, trans-fatty acids, sugar and salt);
 
12.1.5. To encourage more efficient dental care, to implement preventive measures to counteract tooth decay in children;
 
12.1.6. To monitor the dietary habits and the actual diet of various population groups in order to evaluate changes and the effectiveness of implemented instruments.
 
12.2. To increase the physical activity of the population and to enable them to be physically active in all areas of life. During the fulfilment of this task, it is planned:
 
12.2.1. To inform all population groups about the health benefits of physical activity – to provide scientifically-based knowledge, to raise awareness of physical activity that improves health;
 
12.2.2. To encourage various population groups to choose adequate physical activity in order to reduce the amount of time spent without physical activity;
 
12.2.3. To encourage physical activity of children and teenagers, particularly in early childhood, as well as in pre-school education establishments and schools;
 
12.2.4. To encourage physical activity of adults in all areas of life (as well as during travel, leisure time, work) in order to mitigate the impact of overweight and hyperlipidemia on the development of diabetes mellitus type 2, depression, osteoporosis, cancer and other chronic non-infectious diseases, their incidence and mortality;
 
12.2.5. To encourage physical activity of the elderly in order to improve their quality of life, to extend their labour market participation and promote social inclusion;
 
12.2.6. To create, update and develop a safe sports and physical activity infrastructure, to ensure universal access to it, to make it closer to places of residence, to enhance cooperation between authorities that plan and create recreational areas, parks, walkways and cycle routes;
 
12.2.7. To monitor the physical activity of various population groups in order to evaluate changes and the effectiveness of implemented instruments.
 
12.3. To improve public mental health by carrying out interventions that improve mental health, encourage positive changes and raise public awareness. During the fulfilment of this task, it is planned:
 
12.3.1. To pursue integrated national prevention of suicides by increasing the awareness of various sectors, authorities, organisations, politicians, media representatives as well as the public of this problem and the possibilities of effective actions, to pay attention to groups where the risk of suicide is high;
 
12.3.2. To encourage the spread of positive information to the public, to raise public awareness of opportunities of improving mental health and preventing mental illness, to encourage public involvement;
 
12.3.3. To develop activities that improve mental health as well as preventive activities in educational establishments, to pay particular attention to the development of life skills, to teaching constructive behaviour in conflict situations, to solving the problems of bullying and violence, and to healthy lifestyle and social emotional development;
 
12.3.4. To improve the mental health of working-age persons by minimising the impact of psychosocial risk on employee health, by paying attention to the importance of psychosocial stressors and the effect of psychological resilience on employee health;
 
12.3.5. To support healthy ageing by encouraging the elderly to actively participate in this activity, to foster social ties, to develop health education in order to avoid health problems and early disability as well as health differences related to social, economic and environmental factors.
 
13. The second goal of the Programme is to reduce the risk and negative impact of environmental factors and unsafe products and services on public health (hereinafter referred to as the second goal of the Programme).
 
14. Tasks for achieving the second goal of the Programme:
 
14.1. To create a healthy living environment. During the fulfilment of this task, it is planned:
 
14.1.1. To improve the management and monitoring of environmental air quality – to prepare and improve legal acts regulating the assessment and management of environmental air pollution and quality, to inform the public about the potential impact of air pollution on health and the measures of preventing this impact;
 
14.1.2. To ensure healthy spatial planning;
 
14.1.3. To encourage health-improving national, regional and community environmental initiatives;
 
14.1.4. To lower the incidence of injuries and accidents – to organise targeted training of children, young people, and the elderly.
 
14.2. To reduce the impact of hazardous chemical substances throughout the life cycle of the substances. During the fulfilment of this task, it is planned:
 
14.2.1. To form a harmonious attitude of businesses and the public to sustainable use of chemicals (mixtures), to pay particular attention to the prevention of accidental poisonings;
 
14.2.2. To encourage the production of healthy and environmentally-friendly chemical mixtures and the implementation of technologies that are safe for health, the environment and the climate;
 
14.2.3. To improve the database of commercially available chemicals (mixtures), their properties, effect, and protective measures and to make the best effort to ensure that its contents meet the needs of highly-qualified medical assistance in the cases of poisoning and prevention thereof;
 
14.2.4. To ensure the biological monitoring of dangerous chemical substances – to study the exposure of heavy metals, trace elements, their biomarkers and persistent organic pollutants in the biological media of the Lithuanian population.
 
14.3. To lower the risk of environmental noise. During the fulfilment of this task, it is planned:
 
14.3.1. To develop the awareness of residents in all age groups regarding the negative exposure of noise (to increase the noise literacy of the population, to spread information on “quiet” technologies and products, to increase the availability of this information to the public);
 
14.3.2. To improve the prevention of noise caused by domestic and entertainment activity – to improve the legal regulation of noise control;
 
14.3.3. To include aspects of noise reduction at its source in the processes of spatial planning, urban development and construction, to prepare sustainable urban mobility plans;
 
14.3.4. To make strategic noise maps of major roads and railroads, to draw noise prevention action plans according to strategic noise mapping results, to consult the public during planning of noise prevention measures;
 
14.3.5. To improve the legal regulation of noise in order to reduce noise pollution in living areas to levels recommended by the WHO.
 
14.4. To reduce the risk of ionising and non-ionising radiation. During the fulfilment of this task, it is planned:
 
14.4.1. To educate and inform the public on matters related to the impact of electromagnetic and ultraviolet radiation on health and the reduction thereof;
 
14.4.2. To ensure the monitoring of ionising and non-ionising radiation – to assess exposure levels, to implement reducing measures, to improve the systems of monitoring and controlling the sources of ionising and non-ionising radiation;
 
14.4.3. To prepare and implement educational programmes regarding protection from ionising and non-ionising radiation.
 
14.5. To increase the safety of products and services. During the fulfilment of this task, it is planned:
 
14.5.1. To encourage public behaviour based on the choice and consumption of products and services that do not pose a health risk, to prepare and spread information on matters of product safety;
 
14.5.2. To raise the awareness of economic operators and to improve their competence in matters of ensuring the safety of products and services – to organise seminars, to hold consultations with economic operators on matters of fulfilling product safety requirements;
 
14.5.3. To improve the effectiveness of products and services monitoring – to improve the regulatory framework of this activity.
 
15. The third goal of the Programme is to ensure the sustainability of the public healthcare system (hereinafter referred to as the third goal of the Programme).
 
16. Tasks for achieving the third goal of the Programme:
 
16.1. To increase the availability of high-quality and acceptable public healthcare services. During the fulfilment of this task, it is planned:
 
16.1.1. To develop and implement models of integrated public healthcare services, which include the provision of personal healthcare services and public healthcare services;
 
16.1.2. To analyse and evaluate new opportunities of providing public healthcare services that meet the modern needs of the population, to increase the diversity of services, to encourage the cooperation of pharmacists, social workers and other participants on matters of prevention of chronic non-infectious diseases;
 
16.1.3. To improve the implementation of delegated functions in municipalities, to improve the quality and availability of the functions as well as compliance with public needs – to improve the regulation of functions, to provide methodological support, to establish unified criteria of providing public healthcare services;
 
16.1.4. To improve the prevention of work-related health problems, accidents at work, and occupational diseases – to identify more cases, to eliminate current, new and arising risk, to review and improve the legal acts that regulate working environment factors and occupational risk assessment, to create a mechanism of monitoring work-related health problems and a system for ensuring the quality of employee health checks;
 
16.1.5. To establish legal, administrative, financial and organisational conditions of occupational healthcare development, to enshrine the concept of occupational healthcare in law and to establish that occupational healthcare services must be provided to all employees, to define the contents of occupational healthcare activity, to ensure the capacity of the coordinating authority at national and regional level in order to effectively develop interinstitutional cooperation on matters of occupational healthcare;
 
16.1.6. To create financial and economic mechanisms that would encourage employers to take care of the employees’ health – to draft legal acts regarding the matters of encouraging the social initiatives of companies;
 
16.1.7. To create institutional capacities (infrastructure) for providing occupational healthcare services in regions (counties), particularly to small and medium enterprises – to draft the nomenclature and description of occupational healthcare services, to establish how many occupational healthcare professionals (including occupational physicians, public health professionals, nurses, ergonomics specialists, physiotherapists, general practitioners) have to be trained, to provide for competence assurance procedures, and to monitor and evaluate occupational healthcare activity;
 
16.1.8. To reduce the incidence of tuberculosis among the Lithuanian population, to lower morbidity and mortality caused by the disease in order to prevent the emergence and spread of medication-resistant mycobacteria tuberculosis, to enhance tuberculosis prevention, to identify more cases of the disease, and to ensure that healthcare establishments work more efficiently in this area;
 
16.1.9. To reduce the spread of HIV and other sexually transmitted infections – to ensure that the public, especially young people and other target groups, are properly informed, to improve the knowledge and competence of healthcare professionals and other specialists with regard to the prevention of HIV/AIDS and other sexually transmitted infections, to foster tolerance towards people with HIV/AIDS and to reduce the stigma of HIV, to ensure comprehensive prophylaxis activity in risk groups, especially young people and teenagers, and early diagnosis and treatment of HIV and other sexually transmitted infections, to improve epidemiological surveillance, and to develop low-threshold services and services for young people.
 
16.2. To improve the management of the public healthcare system. During the fulfilment of this task, it is planned:
 
16.2.1. To implement the “health in all policies” approach – to actively coordinate the implementation of the public health policy at both national and local levels, to encourage comprehensive cooperation of state institutions, municipalities, non-governmental organisations, business, and the media;
 
16.2.2. To develop the competence of municipal councils, municipal doctors, municipal community health councils, the primary health care level and communities with regard to public health improvement and promotion;
 
16.2.3. To encourage and support the initiatives of the public sector and local self-government, communities and other non-governmental organisations, the inclusion (or participation) of social business, and volunteering that are aimed at promoting public health;
 
16.2.4. To develop the assessment of public healthcare technologies, to implement evidence-based public healthcare measures and interventions, and to constantly evaluate the effectiveness of applied measures;
 
16.2.5. To develop public health monitoring registers and information systems – to create new and improve existing ones, to improve the quality of primary data, to make them more detailed, and to improve the technologies of collecting, processing and transferring them;
 
16.2.6. To improve the management of hospital-acquired infections – to improve the system for monitoring hospital-acquired infections and associated risk factors, to ensure that personal healthcare establishments implement measures to prevent and control identified hospital-acquired infections;
 
16.2.7. To ensure that the competence of professionals who administer and provide public healthcare services at the national and municipal levels corresponds to the needs of the labour market, to prepare and implement a model for the training and professional development of public healthcare specialists, to intensify cooperation with the universities in the country in order to ensure that the need for state public healthcare professionals is consistently met;
 
16.2.8. To optimise the activity and management of public administration entities operating in the sphere of public healthcare, to create, improve, and implement advanced instruments for supervising the activity of economic operators: risk assessment and management and systems of uniform consultation and inspection of economic operators;
 
16.2.9. To develop immunoprophylaxis activity in the country in order to manage vaccine-preventable communicable diseases and to reduce the burden on public health, to inform and raise awareness of the population regarding vaccines and vaccine-preventable communicable diseases, to boost trust in vaccines, to prepare and implement a training programme for specialists, to ensure that communicable diseases (poliomyelitis, measles, rubella) are eliminated on time according to the requirements of the WHO and proper epidemiological surveillance is carried out during the elimination period, to evaluate the actual degree of herd immunity, to conduct seroepidemiological studies, to promote the inclusion of new vaccines in the Lithuanian children immunization  schedule, and to promote vaccination of adults;
 
16.2.10. To encourage prudent prescription and use of antimicrobial medications – to solve the issues of antimicrobial resistance management at the national level, to involve all institutions concerned in this activity and to take necessary measures in health, education, veterinary and agricultural sectors, to set up and formalise proper antibiotics use and antimicrobial resistance management indicators for personal healthcare establishments and to use them to assess the quality of services, to implement regional (county) antimicrobial resistance management models throughout Lithuania;
 
16.2.11. To ensure that personal and public healthcare institutions belonging to the national health system of Lithuania are ready to organise their activity in case of disasters and emergencies.
 
17. The criteria for evaluating the goals and tasks of the Programme for 2019 and 2023 as well as the target values are specified in the Annex to the Programme.
 
 
 
CHAPTER IV
 
IMPLEMENTATION AND FUNDING OF THE PROGRAMME
 
18. Implementation of the programme is coordinated by the Ministry of Health. Monitoring and analysis of changes of the indicators of the Programme implementation assessment criteria specified in the Annex to the Programme shall be carried out by the Ministry of Health or an institution authorised by it.
 
19. The Programme shall be implemented by ministries, institutions and organisations under the Government of the Republic of Lithuania, municipalities, businesses, non-governmental organisations and communities, and media representatives, acting within their areas of expertise; in addition, residents of the country, who are encouraged to take care of their health and the health of their children and parents, shall be involved in this activity as well.
 
20. The goals and tasks of the Programme shall be carried out via strategic documents (strategic, interinstitutional activity plans, annual activity plans) that are related to health and the management and prevention of associated risk factors; during the implementation of the Programme, participating state and municipal institutions shall provide for respective measures, funds requirements for implementing the measures, assessment criteria and values in their strategic planning documents.
 
21. Strategic planning documents of other sectors that are being implemented shall contribute to achieving the goals of the Programme, fulfilling the tasks defined in it, and improving the status of public health:
 
21.1. To create a healthy environment and conditions for safe leisure time – the National Environmental Protection Strategy, the State Environmental Monitoring Programme for 2011–2017, approved by Resolution No. 315 of 2 March 2011 of the Government of the Republic of Lithuania “On Approval of the State Environmental Monitoring Programme for 2011–2017”, the National Strategy of the Climate Change Management Policy, approved by Resolution No. XI-2375 of 6 November 2012 of the Seimas of the Republic of Lithuania “On Approval of the National Strategy of the Climate Change Management Policy”, the Interinstitutional Action Plan of Implementing the Goals and Tasks of the National Strategy of the Climate Change Management Policy, approved by Resolution No. 366 of 23 April 2013 of the Government of the Republic of Lithuania “On the Approval of the Interinstitutional Action Plan for the Implementation of Goals and Objectives of the National Strategy for Climate Change Management Policy”, the State Road Safety Development Programme for 2011–2017, the Inter-institutional Action Plan for the Implementation of the National Road Safety Development Programme for 2011–2017, approved by Resolution No. 1165 of 5 October 2011 of the Government of the Republic of Lithuania “Approving the Inter-Institutional Action Plan for the Implementation of the National Road Safety Development Programme for 2011-2017”;
 
21.2. To reduce the use of alcohol, tobacco, narcotic drugs and psychotropic substances – the National Programme of Drug Control and Drug Addiction Prevention for 2010–2016, approved by Resolution No. XI-1078 of 4 November 2010 of the Seimas of the Republic of Lithuania “On Approving the National Programme of Drug Control and Drug Addiction Prevention for 2010–2016”, the Interinstitutional Action Plan of the Republic of Lithuania to Prevent the Use of Drugs, Tobacco and Alcohol, approved by Resolution No. 217 of 25 February 2015 of the Government of the Republic of Lithuania “On Approving the Interinstitutional Action Plan of the Republic of Lithuania to Prevent the Use of Drugs, Tobacco and Alcohol”.
 
22. The Programme shall be financed from the state budget of the Republic of Lithuania of the corresponding year and from overall allocations to respective ministries, municipalities and institutions participating in the Programme stipulated in the Law on Approving the Financial Indicators of Municipal Budgets, from EU financial assistance and other received international financial assistance, international programmes, and other lawfully obtained funds.
 
23. The Ministry of Health provides information to the Government of the Republic of Lithuania regarding the implementation of the Programme in the annual activity report.
 
24. After the Programme is implemented, a report on implementing the Programme shall be compiled and made available to the public.––––––––––––––––––––
 
 
Annex to
 
the National Public Healthcare Development Programme for 2016–2023
 
 
 
LIST OF ASSESSMENT CRITERIA AND VALUES THEREOF OF THE IMPLEMENTATION OF GOALS AND TASKS OF THE NATIONAL PUBLIC HEALTHCARE DEVELOPMENT PROGRAMME FOR 2016–2023
 
 
 
 
 
 
 
 
  Strategic goal, goal of the programme
  Task
  Assessment criterion (unit of measurement) (criterion data source)
  Value
  Institution responsible for achieving the assessment criterion value
  Status (year)
  2019
  2023
  Strategic goal – to extend the healthy life years of Lithuanian residents
   
  Healthy life expectancy of men in Lithuania (years)   (Eurostat)
  56.8 (2013)
  58.6
  60
  The Ministry of Health of the Republic of Lithuania (hereinafter referred to as the Ministry of Health)
  Healthy life expectancy of women in Lithuania (years)   (Eurostat)
  61.6 (2013)
  62.6
  63.6
  The Ministry of Health
  1. To promote physical and mental health – to encourage healthy living and culture, to promote health literacy
   
  Lifestyle changes with regard to health (per cent)   (Health Behaviour among Lithuanian Adult Population of the Lithuanian University of Health Sciences)
  19 (2014)
  24
  26
  The Ministry of Health
   
   
  Share of people in the 20–64 age group who evaluated their quality of life as very good or good (per cent)   (Health Behaviour among Lithuanian Adult Population of the Lithuanian University of Health Sciences)
  45 (2014)
  50
  55
  The Ministry of Health
   
   
  Share of obese people in Lithuania in the 18–75 age group (percentage)   (Health Education and Disease Prevention Centre, Studies of the Actual Dietary Habits and Dietary and Physical Activity Habits of the Lithuanian Population)
  19 (2014)
  19
  19
  The Ministry of Health
   
  1.1. To develop healthy eating habits of the residents, to improve opportunities for all population groups to choose healthy food
  Consumption of fruit and vegetables per person (grams per day)   (Health Education and Disease Prevention Centre, Studies of the Actual Dietary Habits and Dietary and Physical Activity Habits of the Lithuanian Population)
  260 (2014)
  272
  280
  The Ministry of Health
   
   
  Number of healthy products labelled with the “Keyhole” symbol (units)   (The Ministry of Health)
  9 (2014)
  50
  90
  The Ministry of Health
   
  1.2. To increase the physical activity of the population and to enable them to be physically active in all areas of life
  Share of people in the low physical activity group (percentage)   (Health Education and Disease Prevention Centre, Studies of the Actual Dietary Habits and Dietary and Physical Activity Habits of the Lithuanian Population)
  19.6 (2014)
  18.6
  17.6
  The Ministry of Health
   
  1.3. To improve public mental health by carrying out interventions that improve mental health, encourage positive changes and raise public awareness
  Suicide mortality  (standardised mortality rate per 100,000 population )   (The Institute of Hygiene)
  31.7 (2014)
  20
  16
  The Ministry of Health
   
   
  Share of pupils who have not experienced bullying in 2 months (percentage)   (Health Behaviour in School-Aged Children (HBSC) of the Lithuanian University of Health Sciences)
  46.2 (2014)
  60
  70
  The Ministry of Education and Science of the Republic of Lithuania
  2. To reduce the risk and negative impact of environmental factors and unsafe products and services on public health
   
  Share of people who are aware of environmental risk factors and their possible harmful effect on health (percentage)   (Survey of the Ministry of Health)
  –
  30
  50
  The Ministry of Health
   
   
  Mortality due to external causes (standardised mortality rate per 100,000  population)   (The Institute of Hygiene)
  113.8 (2014)
  105
  100
  The Ministry of Health
   
  2.1. To create a healthy living environment
  Share of people living in households and experiencing air and environmental pollution (smog, dust, odours, contaminated water) (percentage)   (Statistics Lithuania, Income and Living Conditions Survey)
  14 (2014)
  12
  10
  The Ministry of Environment of the Republic of Lithuania
   
  2.2. To reduce the impact of hazardous chemical substances throughout the life cycle of the substances
  Number of poisonings among children under 7 years of age (cases)   (The Health Emergency Situations Centre of the Ministry of Health)
  381 (2014)
  360
  340
  The Ministry of Health
   
  2.3. To lower the risk of environmental noise
  Share of people claiming to suffer from noise (percentage) Proportion (percentage) of population living in households considering that they suffer from noise   (Eurostat)
  14.4 (2014)
  12.75
  12.3
  The Ministry of Health
   
  2.4. To reduce the risk of ionising and non-ionising radiation
  Collective effective dose received by the Lithuanian population (mSv/1,000 people)   (Radiation Protection Centre)
  960 (2014)