The
Ministry of Health and Social Welfare has forwarded to us an EU document
called “Enabling Good Health for All; A reflection process for a new EU
health strategy”. Mr. David Byrne, member of the European Commission
for Protection of Health and Consumers calls in the enclosed letter on
the governments of European countries, international organisations,
medical professionals and citizens to collaborate and offer suggestions
in connection with the documents to incorporate into recommendations for
a future EU health strategy.
The
CNIPH professionals feel that this document, which is of special
importance for all European states, has been drawn up based on a public
health approach that sets priorities for future EU health policy action
as evident from many items.
1.
Good health is not only the quality of life, but a key to the economic
development and continuous progress
2. The
time has come to transfer the priority from treatment of disease to
health promotion
3.
Health is largely a consequence of personal choice of what one eats,
smokes, drinks and does
4. Every individual should be suitably informed about how lifestyle
affects health and how to preserve his health; therefore, citizens
should be given reliable, accessible and comprehensible information on
how to maintain their health
5.
States being responsible for health care and health system, they decide
on organisation, budget allocations, drug list and technology
6.
States are responsible to ensure the accessibility of healthcare to all
citizens, investing into new procedures, promoting of the quality of
healthcare and meeting of special needs of ageing population
7. EU
sets the quality and safety standards for medical preparations and
devices
8.
Citizens should be given options where health is involved and taking
part in decision‑making from the outset
9.
One should regard health expenditure as a long-term investment, not a
short‑term cost
10. In
the absence of long‑term investment in health, healthcare and social
welfare expenses grow to the detriment of the economy
11.
Where a choice between equally effective therapies is available, the
less expensive therapy should be administered
12.
The money well spent is the one invested in disease prevention: a
long‑term investment in preventing the future illness saves the costs of
treatment
13.
Investing into medical workers and their training is important – “…
healthcare providers need assistance to be able to exchange their
knowledge and achieve the necessary interconnection” as well as “… to
link with a strong EU knowledge base”
14.
Importance of developing information and communication technologies,
building of a “knowledge base, “… support to institution networking and
setting up an EU health portal for access to health information via
Internet“, “the development of reliable, objective, comparable and
timely information based on which efficient/effective decisions are made
on national and EU levels”, and “EU spends
Î50
million on public health projects, many of which are directed at
stakeholders and the expansion of knowledge base …”
15.
The flow of information is instrumental to facilitating and accelerating
the access in the realisation of health services in any part of the
Union: “… enabling everyone to utilise efficiently the latest and best
possible treatment so as not to jeopardise equity”, enabling a ready and
quick access to good care for all anywhere and at any time. In the
future EU, unhindered retrieval of clear and reliable information on
good health, diseases treatment options should be feasible”, “… the EU
eHealth Action Plan will materialise through electronic drug prescribing
and through an electronic health card so as to increase efficiency in
health. Citizens will carry on them their electronic health record on a
smart video card in the wallet so that any physician may provide care to
them at any time and in any place”
16.
Reorientation not only of health systems, but also of society attitudes
toward health: ”… ensuring participation in decision-making and
encouraging partnerships”.
The above allows of conclusion that the document focuses on the
importance of health and its fundamental determinants. Key of these for
healthier lifestyle are: training for self-control of own health,
raising of the awareness that health constitutes an investment with
future economic benefits, and a realisation that the costs arising from
disease and sick leaves are generated precisely because of insufficient
investing into health. By adopting a healthier lifestyle, combined with
the promotion of health as a whole and by joint action as partners, the
state, governments and civil society reduce the prevalence of individual
risk factors and act preventively. One also attaches great significance
to health security, ranging health ecological measures to the control
and prevention of infectious diseases, and to measures for the
prevention and control of bioterrorism through co-ordinated action at
the “European CDC” level.
One
the main features of this document is not only a reorientation for
health systems. There are also its attitudes toward health, acceptance
of facts based on the scientific research showing health to be a lever
of economic development bringing great economic benefits, and the view
that health systems must be regarded not only as generators of the
consumption arising from disease and work days and years of life lost.
Besides the health system itself, “partners” from different sectors,
NGOs and individuals take part in health investment programmes; also
promoted are the concepts relating to the importance of assessing
influences from different segments of life and work on health (health
impact assessment).
Finally, we could say that this document has sent everyone a clear
signal that health is a common resource that we should strive to
maintain and promote by applying a defined strategy and measures.
Institutes of public health as public health institutions are
particularly aware of their role and responsibility in disseminating and
transferring the health knowledge, in advocating health and in assessing
different effects on health.
MICROBIOLOGY SERVICE
- Head, Prof.
Dr Gordana Mlinaric-Galinovic
M. caprae
has
been isolated and identified at CNIPH’s TB Bacteriologic Diagnostics
Department for the first time in human material. In addition to
undergoing biochemical identification (negative nitrate reduction,
negative niacin test, susceptibility to pyrazinamide), the isolate was
confirmed using the hybridisation test (GenoType® MTBC; Hain
Lifescience). M. caprae isolations in Croatia have until now
only been made in cattle (by the Veterinary Institute in Zagreb).
The
species M. tuberculosis, M. bovis, M. africanum, M. canettii, M.
microti and M. Pinnipedi belong to the Mycobacterium
tuberculosis complex and display a close relatedness. They are the
causative agents of human and animal tuberculosis. Mycobacterium
bovis subsp. caprae and most recently Mycobacterium
caprae is also a member of the complex. Variations in the
biochemical properties and molecular characteristics of the species
Mycobacterium tuberculosis complex permit their differentiation and
identification, something of special epidemiological value.
HEALTH ECOLOGY SERVICE
-
Head, Krunoslav Capak, MD,
MSc
The
GMO Laboratory at CNIPH’s Environmental Health Service, is one
of the main instruments for the implementation of the legislation and
policy on protecting health and environment from GMOs. In August
2004, a ministry of health and social welfare‑appointed committee
exercised its supervisory powers to establish whether the Laboratory
fulfilled the requirements of the Regulation on Authorised
Laboratories for GMO Control and Monitoring. It has reached the
conclusion that the Laboratory met all legal requirements; based on
this, the Ministry issued a licence certifying that the Laboratory may
perform such tests. Actually, the Laboratory started operation
festively in September 2003, doing the first GMO analyses last
November. Between then and now, it had carried out more than 1,000
tests on samples of food, food industry’s raw material and plant
reproduction materials. The reasons for not submitting to the
accreditation process earlier were the nonexistence of an implemental
regulation and the Laboratory operating under the Nature Protection
Act.
A
session of the appointed committee to draft a regulation on food
pesticide, toxin, mycotoxin, metal, non‑metal, histamine and similar
substance allowances was convened for September 10. Dr Zeljko
Sljemensek from the Ministry of Health and Social Welfare is its chair,
with Mr. Mario Vukoja, a jurist from the same ministry also taking
part. At its first session in May, the Committee decided to assign
pesticide and veterinary drug areas to separate regulations because of
the complexity and specificity of the topics. This extensive and
heterogeneous area requires contributions from different professionals.
Thus, veterinary drugs need solving through the efforts of the Faculty
of Veterinary Medicine and of the Nutrition and Biotechnology Faculty’s
Food Control Centre. The pesticide area was allotted to the Plant
Protection Institute staff and to Dubravka Kipcic, MSc, from CNIPH.
They were joined by their colleagues from the Food Control Centre,
Ministry of Agriculture, Forestry and Water Management, and those from
public health institutes of the Primorsko-Goranska and
Splitsko-Dalmatinska counties. For the session, chairpersons had
prepared a draft pesticide list and a list of
veterinary‑drug‑of‑animal‑origin allowances.
Marijan Katalenic, MSc, from CNIPH has been given the charge of other
contaminants area. Given that this area too is heterogeneous, it was
proposed to have other professionals join this working party as well.
Thus included from CNIPH were Nada Milanovic, MSc, (for mycotoxins),
Jadranka Pongracic, MSc, and Ana Benutic, MSc, (for metals and
non‑metals), engineer Jelena Vukusic (for histamines), Jadranka
Balenovic, MSc, (for PAHs), and Dr Jasna Bosnir from the Zagreb
Institute of Public Health (for PCBs and dioxins), as well as Branka
Medugorac, MSc, from the Primorsko‑Goranska County Institute of Public
Health (for metals and non‑metals). It has been agreed to process for
the session the EU directives on mycotoxins, metals and non‑metals, and
do likewise with other directives by the next session. Apart from
deadlines, another problem for work quality in the process of equalising
Croatian with the EU regulations is the specifics of our legislation.
Well‑drafted regulations are a base in making proper food safety
assessments and hence in achieving good consumer health.
CNIPH
and county public health institutes are organising the 8th
technical‑scientific gathering “Water and Public Water Supply”, due to
take place on 04-07 October 2004 and tackle the subject “Croatia’s
mineral, source and thermal Waters” under the auspices of the
deputy prime minister and minister of health and social welfare,
Professor Andrija Hebrang.
Croatia is a country with an above average amount of water per capita.
Of the available water, underground water of satisfactory quality
accounts for 12.0% “thanks to” limited development, low population
density, and partly to rational water resource management. Mineral,
thermal and source waters constitute special wealth, the utilisation
level of which is very low. This is particularly true for thermal
waters; their medical, power‑generative and economic potentials are
used to a negligible percentage, however. The thus available amounts
are large and well distributed. As all preconditions are fulfilled,
every effort should be made to turn water into Croatia’s strategic
export item somehow. In addition to the central topic, other
water‑related subjects associated with the water problem area will be
considered from the standpoints of health safety, technology,
protection, analysis, legislations etc. We hope this scientific
gathering will provide opportunities to present the experience,
knowledge and opinions linked with this invariably topical and
interesting subject as well as with other water problems.
News (monthly) Croatian National
Institute of Public Health
ISSN 1333-0608
Editor-in-chief: Prof. Marija
Strnad, MD, MPH, PhD
Editor and co-ordinator: Mario Troselj, MD
Editorial Board: Bernard Kaic, MD; MSc Verica Kralj, MD; Jasminka
Tunukovic, MD; Andreja Barisin, MD
Translator: Vilim Crlenjak, BA
Graphic design: Mario Hemen, EE
Publisher: Croatian National Institute of Public Health
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