PUBLIC HEALTH IN LATVIA WITH PARTICULAR REFERENCE TO HEALTH PROMOTION SCHERFIGSVEJ 8 EUR/ICP/IVST 04 03 02 DK-2100 COPENHAGEN Ø E61121 DENMARK ENGLISH ONLY TEL.: + 45 39 17 17 17 UNEDITED TELEFAX: + 45 39 17 18 18 EUR/HFA target 13 TELEX: 12000 1998 E-MAIL: [email protected] WEB SITE: HTTP://WWW.WHO.DK TARGET 13 HEALTHY PUBLIC POLICY By the year 2000, all Member States should have developed, and be implementing, intersectoral policies for the promotion of healthy lifestyles, with systems ensuring public participation in policy-making and implementation. ABSTRACT Public health and health promotion are currently in a positive phase of development in Latvia, but face a number of problems, upon which the State Minister of Health, Mr Viktors Jaksons, invited expert technical advice from the European Regional Office of the World Health Organization (WHO/EURO). The tasks of the WHO/EURO team were: 1. To review the health promotion function in Latvia, giving particular attention to: 2. To make recommendations for achievable improvements. 3. To take fully into account the proposed health promotion component of the World Bank health sector loan to Latvia, which is under negotiation. The present document describes the analysis, conclusions and main recommendations of the WHO/EURO team aimed at ensuring that health promotion is developed in a systematic and sustainable way in Latvia. Working method The team: ⇒ considered the documents which are listed in Annex B; ⇒ discussed the issues with senior people from the Latvian health sector and other sectors, as set out in the programme of work which forms part of Annex A; ⇒ analysed the information it had collected and formulated preliminary conclusions and recommendations; ⇒ discussed its analysis and preliminary conclusions and recommendations with a small “sounding board” (listed in the programme of work); ⇒ prepared a draft report for discussion with Mr Jaksons and subsequent finalization. © World Health Organization All rights in this document are reserved by the WHO Regional Office for Europe. The document may nevertheless be freely reviewed, abstracted, reproduced or translated into any other language (but not for sale or for use in conjunction with commercial purposes) provided that full acknowledgement is given to the source. For the use of the WHO emblem, permission must be sought from the WHO Regional Office. Any translation should include the words: The translator of this document is responsible for the accuracy of the translation. The Regional Office would appreciate receiving three copies of any translation. Any views expressed by named authors are solely the responsibility of those authors. This document was text processed in Health Documentation Services WHO Regional Office for Europe, Copenhagen CONTENTS Page 1. INTRODUCTION.............................................................................................................................. 1 1.1 Background and terms of reference ......................................................................................... 1 1.2 Working method ...................................................................................................................... 1 1.3 Acknowledgements.................................................................................................................. 1 2. REVIEW OF THE HEALTH PROMOTION FUNCTION............................................................... 2 2.1 Overall review of the health promotion function..................................................................... 2 2.2 Measurement and interpretation of health determinants which are especially amenable to health promotion ...................................................................................................................... 4 2.3 Policy-making for health promotion........................................................................................ 5 2.4 The infrastructure, organization and funding of health promotion practice within the overall public health system.................................................................................... 6 3. RECOMMENDATIONS ................................................................................................................... 9 3.1 The health promotion function................................................................................................. 9 3.2 Health determinants ................................................................................................................. 9 3.3 Policy-making ........................................................................................................................ 10 3.4 Infrastructure, organization and funding................................................................................ 10 4. IMPLEMENTATION OF RECOMMENDATIONS....................................................................... 13 4.1 Overview................................................................................................................................ 13 4.2 Implementation scheduling....................................................................................................13 4.3 Technical cooperation, assistance and funding...................................................................... 13 Annex A. Programme of work ............................................................................................................... 17 Annex B. Documents considered ........................................................................................................... 20 Annex C. Health Promotion Glossary.................................................................................................... 22 Annex D. Resourcing health promotion................................................................................................. 43 EUR/ICP/IVST 04 03 02 page 1 1. INTRODUCTION 1.1 Background and terms of reference Public health and health promotion are currently in a positive phase of development in Latvia, but face a number of problems, upon which the State Minister of Health, Mr Viktors Jaksons, invited expert technical advice from the European Regional Office of the World Health Organization (WHO/EURO). A WHO/EURO team visited Latvia from 31 May to 5 June 1998, under the leadership of the Regional Adviser for Health Promotion and Investment for Health, Dr Erio Ziglio, and comprising two other members, both with substantial prior experience in Latvia. The full team membership is set out in Annex A. The Terms of Reference of the team were: 1. To review the health promotion function in Latvia, giving particular attention to: q the measurement and interpretation of health determinants which are especially amenable to health promotion; q policy-making for health promotion; and q the infrastructure, organization and funding of health promotion practice within the overall public health system. 2. To make recommendations for achievable improvements. 3. To take fully into account the proposed health promotion component of the World Bank health sector loan to Latvia. 1.2 Working method The team: ⇒ considered the documents which are listed in Annex B; ⇒ discussed the issues with senior people from the Latvian health sector and other sectors, as set out in the programme of work which forms part of Annex A; ⇒ analysed the information it had collected and formulated preliminary conclusions and recommendations; ⇒ discussed its analysis and preliminary conclusions and recommendations with a small “sounding board” (listed in the programme of work); ⇒ prepared a draft report for discussion with Mr Jaksons and subsequent finalization. 1.3 Acknowledgements The WHO team gratefully acknowledges the great cooperation and assistance it received from many people in undertaking this work. Without the initiative of Mr Jaksons the work would not have happened at all. Moreover, WHO is especially grateful that he gave his time so generously to the work of the team, enabling its understanding to be broadened by his experience and learning. To all the other people who were prepared to break away from demanding responsibilities to give their time and the benefits of their knowledge and experience to the work of the team, WHO offers its thanks. Without their input the work could not have been undertaken at all, and the quality of their documents, knowledge, ideas and reflections contributed inestimably to the analysis, conclusions and recommendations EUR/ICP/IVST 04 03 02 page 2 made by the team. Inevitably, in an exercise conducted with so many busy people in a very limited time, the pace of work did not allow everybody to make their full contribution. WHO apologizes for this and accepts full responsibility for any omissions or contentious emphases that may have resulted. Every attempt has been made to keep these to a minimum, so that this report will be a useful and practical document, and so that in due course the Latvian authorities may wish to follow up some of its proposals for further advice and assistance from WHO. Finally, WHO wishes to offer its thanks to two groups of people who ensured the smooth operation of the work of the team. The staff of the Public Health Department of the Ministry of Welfare warmly welcomed and accommodated the team in well serviced accommodation throughout its work. The commitment, organizational skills and selflessness of the staff of the WHO Latvian liaison office opened many doors to the team and ensured the optimum use of the limited time available.