Creating Environment and Health Information System in Lithuania:

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Creating Environment and Health Information
System in Lithuania

• First steps

Ingrida Zurlyte, Aida Laukaitiene State Public
Health Centre, Vilnius, Lithuania
The Central and Eastern European Chapter/ISEE
Meeting 4 6 September, 2003, Balatonfoldvar
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National Framework

• National Public Health Strategy, 2001
• Law on Public Health Care, 2002
• Law on Public Health Monitoring, 2002 (by-law
  acts, 2003)
• National Environmental Health Action Programme
  (2003 2006)
• National Public Health Monitoring Programme
  (draft)
• Strategic Planning for Health Sector

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National Framewok

• Long Term State Development Strategy, 2002
• National Sustainable Development Strategy and
  Implementation Plan, 2003
• Information Society Programme

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Environmental Health Information System -
environmental health data collection,
transmission, processing and delivery to end-user
in the most efficient way in order to possess
everyday tool for environmental health management
(NEHAP of Lithuania, 2003)

• The purpose is to
• collect and process environmental health
  information on geographical principle and with
  national coverage
• assess environmental health situation
• ensure fast and effective use of environmental
  health data and information for identification of
  hot spots
• provide input for environmental health impact
  assessment
• use in forecasting and policy decision making
  process.

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Input from international projects

• WHO/DEPA Project on Implementation of National
  Environmental Health Action Plans in Czech
  Republic, Estonia, Lithuania, Poland and
  Slovakia, 2000 2001
• WHO mission to review EH monitoring and
  information system in Lithuania, 2001
• Analysis and strategic recommendations for
  integrated EH information system, 2001

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Input from international projects

• WHO project Environment and Health Indicators
  developing methodology for the WHO European
  Region
• Planning, set of EH indicators
• Feasibility study for core set of EH indicators
• Pilot study (data collection, EuroIndy, meta data
  information, fact sheets for reporting)

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Feasibility study

• Issues addressed
• Availability and quality of necessary data
• Accessibility and exchange mechanisms
• Use and usefulness of proposed indicators in
  (sub)national context
• Capacity for multi agency working on the
  information.

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Results of Feasibility Study

• From the WHO core set of indicators (55)
• - most were feasible (24)
• - 17 partly feasible
• - 14 not feasible (exposure related indicators
  noise related effect indicators (annoyance, sleep
  disturbance exceedance of WHO drinking water
  guidelines)
• Only 3 indicators not useful (consumption of
  leaded gasoline blood lead level in children
  standardized mortality ration by occupation)

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Positive experience feasibility study

• Renewed contacts and new contacts established.
• More clear and generalized view on existing EH
  information, assessment of gaps.
• Created understanding, awareness in health and
  other sectors
• Standardized forms for information collection and
  evaluation.
• Cooperation with WHO and EEA.

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Problems

• Problems with identifying data-holders
  (additional administrative capacities and time)
• Data is spread in different institutions (27), 10
  of them from health sector.
• Lack of institutional co-operation and data
  exchange, lack of data or data duplication
• Financial and timing problems motivation,
  reluctance from some institutions and experts
• Transitional period (changes in methods, new and
  old data are hardly comparable and new data are
  not complete)

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Problems

• Reorganization of public health institutions
  moving responsibilities
• Each institutions/expert are very specialized
  difficult to generalize.
• Incompatibility of environment and health data
  collection and presentation formats
• Poor EH reporting

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• National List of Environmental Health Indicators,
  adopted by the Order of the Minister of Health,
  August 30, 2002
• Based on WHO core set of EH indicators,
  feasibility study results and new proposals
• Discussed with public health, environmental
  institutions and Statistical Department
• Procedure for data collection, analysis and
  reporting, end of 2003.

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Example from the national list
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Some other differences

• Children statistics 0-2 3-6 0-14 0-15 years
  old
• Mortality due to external causes in children
  under 6 years old
• Acute communicable intestinal diseases morbidity
  in children under 6 years of age
• Different formulation of food safety indicators
• Number of outbreaks of communicable disease
  transmitted by food per year
• Incidence rate of acute intestinal communicable
  disease and bacterial food toxic infections

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Rate of road traffic causalties (injurydeath)
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Useful floor area per person in Lithuania during
the year 1996-2001
Notes Data of useful floor area are collected in
Lithuania. Lithuanian Statistical Department
defines Useful floor area as the floor space of
dwellings measured inside the outer walls
excluding cellars, uninhabitable attics and, in
multi-dwelling houses, common area.
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Problems encountered

• Interpretation in environmental health terms
• Lack of data for drinking water quality food
  action indicators only from the year 2000 sites
  containing large amount of chemicals
  approximate only
• Action indicators broad very approx estimation
  (subjective judgment)
• Food borne illness or water born illness
  different from WHO indicators
• Regulatory requirements for land use around areas
  with large quantities of chemicals who is
  responsible?

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Application on local level

• Interest from local level exist
• Differences between counties and localities
• Need for additional training and guidance from
  national level
• Should be clear for local authorities what data,
  where to get etc.

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Expectations

• Environmental health assessments
• Environmental Health (Public Health) reporting
  and communication
• Contribute to monitoring of environment and
  health actions
• Incorporate children EH indicators

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Tasks

• Ensure continuity of work done
• Build partnership with stakeholders
• Managers and politicians should take ownership of
  the environmental health information system
• Complete legal basis for EHIS functioning.
• Create financial economic basis for EH
  information system functioning.
• Solve issues of EHIS holder(s) management and
  subordination.

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Thank you for your attention!