5.1 Public health

Thursday, 05. May 2011, 0:58


5. Provision of services


5.2 Patient pathways

The growing prevalence of cardiovascular disease, cancer, respiratory disease, allergies and fatal accidents are the most significant health problems facing the population in Slovakia. In addition, communicable diseases also receive a great deal of attention. The four priority areas for public health policy are as follows:

  • chronic diseases – mainly cardiovascular disease, cancer and obesity

  • communicable diseases

  • environment and health

  • tobacco and alcohol.

The PHA, a budgetary organization of the Ministry of Health, is responsible for the coordination of national-level activities in the realm of public health. The PHA manages 36 regional public health authorities and addresses health promotion at the national level, monitors communicable diseases, and adopts measures for health protection and health improvement when necessary.

5.1.1 Health promotion

Health promotion clinics were established in 1993 as an integral part of regional public health authorities to provide advice on risk factors, healthy nutrition, smoking cessation, physical activity, mental health and stress management, occupational health support and protection, non-pharmacological treatment, AIDS and anti-drug counselling, children and youth counselling, hepatitis B positive families counselling, and counselling for breastfeeding women. Numerous conferences, seminars, courses and health educational sessions are organized to raise awareness (for example World Health Day, World Environment Day, International Drug Dependency Day, World Nutrition Day, World No Tobacco Day and World AIDS Day). Furthermore, health clinics advise on topics such as air quality, environmental noise, quality of housing, and drinking and bathing water and its impact on human health.

Regional public health authorities supervise the living conditions of children and youth by monitoring canteen services, the education process, extracurricular activities, and housing conditions of children and youth. Regional public health authorities promote health through programmes for children and youth about healthy lifestyle issues (smoking, healthy nutrition, drugs, HIV/AIDS and sex). Furthermore, various programmes are organized with WHO support (for example Health Promoting Schools, Healthy Children in Healthy Families, Healthy Kindergartens). Despite these projects, the 2007 Slovak Consumer survey (Publicis Knut, 2007), based on 4000 respondents aged 15 and over, indicated that more than half of the population is not active in sports and only 8.4% care about a healthy lifestyle and sufficient exercise.

In cooperation with the Ministry of Environment and other sectors, the regional public health authorities monitor risk factors in environment-related health care. This includes, among others, monitoring of water, soil, air and food quality, the level of radiation, as well as impact of these factors on population health.

The PHA is responsible for monitoring and surveillance of communicable diseases in Slovakia. This includes mandatory reporting of incidences of communicable diseases, the suspicion of communicable diseases, and of cases of pathogen carriers. Upon reporting, epidemiological and laboratory investigations are carried out. If necessary, these are followed by prevention measures against widespread infection. Surveillance mainly focuses on areas such as food poisoning, viral hepatitis, infectious diseases of the nervous system, zoonosis, AIDS and tuberculosis. Since 1991, the register for communicable diseases has been part of the epidemiological information system of communicable diseases (EPIS). This enables long-term follow-up on diseases. In 2007, a total of 57 650 cases of communicable diseases were reported, which was 11% more than in 2006. This was the result of an increased incidence of varicella and herpes zoster, type C viral hepatitis, salmonella infections and diarrhoea viral infections.

The centrepiece of the infection prevention strategy is maintaining a high vaccination rate. Slovakia has followed a strict immunization programme since 1986, which aims at the elimination and eradication of communicable diseases mainly by targeting children. The implementation of the immunization programme includes administering the vaccination, vaccination monitoring and evaluation of efficacy. Compulsory vaccinations include vaccinations against tuberculosis, diphtheria, pertussis, poliomyelitis, H. influenzae, type B viral hepatitis, rubella, morbilli and parotitis. The national immunization programme in Slovakia has been planned and implemented in accordance with the objectives of the WHO policy document Health for All in the 21st Century.

Consistent implementation of this programme succeeded in improving and maintaining low or zero incidences of vaccination-preventable diseases. Slovakia reports a high vaccination rate in all relevant categories ranging from 98.1% to 99.5% in 2007. Vaccinations are administered by primary care paediatricians. No cases of poliomyelitis, diphtheria or morbilli, and only two cases of rubella were reported in 2007. In the same year, the incidence of type B viral hepatitis had decreased by 16% compared to 2006. The considerable decrease among adolescents was the result of a vaccination programme for this age group from 2004 to 2007. Higher incidence is still reported among young children who have not yet been vaccinated. The incidence of type A viral hepatitis (VH-A) continues to decline, as a result of a vaccination programme targeted at children living in communities with low standards of hygiene. Slovakia reported 384 cases of VH-A in 2007 (incidence 7.12 per 100 000), which is 17% less than in 2006 and 32% less than the five-year average.

Prevention and screening programmes in Slovakia are covered by SHI. The incidence of developmental and genetic malformations and diseases is determined using prenatal and perinatal diagnostics. Screening for phenylketonuria and congenital adrenal hyperplasia, as well as ultrasonography of kidneys, is performed on all newborns. Numerous examinations for children are covered by health insurance, including psychomotor development follow-up and compulsory vaccinations. Each child undergoes a hip ultrasonography at between 8 to 10 weeks old. Up to age 15, health insurance covers 17 preventive examinations, the contents of which are specified by law. Every insured adult is entitled to preventive examinations by a GP once every two years, including examinations of blood pressure and blood levels of sugar and fats, as well as an ECG, a faecal occult test, and colorectal cancer screening for those 50 years of age and older. Preventive gynaecological examinations include uterine cancer screening in all women aged 23 to 64. A preventive mammodiagnostic programme for women has been operating since 2001. In this programme, all women between the ages of 40 and 69 are entitled to one preventive mammogram every two years. Men over 50 years of age are entitled to one preventive urological examination every three years. The examination also includes screening for prostate cancer. Health insurance covers two preventive dental examinations per year for children (up to age 18) and one preventive dental examination for those over 18.

Alcohol- and smoking-related legislation is outlined in the Act on Protection Against Alcohol Abuse and the Act on Protection of Non-smokers. According to 2007 data from the Statistical Office of the Slovak Republic (2007), 38% of the population in 2006 were smokers, which is 8% less than in 2000. Results from the 2007 ESPAD Report on alcohol and drug use among European 17–18-year-old students found that 51% of Slovak boys and 43% of Slovak girls had smoked at least one cigarette in the last 30 days (Hibell et al., 2007). Approximately 11 000 people die due to smoking-related diseases and conditions (PHA, 2010). The most frequent diseases caused by smoking are ischemic heart disease, cerebral apoplexy, lung cancer and chronic respiratory diseases. In 2006 and 2007, the government approved two strategic documents concerning legal drugs: the National Action Plan for Alcohol-related Problems for the years 2006 to 2010 and the National Programme of Tobacco Control. NGOs promote awareness of the dangers associated with smoking.