Vol 75, No 6 (2017)
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Kardiologia Polska 2017 nr 06-20

 

ARTYKUŁ ORYGINALNY / ORYGINAL ARTICLE

Preventive healthcare and health promotion in local governments based on the example of health policy programmes concerned with cardiovascular diseases implemented in Poland in 2009–2014

Anna Augustynowicz, Aleksandra Czerw, Mariola Kowalska, Krzysztof Bobiński, Adam Fronczak

Department of Public Health, Medical University of Warsaw, Warsaw, Poland

Address for correspondence:
Anna Augustynowicz, PhD, Department of Public Health, Medical University of Warsaw, ul. Banacha 1a, 02–097 Warszawa, Poland, tel: +48 22 599 21 80,
fax: +48 22 599 21 80, e-mail: aaugustynowicz@poczta.onet.pl
Received: 06.10.2016 Accepted: 30.01.2017 Available as AoP: 07.03.2017

Abstract

Background: Cardiovascular diseases (CVD) are the cause of over 4.3 million deaths in the World Health Organisation European Region and around 1.9 million deaths in the European Union member states alone. They are also the number-one cause of death in Poland. In 2010 CVDs accounted for 46% of all deaths, and in 2013 — 45.8%.

Aim: The aim of the study was to evaluate the performance of the tasks of local government units in the area of preventive healthcare and health promotion on the basis of health policy programmes concerning CVD.

Methods: The study was based on a desk research. The data included in the annual reports submitted to the Minister of Health concerning completed health policy programmes concerned with CVD, was used.

Results: A total of 795 programmes were completed in 2009–2014. The greatest number of programmes were completed by municipalities followed by counties. The costs incurred by voivodeships in connection with the programmes were significantly higher compared to the costs paid by municipalities and counties. Diagnostic programmes accounted for 74% of the overall number of programmes, and preventive programmes made up only 24%. The greatest number of programmes were completed in Mazowieckie and Swietokrzyskie voivodeships. The smallest number of programmes were completed in Lubelskie, Lubuskie, and Podlaskie voivodeships.

Conclusions: Insignificant involvement of local government units can be seen in the fight against CVD. Particular types of local government units demonstrate a varied degree of involvement in the performance of health policy programmes. The small number of preventive programmes points to the fragmentary completion of tasks concerned with preventive healthcare and health promotion. Some of the voivodeships failed to properly address the health needs of local communities in respect of CVD. More programmes need to be completed, and they need to cover more people. Some guidelines should be developed for local government units concerning their involvement in the fight against CVD.

Key words: preventive healthcare and health promotion, health policy programme, local government unit, cardiovascular disease

Kardiol Pol 2017; 75, 6: 596–604

INTRODUCTION

Cardiovascular diseases (CVD) account for over 4.3 million deaths in the World Health Organisation (WHO) European Region and around 1.9 million deaths in the European Union (EU) member states alone [1]. The death rates for CVD vary greatly between different EU member states. In Bulgaria, Romania, Estonia, Latvia, and Lithuania the diseases account for over 50% of the overall number of deaths, while in Denmark, the Netherlands, the United Kingdom, France, and Belgium the percentage is below 30% [2]. According to the WHO, CVD will remain the number-one cause of death in developed countries at least until 2030 [3].

Cardiovascular diseases are also the number-one cause of death among Poles. In 2010 the diseases claimed the lives of 174,000 people, i.e. 46% of the overall number of deaths. The standardised mortality rates for CVD reached 451.8/100,000 [4]. In 2013 in Poland 177,000 people died due to a CVD, i.e. 45.8% of the overall number of deaths. The standardised mortality rates in that year reached 433.3/100,000 [2].

The current rate of decrease in CVD death rates in Poland is only slightly greater than the average of the EU-15 countries. If the rate continues at the same level, men in Poland will reach the mortality level recorded in the EU-15 countries in 2029, and women five years earlier. The situation looks worse in terms of premature deaths, i.e. among people below 65 years of age. With the current rate of decrease, Polish men will reach the average mortality level recorded in the EU-15 countries around 2040, and women around 2028 [5].

At a national level, in 2003–2012 there was a National Programme of Prevention and Treatment of Cardiovascular Diseases [6] and the National Programme of Providing Equal Access to the Means of Prevention and Treatment of Cardiovascular Diseases for 2013–2016 [7]. At a regional and local level, the tasks in the area of healthcare are conducted by local government units. Under those tasks, local government units complete programmes in the area of preventive healthcare and health promotion, e.g. through health policy programmes [8]. The programmes concern, for instance, important epidemiological issues and other significant health problems [9].

The aim of the study was to evaluate the performance of health policy programmes concerned with CVD by local government units in 2009–2014.

METHODS

The study was based on desk research. The data included in the annual reports submitted by voivodes to the Minister of Health concerning health policy programmes completed by local government units, was used. The analysis covered all the programmes concerned with CVD completed in 2009–2014. The analysis covered the performance of programmes by local government units at all levels, i.e. the largest divisions (voivodeships), second-degree divisions, which form parts of voivodeships (counties), and the fundamental divisions (municipalities). Cities with the status of a county are reported as counties.

The analysis covered programmes whose name, objective, or description of tasks indicated that they concern a CVD. The programmes were classified into one of the three group types: preventive programmes, diagnostic programmes, and therapeutic programmes. The programmes were classified into particular groups on the basis of the objective specified by a given local government unit, the type of programme, and the description of actions taken under the programme.

Analysis was performed for the number of programmes implemented in particular voivodeships in 2009–2014, the number of programmes implemented in successive years by all the voivodeships collectively, the number of programmes implemented in successive years by particular voivodeships, the number of programmes implemented in particular years by municipalities, counties and voivodeships, the number of preventive and diagnostic programmes implemented in particular years, and the number of preventive and diagnostic programmes implemented by municipalities, counties, and voivodeships.

The mean value of total costs of all preventive and diagnostic programmes implemented in municipalities, counties, and voivodeships in 2009–2014 was also calculated.

The analysis also included the distribution of maximum populations covered by programmes relative to the costs of the programme.

RESULTS

In the period covered by the analysis, local government units at all levels completed 795 programmes. The programmes were related to, e.g. prevention of ischaemic heart disease, atherosclerosis, and strokes. The programmes enabled patients to undergo tests, e.g. arterial blood pressure tests, cholesterol tests, electrocardiography, and consult a doctor. Under promotional and educational actions, local government units encouraged patients to have free tests as a part of information campaigns with leaflets and posters with information about the tests.

Figure 1 presents the number of programmes implemented in particular voivodeships in 2009–2014.

302580.jpg 

Figure 1. The number of programmes implemented in particular voivodeships in 2009–2014

The greatest number of programmes were implemented in Mazowieckie and Swietokrzyskie voivodeships, the smallest in Lubuskie and Podlaskie voivodeships.

Figure 2 presents the number of programmes implemented in particular years in all voivodeships.

302591.jpg 

Figure 2. The number of programmes implemented in successive years 2009–2014

There were more programmes implemented in 2009–2011 compared to 2012–2014. The analysis also covered the number of health programmes implemented in successive years by particular voivodeships (Table 1).

Table 1. The number of programmes implemented in particular years and voivodeships

Voivodeship

Year

2009

2010

2011

2012

2013

2014

Dolnoslaskie

12

12

7

11

4

7

Kujawsko-pomorskie

12

10

7

3

3

5

Lubelskie

3

2

2

1

1

2

Lodzkie

5

2

2

1

3

4

Malopolskie

16

11

29

14

10

9

Mazowieckie

43

14

29

19

17

16

Opolskie

5

3

3

1

2

2

Podkarpackie

2

10

9

3

4

3

Podlaskie

1

1

1

4

1

1

Pomorskie

31

16

9

4

4

6

Slaskie

7

12

9

5

4

5

Swietokrzyskie

17

27

25

18

13

20

Warminsko-mazurskie

3

4

4

2

2

8

Wielkopolskie

5

7

9

6

5

6

Zachodniopomorskie

14

17

15

11

12

18

Lubuskie

2

2

1

1

2

3

There are dynamic changes in terms of the number of programmes implemented in successive years in Malopolskie, Mazowieckie, Podkarpackie, and Pomorskie voivodeships. The number of programmes held in subsequent years in Malopolskie voivodeship increased in 2011, only to decrease in the following years. The number of programmes held in Mazowieckie and Pomorskie voivodeships was decreasing year by year. The number of programmes implemented in Podkarpackie voivodeship increased in 2010–2011, only to decrease in the following years.

In 2009–2014 municipalities implemented 615 programmes, counties — 143 programmes, and voivodeships — 33 programmes. Table 2 presents distribution in terms of the number of programmes implemented by particular local government units in successive years.

Table 2. The number of programmes implemented in successive years by particular local governments

Local government unit

Year

2009

2010

2011

2012

2013

2014

Municipality

144

115

127

82

63

84

County

29

31

25

17

20

21

Self-governed voivodeship

5

4

9

3

4

8

There is a clear downward tendency in respect of the number of programmes implemented by municipalities in successive years. The numbers of programmes implemented by counties and voivodeships were comparable in successive years.

A clear majority of municipalities and counties did not implement any health policy programmes concerned with CVD in the analysed period. Table 3 presents the number of programmes implemented by particular types of local government units (Table 4).

Table 3. Frequency distribution of particular types of local government units by the number of implemented of programmes in 2009–2014

Local government unit

No. of

programmes

No. of implementing units in particular years

2009

2010

2011

2012

2013

2014

Municipality

0

2371

2386

2381

2413

2425

2402

1

77

72

74

51

45

70

2

23

20

19

14

9

7

3

7

1

5

1

0

0

County

0

356

357

359

367

364

364

1

19

17

17

10

13

12

2

5

5

4

2

2

3

3

0

0

0

1

1

1

4

0

1

0

0

0

0

Voivodeship

0

11

13

9

14

13

9

1

5

2

6

1

2

6

2

0

1

0

1

1

1

3

0

0

1

0

0

0

Table 4. Percentage of municipalities, counties, and voivodeships that implemented programmes in successive the years 2009–2014

Local government unit

Year

2009

2010

2011

2012

2013

2014

Municipality

4.3%

3.75%

3.95%

2.66%

2.17%

3.10%

County

6.31%

6.05%

5.52%

3.42%

4.21%

4.21%

Voivodeship

31.25%

18.75%

43.75%

12.5%

18.75%

43.75%

The highest percentage share of municipalities that implemented programmes in the analysed period was recorded in 2009 and it reached 4.3%. The lowest percentage was recorded in 2013 — 2.17%. An insignificant involvement in implementation of health policy programmes concerned with CVD was also proved true for counties. The highest percentage of counties that implemented programmes was recorded in 2009 — 6.31%, and the lowest in 2012 — 3.42%.

In 2009–2014 there were in total 595 diagnostic programmes, 192 preventive programmes, and one therapeutic programme. Table 5 presents the number of preventive and diagnostic programmes implemented in successive years. The greatest number of programmes was implemented in 2009. The numbers of programmes implemented in 2010–2014 are also presented as a percentage of the programmes that were implemented in 2009.

Table 5. The number of preventive and diagnostic programmes implemented in successive years 2009–2014 (percentage in relation to the number in 2009)

Programme type

Year

2009

2010

2011

2012

2013

2014

Preventive

49

33 (67.3%)

38 (77.6%)

22 (44.9%)

21 (42.9%)

29 (59.2%)

Diagnostic

128

117 (91.4%)

123 (96.1%)

77 (60.2%)

66 (51.6%)

84 (65.6%)

A decrease in the number of preventive and diagnostic programmes implemented in 2012–2014 in relation to the number of programmes implemented in 2009–2011 was found.

The analysis also covered the relations between the type of a programme (preventive, diagnostic) and the local government unit (municipality, county, voivodeship) (Table 6).

Table 6. The number of preventive and diagnostic programmes implemented by municipalities, counties, and voivodeships in 2009–2014

Programme type

Local government unit

Municipality

County

Voivodeship

Preventive

134

43

14

Diagnostic

480

100

19

Preventive programmes accounted for 21.8% of all the programmes implemented by municipalities, 30.06% of all the programmes implemented by counties, and 42.4% of all the programmes implemented by voivodeships.

The programmes were divided into those addressed to adults and children and those addressed to women and men. The greatest number of programmes, namely 513, were addressed to adults, and only 60 were addressed to children. The number of programmes dedicated for women (184) and men (187) was comparable. The same relation was observed for all the successive years.

The analysis also covered the total costs in PLN of preventive and therapeutic programmes in municipalities, counties, and voivodeships (Table 7).

Table 7. Average overall costs of preventive programmes and diagnostic programmes implemented in municipalities, counties, and voivodeships in 2009–2014

Programme type

Local government unit

Municipality

County

Voivodeship

Preventive

24801.10 PLN

25025.75 PLN

141168.54 PLN

Diagnostic

21656.25 PLN

11899.33 PLN

67468.50 PLN

The expenditure on the preventive and diagnostic programmes incurred in voivodeships were higher than the expenditure of counties and municipalities. Voivodeships and counties expended significantly more on preventive programmes compared to diagnostic programmes. The expenditure on preventive and diagnostic programmes incurred by municipalities was comparable (Table 8).

Table 8. Maximum population covered by a programme relative to the costs of implementation of the programme

Costs in PLN

Maximum population covered by a programme

Up to 10,000

Up to 14,316 persons

10,000–20,000

Up to 6,656 persons

20,000–50,000

Up to 39,782 persons

50,000–100,000

Up to 6968 persons

100,000-250,000

Up to 50,000 persons

250,000–500,000

Up to 13,500 persons

500,000–700,000

Up to 1967 persons

There clearly is no correlation between the costs of a programme and the size of population covered by the programme. The programmes addressed to the smallest population (up to 1967 people) were the most expensive.

DISCUSSION

Despite the improvement of the epidemiological status that has taken place over the last two decades, death rates for CVD in Poland, specifically regarding the number of premature deaths (i.e. under 65 years of age), remain at a high level [10]. It is estimated that the number of deaths due to CVD will exceed 188,000 per year in 2020, and 200,000 in 2030 [2]. The anticipated increase in the population of elderly people in Poland by 2030 (increase of 1.4 million of people aged 65–74 years and 1.6 million of people aged 75 years or more) will lead to a significant increase in the number of people with cardiovascular problems [11]. Forecasts predict that the number of heart attacks in the population in Poland will increase by 2030 compared to the situation observed in 2009–2012, only because of the change of age structure, by 39% among men and 42% among women, i.e. 38,000 cases. If the hospitalised prevalence remains at the current level, by 2030 one may expect an increase in the number of hospitalised cases of CVD of nearly 390,000 compared to 2012 (37% for men and 34% for women) [5, 12]. In the context of the epidemiological data, the insufficient activity of local government units in terms of implementation of CVD programmes and the annually decreasing number of implemented programmes must be viewed in a negative light.

The greatest number of health policy programmes in the analysed period were completed by municipalities, and the smallest by voivodeships. Local government units ran mostly diagnostic programmes, which accounted for 75.5% of the overall number of programmes. It is not to be criticised because the programmes provide financing for a wide range of actions. Nonetheless, it might be symptomatic of deficits in the healthcare system in Poland, which consists of imposing the obligation of financing certain health services on diagnostic health policy programmes [13]. One can assume that the programmes that entailed the highest expenses and covered the smallest population (up to 1967) were diagnostic programmes.

Preventive programmes made up only 24% of the overall number of programmes. The greatest number of preventive programmes were implemented by municipalities followed by counties. At the same time, the costs incurred by municipalities and counties in connection with diagnostic and preventive programmes reached a comparable sum. Voivodeships expended significantly more money on preventive programmes compared to diagnostic programmes. Analyses conducted by the WHO show that around 80% of heart attacks, strokes, or type 2 diabetes cases could be avoided if we managed to eliminate the most important risk factors [14, 15]. In addition, high blood pressure, high cholesterol levels, overweight and obesity, low consumption of fruit and vegetables, limited physical activity, tobacco smoking, alcohol consumption, and air pollution in cities account for 80% of deaths and 84% of cases of ischaemic heart disease, and 54% of deaths and 68% of years of health that are lost due to stroke, in countries with high-income economies [16]. In view of the foregoing, the implementation of a small number of preventive programmes by local government units and the significant decrease in the number of preventive programmes implemented in 2012–2014 compared to the number of programmes implemented in 2009–2011 must be viewed in a negative light. Some doubts are raised by the fulfilment of objectives established under the National Health Programme for 2007–2015 [17]. Chapter 4 “Essential action on the part healthcare institutions and local government units” names two objectives: activation of local government units and non-governmental organisations for the benefit of health and improvement; and optimum use of healthcare system and local government infrastructure for the purpose of health promotion and health education.

The study also evaluated how local government units addressed the health needs of citizens arising out of mortality due to CVD. In 2000–2001 the highest death rates were recorded in Slaskie, Lodzkie, and Opolskie voivodeships, and the lowest rates were recorded in Warminsko-Mazurskie, Podlaskie and Pomorskie voivodeships. In 2009–2010 the death rates reached the highest levels in Swietokrzyskie, Lodzkie, and Lubelskie voivodeships, while the lowest rates were recorded in Pomorskie, Podlaskie, and Wielkopolskie voivodeships. Throughout 2000–2010 the number of deaths due to CVD in Poland decreased by 21%, with the most prominent decreases recorded in Pomorskie (30%) and Slaskie (29%) voivodeships. The least significant improvement was recorded in Warminsko-Mazurskie (decrease of 2%) and Swietokrzyskie (decrease of 6%) voivodeships [4]. In 2012 the largest number of deaths due to CVD were recorded in Slaskie, Swietokrzyskie, and Lubelskie (over 490/100,000) — the number was around 25% higher compared to Podlaskie voivodeship, which had the lowest death rate (394/100,000). Although the number of deaths in Lodzkie and Lubelskie voivodeships was the highest, the voivodeships implemented a small number of programmes on CVD. In addition, the number of programmes implemented in Lubelskie voivodeship decreased year by year. Since 2012 Lodzkie voivodeship has seen an insignificant increase in the number of implemented programmes. Those voivodeships failed to properly address the health needs of their citizens. In terms of the number of programmes implemented in 2009–2013, the actions taken by local government units in Swietokrzyskie voivodeship deserve the greatest praise. Nonetheless, the decreasing number of programmes implemented throughout 2010–2013 is an alarming tendency. A similar observation was made for Slaskie voivodeship.

The analysis also covered the expenditure on particular types of health policy programmes on CVD. In 2009–2013 the largest resources on health policy programmes [18–20] were expended by voivodeships (the greatest share in 2013, around 10% of the budget) followed by municipalities (the greatest share in 2012, around 1.1% of the budget). The percentage share of expenditure on programmes on CVD in counties during the period covered by the study did not exceed 0.2%. A positive tendency is the increase in the percentage share of the funds expended on programmes on CVD observed in voivodeships and municipalities in 2010–2013. The analysis of the structure of expenditure incurred by particular local government units shows that the funds are probably dedicated in the first instance to the fulfilment of obligatory tasks prescribed by the law. The decrease in the number of programmes observed since 2010 might be a consequence of introduction of changes in regulations on implementation of health policy programmes. Since 31 August 2009 ministers and local government units are obliged to consult projects with the Agency for Health Technology Assessment and Tariff System (AOTMiT) [21]. In 2010–2013 the AOTMiT approved only 31.3% of programmes, it rejected 46.9% of programmes, and granted conditional approval to 21.9% of programmes concerned with CVD [22]. Although the opinion of the AOTMiT is not binding on the local government units, one might assume that they did not want to risk implementing programmes that were not approved. The conclusion of long-term programmes that started before 2010 and the insignificant percentage of approved programmes could account for the decrease in the number of programmes. It is probable that more funds were dedicated for continuation of running programmes (that did not require approval of AOTM) and implementation of programmes that received positive reviews.

Another aspect covered by the analysis was the population covered by a given programme on CVD. Since CVD are indicated as the cause of death of mainly elderly people, i.e. aged 65 years or more, it seems reasonable that more programmes are addressed to adults. The number of programmes addressed to women and the number of programmes addressed to men were comparable. CVDs are more common among women and the death rates are significantly higher among women compared to men. In 2013 as many as 95,000 women died because of CVD, i.e. 51% of the overall number of deaths. The number of deaths among men was lower by around 10% — in 2013 it reached around 41% [2]. One should stress that the fact that women are more likely to die due to CVD than men arises from the women’s age structure. After elimination of the differences in age structure between the sexes, it turns out that CVDs pose a much greater threat to men. In 2013 the standardised mortality rates for men was 70% higher compared to the ratio measured for women [23]. In the context of the above data, some doubts are raised by the insignificant number of programmes addressed exclusively to men.

CONCLUSIONS

  1. 1. There is insignificant involvement of local government units in the fight against CVD.
  2. 2. Particular types of local government units demonstrate a varied degree of involvement in the performance of health policy programmes concerned with CVD.
  3. 3. The small and gradually decreasing number of preventive programmes shows that the tasks of local government units in respect of preventive healthcare and healthcare are fulfilled to a limited extent only.
  4. 4. Some of the voivodeships failed to properly address the health needs of local communities in respect of CVD.
  5. 5. It is essential that local government units take on and continue actions aimed at fighting CVD by increasing the number of health policy programmes and increasing the size of the population covered by such programmes, as well as by addressing the health needs of the citizens.
  6. 6. Some guidelines should be developed for local government units concerning their involvement in the fight against CVD.

Conflict of interest: none declared

References

  1. 1. http://ec.europa.eu/eurostat/home (access: 14 August 2016).
  2. 2. Cierniak-Piotrowska M, Marciniak G, Stańczyk J. Statystyka zgonów i umieralności z powodu chorób układu krążenia. In: Strzelecki Z., Szymborski J. editors. Zachorowalność i umieralność na choroby układu krążenia a sytuacja demograficzna Polski. Rządowa Rada Ludnościowa, Warszawa 2015: 46–80.
  3. 3. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015; 385(9963): 117–171, doi: 10.1016/S0140-6736(14)61682-2, indexed in Pubmed: 25530442.
  4. 4. Wojtyniak B, Stokwiszewski J, Goryński P, Poznańska A. Długość życia i umieralność ludności Polski. In: Wojtyniak B., Goryński P., Moskalewicz B. eds. Sytuacja zdrowotna ludności Polski i jej uwarunkowania. Narodowy Instytut Zdrowia Publicznego – Państwowy Zakład Higieny, Warszawa 2012: 38–122.
  5. 5. Wojtyniak B. Choroby układu krążenia jako priorytet zdrowia publicznego; Polska, Europa, In: Strzelecki Z, Szymborski J. eds. In: Zachorowalność i umieralność na choroby układu krążenia a sytuacja demograficzna Polski. Rządowa Rada Ludnościowa, Warszawa 2015: 81–100.
  6. 6. Narodowy Program Profilaktyki i Leczenia Chorób Układu Sercowo-Naczyniowego na lata 2003-2005 „POLKARD, Warszawa 2003.
  7. 7. Narodowy Program Wyrównywania Dostępności do Profilaktyki i Leczenia Chorób Układu Sercowo-Naczyniowego na lata 2013–2016 „POLKARD, Warszawa 2015.
  8. 8. Leśniewska A, Posobkiewicz M, Kanecki K, et al. Działania powiatów w zakresie profilaktyki i promocji zdrowia w Polsce — w świetle badań ankietowych. Hygeia Public Health. 2014; 49: 472–477.
  9. 9. The Act of 27 August 2004 on healthcare services financed with public funds (Journal of Laws of 2015, item 581, as amended).
  10. 10. Drygas W, Niklas A, Piwońska A, et al. Wieloośrodkowe Ogólnopolskie Badanie Stanu Zdrowia Ludności (badanie WOBASZ II): założenia, metody i realizacja. Kardiol Pol. 2016; 74(7): 681–690, doi: 10.5603/kp.a2015.0235.
  11. 11. Prognoza ludności na lata 2014–2050, Studia i Analizy Statystyczne. Główny Urząd Statystyczny, Warszawa 2014.
  12. 12. Gierlotka M, Zdrojewski T, Wojtyniak B, et al. Incidence, treatment, in-hospital mortality and one-year outcomes of acute myocardial infarction in Poland in 2009-2012 — Nationwide AMI-PL database. Kardiol Pol. 2015; 73(3): 142–158, doi: 10.5603/KP.a2014.0213, indexed in Pubmed: 25371307.
  13. 13. Augustynowicz A, Czerw A, Deptała A. Health needs as a priority of local authorities in Poland based on the example of implementation of health policy cancer programmes. Archives of Medical Science. 2016, doi: 10.5114/aoms.2016.62283.
  14. 14. WHO Report, Gaining Health. The European Strategy for the Prevention and Control of Noncommunicable Diseases 2006.
  15. 15. WHO Europe, The European health report 2005: Public health action for healthier children and populations. http://www.euro.who.int/__data/assets/pdf_file/0004/82435/E87325.pdf (access: 22 August 2016).
  16. 16. Lopez AD, et al. Murray Ch.J.L, Gakidou E. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014; 384: 766–781, doi: 10,1016/S0140-6736(14)60460-8.
  17. 17. Resolution no. 90/2007 of the Council of Ministers of 15 May 2007 on the introduction of “National Health Programme for 2007-2015”.
  18. 18. Zdrowie i Ochrona Zdrowia w 2010, Główny Urząd Statystyczny, Warszawa 2012. http://stat.gov.pl/cps/rde/xbcr/gus/zo_zdrowie_i_ochrona_zdrowia_w_2010.pdf (access: 22 June 2016).
  19. 19. Zdrowie i Ochrona Zdrowia w 2012, Główny Urząd Statystyczny, Warszawa 2014. Główny Urząd Statystyczny, Warszawa 2014 (access: 22 June 2016).
  20. 20. Zdrowie i Ochrona Zdrowia w 2014, Główny Urząd Statystyczny, Warszawa 2015. http://stat.gov.pl/obszary-tematyczne/zdrowie/zdrowie/zdrowie-i-ochrona-zdrowia-w-2014-r-,1,5.html (access: 22 June 2016).
  21. 21. Ustawa z 25 czerwca 2009 r. o zmianie ustawy o świadczeniach opieki zdrowotnej finansowanych ze środków publicznych oraz ustawy o cenach (Dz. U. Nr 118, poz. 989).
  22. 22. http://www.aotm.gov.pl (access: 29 październik 2016 r.).
  23. 23. Zdrojewski T, Gierlotka M, Wojtyniak B. Sukcesy i porażki w prewencji i terapii zawałów serca w Polsce. In: Strzelecki Z, Szymborski J. eds. Zachorowalność i umieralność na choroby układu krążenia a sytuacja demograficzna Polski. Rządowa Rada Ludnościowa, Warszawa 2015: 156–184.

 

Cite this article as: Augustynowicz A, Czerw A, Kowalska M, et al. Preventive healthcare and health promotion in local governments based on the example of health policy programmes concerned with cardiovascular diseases implemented in Poland in 2009–2014. Kardiol Pol. 2017; 75(6): 596–604, doi: 10.5603/KP.a2017.0041.




Polish Heart Journal (Kardiologia Polska)