1 Health Targets for Austria Relevance Options Contexts
2 Editorial Information Owner, editor and publisher Federal Ministry of Health Radetzkystrasse 2, 1030 Vienna, Austria Editors in charge Dr. Pamela Rendi-Wagner, Director General of Public Health and Medical Affairs, Federal Ministry of Health Christa Peinhaupt MBA, Head of FGÖ Fonds Gesundes Österreich (GÖG Gesundheit Österreich GmbH) Process consulting GÖG (Gesundheit Österreich) Translator Susanne Ofner (phoenix) Printed by Federal Ministry of Health All rights reserved. This document shall not be reproduced (neither in part nor in full) without the prior written permission of the owner. Errors and omissions, printing and typesetting mistakes excepted. Vienna, May 2012
3 Preamble Health for all In 2011 the Federal Health Commission of Austria and the Austrian Council of Ministers decided to draw up health targets. The corresponding targets have now been drafted. They describe approaches towards a further increase in general health in Austria and the path to be taken to attain this. The 10 health targets will be in force for the next 20 years. The overall target that has been defined is to improve the health of all people living in Austria, irrespective of level of education, income or situation in life. It is crucial to maintain people's health and not just to respond to illness. It is thus possible not only to improve population health but also to reduce pressure on the health care system. More healthy years of life The health targets aim to contribute to a specific target to be attained within the next 20 years: to increase by two years the number of years lived in a healthy condition. While Austria has a high-quality health care system, and life expectancy in Austria is above the OECD average, this does not apply to the number of healthy years of life. People living in Austria can expect slightly less than 60 years of life in good health and without disability. This puts Austria below the EU average. Therefore a priority aim is to increase the number of healthy years of life. The health targets focus on those areas where a positive influence on maintaining and improving population health can be achieved. Therefore determinants that have a decisive influence on health are given priority, i.e. education, employment, social security and environmental influences. A broad subject requires a broad process Health targets have been adopted in other countries as well, and are recommended by the WHO. The process that Austria started in order to define health targets has been regarded as exemplary at the international level, because all relevant political and social stakeholders have been actively involved. Drawing up Austria's health targets on a broad basis has been an essential prerequisite as many factors relevant to health are outside the health-care system. All relevant political and societal areas have been integrated into the process: many federal and provincial authorities, social security funds, social partners, health-care professions, health experts, health and welfare institutions, patient representatives, and representatives of children, young people and senior citizens, as well as Armutskonferenz, the Austrian member of the European Anti-
4 Poverty Network. In addition, all persons interested in this issue were invited to contribute their views online. Basic principles The health targets are based on a number of principles that are reflected in the 10 health targets finally set. These principles were defined by the plenary, based on suggestions by the input conference, as well as online contributions, before the process of target definition was started: orientation towards health determinants, i.e. towards factors influencing population health; health-in-all-policies approach, i.e. taking into account that diverse policy areas may contribute to target attainment; promoting equal opportunities, i.e. reducing health and social inequities as a general requirement for all areas; orientation towards resources, i.e. towards strengths and potential; orientation towards public health, i.e. towards benefit in terms of health of the entire population and individual population groups; orientation towards the future and sustainability, i.e. towards long-term benefit for population health; evidence-based, oriented towards effectiveness and relevance, i.e. corroboration of sensibility and relevance by facts and figures; comprehensible, i.e. use of everyday language that is understandable for nonexperts as well The first three principles are regarded as particularly relevant. The targets derived from them therefore take into account the health determinants and policy areas that are relevant in this respect, they relate to both social situations and individual behaviour, and identify what can be contributed to improve health equity.
5 A framework for action The health targets provide a framework for coordinated action, which is backed by all institutions involved. In the next few months, a binding plan for implementation supported by the relevant stakeholders will follow, based on cooperation across institutions.
7 10 health targets for Austria Target 1: To provide health-promoting living and working conditions for all population groups through cooperation of all societal and political areas Health is strongly influenced by general living and working conditions, and thus by decisions in diverse policy fields. It does not solely depend on individual behaviour and physical factors. People's quality of life and their health are largely determined by everyday life, i.e. the environment in which they live, play, study, work, travel and spend their spare-time. It is therefore essential for people to live and work under conditions that promote health and allow a good balance between working life and private life. This requires commitment from all the relevant stakeholders and thus the cooperation of federal, provincial and local authorities, public corporations and social partners across different areas of policy and society. Other factors of great importance include integration and participation of citizens in decisions that influence their living and working conditions.
8 Target 2: To promote fair and equal opportunities in health, irrespective of gender, socio-economic group, ethnic origin and age All population groups should have the same, fair opportunities for maintaining, promoting and regaining health. Besides social status and income, education is a key determinant of health. Equal opportunities have to be ensured in particular with regard to healthy life expectancy and burden of disease. It is essential to ensure that all age groups have equal health opportunities, irrespective of ethnic origin, place of residence and gender. To achieve this, disadvantaged population groups have to be empowered in all spheres of life, and fair starting conditions in the educational system are imperative. The health and welfare system should be designed in a way that guarantees equal accessibility for all population groups, in line with the needs of specific target groups. It must be a common target of all decision makers in the health care system to provide and sustainably ensure access to evidence-based innovation in the health sector for all.
9 Target 3: To enhance health literacy in the population Health literacy is a central pillar for the promotion of health and equity in health among the population. It helps people make appropriate decisions for themselves in everyday life that promote their health. This requires enhancing personal competencies and accountability in all population groups, and particularly in disadvantaged groups, facilitating access to objective, easilycomprehensible information of assured quality and increasing awareness of health promotion issues. Patients and users of the health care system should play an important role as stakeholders, which also enhances patients' self-efficacy. It should be easy for people to find their way through the health care, educational and welfare systems and to play an active role as committed partners in the system.
10 Target 4: To secure sustainable natural resources such as air, water and soil and healthy environments for future generations A healthy environment is an essential health resource. Environmental factors may impair people's health and well-being and contribute to the development of chronic diseases such as respiratory diseases and certain types of cancer. Environmental hazards affect the population to different degrees. In particular, vulnerable groups and children must be protected. It is vital for the sustainability of health care and health promotion to ensure (access to) clean air, water, soil and the entire natural environment and to produce safe food of high quality. Ensuring the sustainability of our environment and enhancing people's environmental literacy are essential factors that contribute to the health of present and future generations.
11 Target 5: To strengthen social cohesion as a health enhancer Social relationships and social networks are vital for people's health and wellbeing: solidary societies are healthy societies. Social cohesion both within and between different generations and genders, as well as socio-economic and sociocultural groups, plays an important role in a society s quality of life. Social cohesion, respect for diversity as well as opportunities for participation and a sense of responsibility of individuals towards society will help enhance the community spirit. All these factors, combined with adequate social skills on the part of the individuals in the community, are an important basis for social cohesion and population health. Maintaining social relationships, volunteer work and participation in democratic community processes (social health) requires time and appropriate structures.
12 Target 6: To ensure conditions under which children and young people can grow up as healthy as possible The basis for healthy living and life-long health is established in the early stages of life. Special attention should therefore be paid to children and young people. Inequity in health opportunities during infancy may result in inequity during adulthood in terms of health status as well. Creating optimal conditions for children and young people will thus be a long-term benefit both for the young generation and for society. Already during pregnancy and infancy, it is important to help parents and guardians to care for their children in the best possible way and to create a safe, positive bond with them, as this is an essential protective factor for health. In addition to providing support to parents in everyday situations, in view of parents' responsibility as role models, their parenting and family relationship skills should also be promoted. The pursuit of gender-sensitive approaches to education and life skills in infancy and childhood is another important contributing factor to a healthy life. Moreover, it is important to ensure that health care services that are accessible to all children and young people are comprehensive and appropriate and respond to their specific needs.
13 Target 7: To provide access to a healthy diet with food of good quality for all An adequate diet is an essential determinant of health and well-being at all stages of life. Maintaining a balanced diet can reduce the risk of many chronic diseases (particularly coronary diseases and diabetes). Therefore, the meals provided by communal catering services, e.g. in kindergartens or schools, enterprises, hospitals or care homes, should be prepared in a healthy way and in accordance with health promotion criteria, and take into account special dietary needs. Food should be produced, processed and marketed in accordance with ecological, social and health-care aspects. Healthy food of good quality must be available to all population groups. Seasonal and local food is an important component of an appropriate diet. Dietary skills should be promoted in the entire population, in particular children, young people, pregnant women, parents and guardians as well as older people.
14 Target 8: To promote healthy, safe exercise and activity in everyday life through appropriate environments Regular physical exercise is a major health determinant and has sustainable positive effects. Exercise and activity help prevent chronic illness and enhance physical and psychological well-being. Sufficient exercise is a vital part of health promotion from infancy to old age. Therefore this target includes integrating adequate levels of exercise in everyday life, which means that environments and infrastructures (such as cycle paths, playgrounds, recreation rooms, as well as the way to school and back) have to be designed in a way that permits and encourages activity. Apart from providing opportunities for safe activity and exercise in everyday life, it is particularly necessary to promote exercising skills in kindergartens and schools, as well as in care and nursing homes, and also clubs, so that people can enjoy activities and sports. In addition, the needs of people with disabilities have to be taken into account.
15 Target 9: To promote psychosocial health in all population groups Psychosocial health is an important determinant of quality of life and interacts with acute, and especially with chronic, diseases. People should live and work under conditions that enhance psychosocial health at all stages of life and reduce psychosocial stress as much as possible. Particular attention should be paid to enhancing life skills and to interventions that prevent violence and addiction (e.g. addiction to legal and illicit substances, or non-substance-related forms of addiction such as eating disorders). Knowledge about, and sensitivity in responding to, mental disorders should be increased, with the aim of challenging stigmatisation in any form. People suffering from mental disorders, and their relatives (especially parents and children) need comprehensive, appropriate care services, and their (re)integration into society must be assured.
16 Target 10: To secure sustainable and and efficient health care services of high quality for all In order to secure population health, it is necessary to provide well-coordinated, process-oriented health care services of assured quality that focus on patients and patient needs as well as effectiveness. This means maintaining a public, solidary health care system that is sustainable in the long run. Priority is given to enhancing prevention and primary health care, and to ensuring nondiscriminatory access to health care with the focus on specific population groups, in particular disadvantaged groups. It is important in terms of quality, effectiveness and efficiency to have integrated, multi-professional and healthpromoting care systems and networks. Effective early diagnosis, early intervention, integrated care services and enhancing patients' skills with regard to responding to their diseases are factors of key relevance. A health care system that is oriented towards the future requires efficient, focused planning, control and financing on a basis of joint responsibility and a joint target controlling system maintained by equal partners. Transparency and orientation towards quality targets are essential aspects of patient safety and patient benefit. It is essential also to build capacities in the areas of public health, health economics, gender medicine, care research as well as adequate education and training structures for health care professionals, oriented towards practical needs and demandshyperlink. Good working conditions in the health care professions are an essential contributing factor for high quality in health care.
17 Institutions involved in the process of defining the health targets Vienna Chamber of Labour Main Association of Austrian Social Security Institutions Aks Austria (forum of Austrian working groups on health) Federation of Austrian Industries Association of Patients' Ombudspersons KFA (health-care institution of the City of Vienna) Austrian Self-Help Association MTD Austria (umbrella organisation of technical medical services) European Anti-Poverty Network Austria Austrian Chamber of Pharmacists BAG federal free welfare association Austrian Senior Citizens' Council / Retiree Association of Austria Professional Association of Austrian Psychologists Austrian Medical Association 4 provincial representatives, nominated by the provincial liaison offices Austrian Trade Union Federation
18 Federal Ministry of Labour, Social Affairs and Consumer Protection Health Insurance Fund of Upper Austria Federal Ministry of Finance Austrian Association of Municipalities Federal Ministry of Health Austrian Society of Public Health Federal Ministry of Agriculture, Forestry, Environment and Water Management Austrian League for Children's and Young People's Health Federal Ministry of Defence and Sports Austrian Health Care and Nursing Association Federal Ministry of Education, Arts and Culture Austrian Association of Cities and Towns Federal Ministry of Economy, Family and Youth Social Insurance Institution for Austrian Railway and Mining Industries Austrian National Youth Council Austrian Economic Chamber Federal Parents' Association
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