Leren van de buren (samenvatting). Beleid publieke gezondheid internationaal bezien: roken, alcohol, overgewicht, depressie, gezondheidsachterstand, jeugd, screening

English summary of report 270051010 A full English translation is available in report 270626001Nederland kan veel leren van het gezondheidsbeleid in andere landen. De overheid doet er goed aan gezondheidsproblemen vaker aan te pakken met een nationale strategie of actieplan. Ervaring uit het buitenland leert dat een dergelijk nationaal actieplan bijdraagt aan een systematischer beleid en minder versnippering van maatregelen. Dit concludeert het RIVM op basis van het internationaal vergelijkend rapport Leren van de buren. Het rapport is 9 juli 2007 aangeboden aan minister Klink van VWS. Het RIVM concludeerde vorig jaar dat Nederland op gebied van gezondheid niet langer bij beste Europese landen hoort.* Zo blijft Nederland achter met de daling van het aantal rokers en drinken Nederlandse jongeren vaker alcohol dan hun Europese leeftijdsgenoten. Het ontmoedigingsbeleid voor tabak en alcohol blijkt niet streng vergeleken met veel andere landen. Ook met de bestrijding van bijvoorbeeld depressies en gezondheidsachterstanden bij bevolkingsgroepen ontbreekt in Nederland een integrale aanpak. Het RIVM heeft het Nederlandse gezondheidsbeleid op roken, alcohol, overgewicht, gezondheidsachterstanden, depressie, jeugd en screening, vergeleken met dat van andere Europese landen. Hieruit blijkt dat veel maatregelen effectiever en meer in samenhang kunnen gebeuren. Zo heffen Duitsland, Zwitserland, Frankrijk en Denemarken extra belasting op breezers om jongeren te ontmoedigen alcohol te drinken. In sommige landen is een pakje sigaretten twee keer zo duur als in Nederland. Schotland, Finland en Australie bevorderen de psychische gezondheid met programma's op school en werk. Marktkrachten en andere -internationale- invloeden bemoeilijken soms de weg naar goed beleid, maar kunnen ook kansen bieden. Het RIVM adviseert de Nederlandse overheid om op basis van de buitenlandse ervaring haalbare doelen en effectieve maatregelen te vinden voor een meer integraal gezondheidsbeleid in Nederland. * Volksgezondheid Toekomst Verkenningen, RIVM juni 2006.The Netherlands does not make sufficient use of national strategies or action plans in tackling its public health problems. Our neighbours teach us that a comprehensive national strategy can contribute to the creation of a more systematic body of policy and less fragmented preventive measures. This is the conclusion reached by the RIVM in an international comparative report 'Learning from our neighbours; Cross-national inspiration for Dutch public health policies'. The Report was presented to Ab Klink, the Minister of Health, Welfare and Sports on July 9th 2007. Last year, the RIVM concluded that Dutch public health lags behind leading European nations.* The percentage of smokers hasn't decreased as fast as in other countries and Dutch young people drink alcohol more often than their European peers. The alcohol and tobacco control policies in place in the Netherlands are not as strict as those in other countries. Prevention of depression and reducing health inequalities miss a coherent strategy. Learning from our neighbours outlines existing policies on smoking, alcohol, overweight, depression, health inequalities, youth and screening throughout the world. For example Germany, Switzerland, France and Denmark levy extra taxes on breezers to discourage young people to drink alcohol. In some countries a package of cigarettes is two times as expensive as in the Netherlands. Scotland, Finland and Australia promote mental health through programmes at school and work. Market forces and other -international- influences sometimes interfere with good policy-making, but they also offer opportunities. To ensure a more coherent body of health policy, the RIVM recommends that Dutch public authorities make use of the lessons from our neighbours to set realistic goals and effective measures

Leren van de buren : Beleid publieke gezondheid internationaal bezien: roken, alcohol, overgewicht, depressie, gezondheidsachterstanden, jeugd, screening

English translation of RIVM report 270051010 RIVM report 270262002 is a summary of this reportNederland kan veel leren van het gezondheidsbeleid in andere landen. De overheid doet er goed aan gezondheidsproblemen vaker aan te pakken met een nationale strategie of actieplan. Ervaring uit het buitenland leert dat een dergelijk nationaal actieplan bijdraagt aan een systematischer beleid en minder versnippering van maatregelen. Dit concludeert het RIVM op basis van het internationaal vergelijkend rapport Leren van de buren. Het rapport is 9 juli 2007 aangeboden aan minister Klink van VWS. Het RIVM concludeerde vorig jaar dat Nederland op gebied van gezondheid niet langer bij beste Europese landen hoort.* Zo blijft Nederland achter met de daling van het aantal rokers en drinken Nederlandse jongeren vaker alcohol dan hun Europese leeftijdsgenoten. Het ontmoedigingsbeleid voor tabak en alcohol blijkt niet streng vergeleken met veel andere landen. Ook met de bestrijding van bijvoorbeeld depressies en gezondheidsachterstanden bij bevolkingsgroepen ontbreekt in Nederland een integrale aanpak. Het RIVM heeft het Nederlandse gezondheidsbeleid op roken, alcohol, overgewicht, gezondheidsachterstanden, depressie, jeugd en screening, vergeleken met dat van andere Europese landen. Hieruit blijkt dat veel maatregelen effectiever en meer in samenhang kunnen gebeuren. Zo heffen Duitsland, Zwitserland, Frankrijk en Denemarken extra belasting op breezers om jongeren te ontmoedigen alcohol te drinken. In sommige landen is een pakje sigaretten twee keer zo duur als in Nederland. Schotland, Finland en Australie bevorderen de psychische gezondheid met programma's op school en werk. Marktkrachten en andere -internationale- invloeden bemoeilijken soms de weg naar goed beleid, maar kunnen ook kansen bieden. Het RIVM adviseert de Nederlandse overheid om op basis van de buitenlandse ervaring haalbare doelen en effectieve maatregelen te vinden voor een meer integraal gezondheidsbeleid in Nederland. * Volksgezondheid Toekomst Verkenningen, RIVM juni 2006.The Netherlands does not make sufficient use of national strategies or action plans in tackling its public health problems. Our neighbours teach us that a comprehensive national strategy can contribute to the creation of a more systematic body of policy and less fragmented preventive measures. This is the conclusion reached by the RIVM in an international comparative report 'Learning from our neighbours; Cross-national inspiration for Dutch public health policies'. The Report was presented to Ab Klink, the Minister of Health, Welfare and Sports on July 9th 2007. Last year, the RIVM concluded that Dutch public health lags behind leading European nations.* The percentage of smokers hasn't decreased as fast as in other countries and Dutch young people drink alcohol more often than their European peers. The alcohol and tobacco control policies in place in the Netherlands are not as strict as those in other countries. Prevention of depression and reducing health inequalities miss a coherent strategy. Learning from our neighbours outlines existing policies on smoking, alcohol, overweight, depression, health inequalities, youth and screening throughout the world. For example Germany, Switzerland, France and Denmark levy extra taxes on breezers to discourage young people to drink alcohol. In some countries a package of cigarettes is two times as expensive as in the Netherlands. Scotland, Finland and Australia promote mental health through programmes at school and work. Market forces and other -international- influences sometimes interfere with good policy-making, but they also offer opportunities. To ensure a more coherent body of health policy, the RIVM recommends that Dutch public authorities make use of the lessons from our neighbours to set realistic goals and effective measures

A Method to Estimate the Chronic Health Impact of Air Pollutants in U.S. Residences

Background: Indoor air pollutants (IAPs) cause multiple health impacts. Prioritizing mitigation options that differentially affect individual pollutants and comparing IAPs with other environmental health hazards require a common metric of harm

Dietary Patterns and the Double Burden of Malnutrition in Mexican Adolescents: Results from ENSANUT-2006.

Mexico is facing the double burden of malnutrition, and adolescents are not an exception. Diet plays an important role, both in causing overweight and undernutrition. This study aimed to describe the dietary patterns (DPs) of Mexican adolescents and to examine its association with nutritional status using data from adolescents aged 12-19 years (n = 7380) from the National Survey of Health and Nutrition (ENSANUT-2006). Principal component analysis was used to derivate the DPs. Associations between DP and nutritional status were determined by prevalence ratio (PR). Four DPs were identified: nontraditional and breakfast-type, Western, plant-based, and protein-rich. The prevalence of overweight and obesity was higher in adolescents who scored high on the Western pattern (PR: 1.15, 95% CI: 1.08-1.21) or on the plant-based pattern (PR: 1.09, 95% CI: 1.03-1.17). The Western pattern was positively associated with anemia in girls (PR: 1.18, 95% CI: 1.03-1.35), while the nontraditional and breakfast-type pattern was inversely associated with anemia in adolescents aged 12-15 years (PR: 0.87, 95% CI: 0.76-0.99) and in girls (PR: 0.84, 95% CI: 0.75-0.97). The Western and plant-based patterns were simultaneously associated with overweight-obesity and at least one indicator of undernutrition. In the context of the double burden of malnutrition, dietary advice must consider malnutrition in all its forms

Disability weights for comorbidity and their influence on Health-adjusted Life Expectancy

BACKGROUND: Comorbidity complicates estimations of health-adjusted life expectancy (HALE) using disease prevalences and disability weights from Burden of Disease studies. Usually, the exact amount of comorbidity is unknown and no disability weights are defined for comorbidity. METHODS: Using data of the Dutch national burden of disease study, the effects of different methods to adjust for comorbidity on HALE calculations are estimated. The default multiplicative adjustment method to define disability weights for comorbidity is compared to HALE estimates without adjustment for comorbidity and to HALE estimates in which the amount of disability in patients with multiple diseases is solely determined by the disease that leads to most disability (the maximum adjustment method). To estimate the amount of comorbidity, independence between diseases is assumed. RESULTS: Compared to the multiplicative adjustment method, the maximum adjustment method lowers HALE estimates by 1.2 years for males and 1.9 years for females. Compared to no adjustment, a multiplicative adjustment lowers HALE estimates by 1.0 years for males and 1.4 years for females. CONCLUSION: The differences in HALE caused by the different adjustment methods demonstrate that adjusting for comorbidity in HALE calculations is an important topic that needs more attention. More empirical research is needed to develop a more general theory as to how comorbidity influences disability

Estimating and comparing incidence and prevalence of chronic diseases by combining GP registry data: the role of uncertainty

Background: Estimates of disease incidence and prevalence are core indicators of public health. The manner in which these indicators stand out against each other provide guidance as to which diseases are most common and what health problems deserve priority. Our aim was to investigate how routinely collected data from different general practitioner registration networks (GPRNs) can be combined to estimate incidence and prevalence of chronic diseases and to explore the role of uncertainty when comparing diseases. Methods. Incidence and prevalence counts, specified by gender and age, of 18 chronic diseases from 5 GPRNs in the Netherlands from the year 2007 were used as input. Generalized linear mixed models were fitted with the GPRN identifier acting as random intercept, and age and gender as explanatory variables. Using predictions of the regression models we estimated the incidence and prevalence for 18 chronic diseases and calculated a stochastic ranking of diseases in terms of incidence and prevalence per 1,000. Results: Incidence was highest for coronary heart disease and prevalence was highest for diabetes if we looked at the point estimates. The between GPRN variance in general was higher for incidence than for prevalence. Since uncertainty intervals were wide for some diseases and overlapped, the ranking of diseases was subject to uncertainty. For incidence shifts in rank of up to twelve positions were observed. For prevalence, most diseases shifted maximally three or four places in rank. Conclusion: Estimates of incidence and prevalence can be obtained by combining data from GPRNs. Uncertainty in the estimates of absolute figures may lead to different rankings of diseases and, hence, should be taken into consideration when comparing disease incidences and prevalences

Obstetrical outcome valuations by patients, professionals, and laypersons: Differences within and between groups using three valuation methods

Background: Decision-making can be based on treatment preferences of the patient, the doctor, or by guidelines based on lay people's preferences. We compared valuations assigned by three groups: patients, obstetrical care professionals, and laypersons, for health states involving both mother and (unborn) child. Our aim was to compare the valuations of different groups using different valuation methods and complex obstetric health outcome vignettes that involve both maternal and neonatal ou

Estimating health-adjusted life expectancy conditional on risk factors: results for smoking and obesity

BACKGROUND: Smoking and obesity are risk factors causing a large burden of disease. To help formulate and prioritize among smoking and obesity prevention activities, estimations of health-adjusted life expectancy (HALE) for cohorts that differ solely in their lifestyle (e.g. smoking vs. non smoking) can provide valuable information. Furthermore, in combination with estimates of life expectancy (LE), it can be tested whether prevention of obesity and smoking results in compression of morbidity. METHODS: Using a dynamic population model that calculates the incidence of chronic disease conditional on epidemiological risk factors, we estimated LE and HALE at age 20 for a cohort of smokers with a normal weight (BMI < 25), a cohort of non-smoking obese people (BMI>30) and a cohort of 'healthy living' people (i.e. non smoking with a BMI < 25). Health state valuations for the different cohorts were calculated using the estimated disease prevalence rates in combination with data from the Dutch Burden of Disease study. Health state valuations are multiplied with life years to estimate HALE. Absolute compression of morbidity is defined as a reduction in unhealthy life expectancy (LE-HALE) and relative compression as a reduction in the proportion of life lived in good health (LE-HALE)/LE. RESULTS: Estimates of HALE are highest for a 'healthy living' cohort (54.8 years for men and 55.4 years for women at age 20). Differences in HALE compared to 'healthy living' men at age 20 are 7.8 and 4.6 for respectively smoking and obese men. Differences in HALE compared to 'healthy living' women at age 20 are 6.0 and 4.5 for respectively smoking and obese women. Unhealthy life expectancy is about equal for all cohorts, meaning that successful prevention would not result in absolute compression of morbidity. Sensitivity analyses demonstrate that although estimates of LE and HALE are sensitive to changes in disease epidemiology, differences in LE and HALE between the different cohorts are fairly robust. In most cases, elimination of smoking or obesity does not result in absolute compression of morbidity but slightly increases the part of life lived in good health. CONCLUSION: Differences in HALE between smoking, obese and 'healthy living' cohorts are substantial and similar to differences in LE. However, our results do not indicate that substantial compression of morbidity is to be expected as a result of successful smoking or obesity prevention

Cost-Effectiveness of an Opportunistic Screening Programme and Brief Intervention for Excessive Alcohol Use in Primary Care

Effective prevention of excessive alcohol use has the potential to reduce the public burden of disease considerably. We investigated the cost-effectiveness of Screening and Brief Intervention (SBI) for excessive alcohol use in primary care in the Netherlands, which is targeted at early detection and treatment of ‘at-risk’ drinkers.We compared a SBI scenario (opportunistic screening and brief intervention for ‘at-risk’ drinkers) in general practices with the current practice scenario (no SBI) in the Netherlands. We used the RIVM Chronic Disease Model (CDM) to extrapolate from decreased alcohol consumption to effects on health care costs and Quality Adjusted Life Years (QALYs) gained. Probabilistic sensitivity analysis was employed to study the effect of uncertainty in the model parameters. In total, 56,000 QALYs were gained at an additional cost of €298,000,000 due to providing alcohol SBI in the target population, resulting in a cost-effectiveness ratio of €5,400 per QALY gained.Prevention of excessive alcohol use by implementing SBI for excessive alcohol use in primary care settings appears to be cost-effective