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HEALTH CARE CHALLENGES IN RURAL AREAS OF HUNGARY S. Jakab Ministry of Health Social and Family Affairs The health status of the population is determined by several factors. Better health depends on influencing the determinants of health factors. The determinants of health factors and their contribution to health according to Canadian researchers are the follows:
In the last decades important changes occurred in the Hungarian settlement structure due to the urbanisation process. The proportion of population living in towns was increased and the proportion of inhabitants in the villages was diminished. In 1980 the proportion of population was 47% living in villages this proportion decreased and was 36% in the year 2000 (table 1.). Almost 1/5th. of the Hungarian population lives in small settlements, under 2000 inhabitants. Out of the 3135 settlements, 2380 (76%) have less than 2000 inhabitants (table 2.). The infrastructure, the level of different services is less developed in the settlements with low population size. It means that settlement size is influencing the quality of life. The drinking water through pipeline supplied 91,4% of flats in 1999 as the country average, but in seven out of the 19 counties these values varied between 81%-89%. The flats connected with the drainage system showed even a worse picture in 1999, the country average was 49,1% and in the counties these values varied between 23% and 60%. The best situation was shown in the capital with 91% supply. The drainage system for example which is less developed in the small settlements get a postponement from EU until 2015 to be fully developed in the country but it relates only to settlements above 2000 inhabitants. The changes in the 90s showed an increase in both quality of life indicators; Table 1. Proportion of population by settlement type
Table 2. Number of settlements and of inhabitants by settlement size Settlement size Number of settlements Relative distribution of population -499 1033 2,8 500-999 688 5.0 1000-1999 657 9,4 2000-4999 483 14,4 5000-9999 138 9,5 10000-19999 76 10,7 20000-49999 39 11,2 50000-99999 12 7,5 100000-199999 7 9,3 200000-300000 1 2,0 Capital 1 18,0 Country 3135 10 043 200 (100%) proportion of flats connected with drinking water supply was raised by 6,5% (84,9% in 1990 and 91,4% in 1999), and the drainage system was increased by 7,5% (41,6% in 1990, and 49,1% in 1999). The health status of the population in the small settlements is worse than the health of the population in bigger settlements and in the villages than in the towns. Two health indicators were used the life expectancy at birth and the lost years of life from the potential age of 70 per hundred thousand inhabitants. In both sexes the expected life expectancy is lower in villages than in the towns or in the capital. In males the difference in life expectancy between the capital and villages is 2,5 years, and in females less than half a year. The smaller the settlement size, the less the life expectancy at birth (table 3.). The smaller the size of settlement, the bigger the lost years of life from the potential age of 70 Table 3. Life expectancy at birth for males and females by settlement size and type Settlement size and type Males Females -999 66,46 75,50 1000-2999 66,69 76.02 3000-4999 66,85 76.20 5000-9999 67,64 76,28 10000-29999 68,64 76,65 30000-49999 69,10 76,90 50000-99999 68,99 76,77 100000-299999 69,40 77,02 Capital 69,28 76,52 Towns 68,79 76,71 Villages 66,83 76,04 Table 4. The lost years of life from the potential age of 70 per hundred thousand inhabitants for males and females by settlement size and type Settlement size and type Males Females All -999 13 564 6 197 9 866 1000-1999 13 335 5 616 9 423 2000-4999 13 258 5 276 9 206 5000-9999 11 916 5 094 8 407 10000-29999 11 030 4 896 7 831 30000-49999 10 679 4 786 7 589 50000-99999 10 686 4 876 7 605 100000-299999 10 341 4 738 7 314 Capital 11 159 5 528 8 128 Towns 10 899 4 891 7 732 Villages 13 079 5 475 9 224 per hundred thousand inhabitants for both males and females. The lost years are the biggest in the villages in both sexes comparing with the towns or with the capital (table 4.). The smaller the settlement size the bigger the standardised mortality ratio strengthening the underprivileged situation of the settlements with small number of inhabitants as it was shown by the other health indicators (table 5.). The standardised mortality rates in the most important disease groups are showing a similar pattern, in the smallest settlement size, the standardised mortality rates are the highest in cardiovascular diseases (CVD), in cancers and in diseases of the digestive system. There is only an exception the standardised mortality rates of tumours are the highest in the capital and not in the settlements with the smallest number of inhabitants (table 6.) The health status of the Hungarian population is very unfavourable comparing the data internationally and is far behind that would be expected on the basis of the social and econom- Table 5. Standardised mortality ratio for males and females by settlement size and type Settlement size and type Males Females All -999 112,1 104,6 108,9 1000-1999 109,2 102,8 106,5 2000-4999 108,4 102,0 105,7 5000-9999 105,7 103,4 105,0 10000-29999 98,9 100,4 99,9 30000-49999 94,8 98,9 96,9 50000-99999 93,9 97,4 95,6 100000-299999 92,8 96,4 94,2 Capital 87,7 95,8 91,2 Towns 96,4 99,1 97,7 Villages 109,2 102,8 106,5 in development of the country. It is true inspite the fact that in the last few years the negative trend has changed and the life expectancy at birth started to raise in the past few years. The life expectancy of males are seven years less than in the EU in males and five years less in females (table 7.). The Hungarian Government taking into consideration the Hungarian public health processes regarded health as a priority to change the unfavourable situation, and fulfil the expectation of the population to approach the life expectancy of the Hungarian population at birth to the mean of the EU value. The Hungarian Government declared The Health of the Decade National Public Health Programme. The Programme has regarded health as a priority and is part of the welfare society. The programme consists of in addition to the public health, the consolidation of health care system and modernisation of financing health services. The biggest effect to improve population health is expected from the National Public Health Programme (NPHP). The NPHP received an unanimous support from the Hungarian Parliament. It has received a government political commitment and a full parliamentary legitimacy. It was important to ensure long term strategy and full implementation. The NPHP main principles are the follows:
Table 6. Standardised mortality rates in CVD, tumours and in the diseases of digestive system by settlement size and type Settlement size and type Tumours CVD Diseases of the digestive system -999 358,0 837,3 111,6 1000-1999 332,4 711,6 104,1 2000-4999 313,2 684,7 99,2 5000-9999 319,0 677,0 87,5 10000-29999 295,4 604,2 80,9 30000-49999 304,5 625,5 80,3 50000-99999 319,6 544,0 88,8 100000-299999 303,6 568,5 85,4 Capital 401,7 687,7 101,7 Towns 307,6 602,2 83,7 Villages 326,5 719,5 102,0 Table 7. Life expectancy at birth in Hungary between 1970 and 2001 compared with EU means Year Males Females 1970 66,3 72,1 1980 66,0 73,2 1990 65,1 73,7 1993 64,5 73,8 1997 66,4 75,1 1998 66,1 75,2 1999 66,3 75,1 2000 67,1 75,6 2001 68,2 76,5 EU mean 75,3 81,4 The main tasks considered to ensure the success of NPHP
Main aims of the National Public Health Programme
The listed programmes are a frame, priorities are determined yearly. The priorities for 2004 are the follows:
Emphasis within priorities or the horizontal programmes are the follows within priorities
Summary: The Hungarian health situation was described with a special emphasis on small settlements. A short account was given on the National Public Health Programme, on its main aims, approaches, priorities Cover Page Region Special Activities Papers HOME |