H EALTH PROMOTION FOR THE ELDERLY FACTS & IDEAS FROM P ORTUGAL Dr. Roberto Falvo Università Cattolica del Sacro Cuore – Roma September 2016
AGENDA Overview of the country Health System history Levels of care HPOP funds and strategies HPOP main actors HPOP main providers Recommendations
OVERVIEW OF THE COUNTRY Population: 10 millions 5 Regions + Madeira and Azores Islands population aged 0-14 was equal to 14,9%, people aged 15-64 represented 66% and people over 65 were 19,1%. life expectancy at birth in 2014 : F 82,6 – M 76,7 Ageing Index Dependence index Longevity index 2014 for elderly 2014 2014 127,8 28,8 47,9
HEALTH SYSTEM HISTORY • Bismark model during the “New State ” • Portuguese Constitutional Law – 1976 • Basic Law on Health (Law No. 48/90) universal, tax-based, National Healthcare System (NHS) health subsystems cover 20-25% of population private voluntary health insurance - VHI provides additional coverage for 10 – 20% of the population
NATIONAL HEALTH PLAN Health Targets for 2020 • Reduce premature mortality (<70 years) to a value lower than 20% • Increase healthy life expectancy at 65 years of age by 30% • Promotion of Active and Healthy Ageing and Intergenerational Solidarity
LEVELS OF CARE Primary Health Care a network of health centres , staffed by family doctors and nurses, and different types of small multidisciplinary teams, that work as gatekeeper of the system Secondary Care Hospitals , about 230 Tertiary Care National Network of Integrated Continuous Care (created by the Ministry of Health and the Ministry of Solidarity, Employment and Social Security in 2006); provides continuous and integrated health care, health promotion & social support to people who are in a situation of dependency
HPOP FUNDS AND STRATEGIES Although there is no specific fund for health promotion for the older people HPOP is financed indirectly within national priority programs (i.e. National Program for the Elderly 2008, Diabetes, Respiratory diseases etc)) projects and initiatives receive funds by diverse sectors (mainly health, social ) and European funds are also sources of funding.
National Health Programmes and initiatives at central level of the Health System
H.P.F.E. MAIN ACTORS �
PROVIDERS AT PRIMARY HEALTH CARE LEVEL Family Health Units URAP – Personalized sharing care units resources Groups of Health Centres - ACES Public Community Health care Units Units-PHU
HPOP MAIN PROVIDERS Providers within ACES Family Health Units and Personalized Care Units • Family doctors and nurses that provides health care at primary level, organized in health centres – daily routine activities and local projects and initiatives
COMMUNITY CARE UNITS • Multidisciplinary teams - nurses, social workers, physicians, psychologists, nutritionists, physiotherapists, speech therapists and other professionals, depending on the needs and availability of resources • Provides health care and psychological and social support at domiciliary and community levels, especially for vulnerable people, families and groups – at primary care level and within the National Network of Integrated Continuous Care • involved in health education activities , integration in family support networks and implementation of mobile intervention units
PUBLIC HEALTH UNITS • Public health doctors , public or community health nurses and environmental health technician • Work as health observatories of their geographic areas; • develop information and plans in the field of public health; • manage interventions for the prevention, promotion and protection of population’s health ; • exercise functions of health authority • Epidemiology and Surveillance
Private Institutions for Social Solidarity - IPSS Nonprofits Institutes that provide, within National Network of Integrated Continuous Care (5000 beds contracted) or not : • Support for children, youth and families; • Protection of citizens in old age and disability and in all situations of lack or reduction of means of subsistence or capacity to work ; • Health promotion and protection , particularly by providing care preventive medicine, curative and rehabilitation; • Education and vocational training of citizens.
MUNICIPALITIES AS HPOP PROVIDERS • Healthy Cities Network • Social Network Project • Geriatric Parks • Other projects, as Integration and Help in the Age Friendly City of Oporto (WHO, 2007)
RECOMENDATIONS Ensure a broader engagement of elderly patients by supporting the development of partnerships between Public health specialists and other health professionals including family doctors and pharmacists Clarify the role of the private sector, the IPSS and the NGOs in the management of the elderly through a coherent policy framework Improve coordination between national and local planning in different areas of both social and health action, either through legislative and regulatory strategies; Improve intersectoral governance actions : decisions and investments in health promotion should be planned and undertaken together by all the ministries eventually involved, thus to exert influence on overall government effectiveness;
National Strategy for the Promotion of Active and Health Aging “Take a stand against ageism!” United Nations International Day of Older Persons 2016 To be launched in 2016
THANK YOU!
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