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1. Governance

2. Cross-sectorial cooperation

Governance

The primary governmental authority responsible for youth health and well-being is the Ministry of Health. Various public actors, including advisory bodies, agencies, and other governmental bodies, participate in the creation of public policies:

•    the Ministry of Health (MH) is responsible for healthcare, welfare, health-enhancing physical activity, health policy, and the initiation and implementation of frameworks for action plans/programmes, guidelines, and subsidies. Additionally, it is tasked with creating and maintaining connections with other ministries and sectors concerning the promotion of physical activity

•    the Croatian Health Insurance Fund (CHIF) is a public institution with its rights, obligations, and responsibilities defined by the Mandatory Health Insurance Act and CHIF’s Statute. Legal oversight is provided by the Ministry of Health (MH). The CHIF structure consists of the Directorate and four regional offices (Zagreb, Osijek, Split, Rijeka), overseeing the operation of 16 regional branches across 134 locations. The mandatory health insurance framework includes around 4 018 300 insured persons (96.4%), while supplemental health insurance covers around 2 500 000 insured persons. From the CHIF perspective, the vision for the healthcare system is to evolve into a system where quality healthcare is available to everyone based on principles of comprehensiveness, accessibility, and solidarity. The mission is to rationally allocate the funds of insured persons toward quality and efficient health services and programmes, to extend life and enhance health

•    the Croatian Institute of Public Health (CIPH) is a central public health institution in Croatia and the region. The CIPH's core mission is to enable the clear and efficient identification of current public health issues, anticipate future trends, and effectively manage them—all with the primary objective of preserving and enhancing the health of the population. It performs activities related to the epidemiology of infectious diseases and mass non-communicable diseases, public health, health education and promotion, as well as disease prevention. The scope also includes health ecology, microbiology, school medicine, mental health, and addiction prevention. 

•    21 regional public health institutes. According to the Health Care Act, each regional self-administration area has a dedicated Institute of Public Health, serving as the public health institution in that region. The services the institutes offer within the regional self-administration areas include epidemiological services, microbiology, public health, health ecology, school medicine, mental health protection, addiction prevention, and outpatient care

•    the Ministry of Science and Education is responsible for primary, secondary, and tertiary education, research institutions and sports

•    the Ministry of Tourism and Sport is responsible for developing recreational sport programmes and facilities, as well as encouraging children and young people to engage in day-to-day physical activity 

Besides the listed institutions, various other governmental bodies, offices, state institutes, agencies, educational institutions, as well as regional and local self-administration bodies and other actors implement measures within their jurisdiction that may partially overlap with those implemented by the Croatian health system.

Civil society and numerous non-governmental organisations (NGOs) participate greatly at the operative level. Many of the NGO's representatives are involved in both the processes of creating the strategic frameworks and at the operative level, performing the activities directly with young people. The general distribution of responsibilities between top-level and regional/local authorities is not strictly defined, except at the institutional level.

Croatian health system has several levels of monitoring the health of the population, and these sources can also provide statistical health information on youth. However, it is worth noting that there is no comprehensive and targeted monitoring of the health of the youth population aged 15-30 years old across all system levels. The Croatian Bureau of Statistics is the main body for statistical data on the state level, while the main body for health statistics data on the state level is the CIPH. In publicly available publications detailing health statistics results, the youth group is mostly presented divided between other groups – children and adult populations, due to the routine age group distribution. The care of sick school-age children and students in primary health care is the responsibility of family medicine physicians. Preventative and specific health care is the responsibility of adolescent medicine specialists in health centres and county institutes of public health as part of their specific activities. Secondary and tertiary health care for youth is covered through their mandatory health insurance, which is provided by the CHIF.

Cross-sectoral cooperation

Cross-sectional cooperation in the health sector is established through constant information exchange and the involvement of various authorities, depending on the topics and areas related to the health protection of youth in Croatia. Many of the aforementioned governmental, academic, and other institutions are involved in decision-making processes, the creation of legislative framework, and more. 

Numerous action and strategic plans, as well as other documents at the national level, involve a significant number of actors who are responsible for individual measures. These actors are in charge of implementing the measures and are obligated to report at planned intervals.

The basic determinants of inter-sectoral and cross-sectoral cooperation in the health system imply 

• its development within a stimulative and legal framework, based on facts established by research and evidence 
• the coordination of various sectors and disciplines on multiple levels 
• education of public policy creators and those responsible for implementation 
• securing funds to ensure the long-term sustainability of the system 
• drawing up a sustainability framework using revision and adaptation mechanisms
• continuous data collection and support in planning, implementing, monitoring, and evaluating strategies for the prevention of specific youth problems

Below are listed several of the most important strategic documents that shape the political direction of public policies development. Among others, these documents address youth health, although many of them pertain to a significantly wider population and/or encompass various age groups that also include youth.

The National Health Development Plan 2021 - 2027

The National Health Development Plan 2021 to 2027 is an exceptionally significant document for the field of health protection, particularly for vulnerable groups, including youth. This strategy includes a broad spectrum of actors responsible for implementing measures and activities. It contains the following basic goals:

• promoting healthier living habits and more effective disease prevention
• improving the health care system
• enhancing the care model for addressing key health challenges
• making the health care system a desirable place to work
• enhancing the financial sustainability of the health system

Strategic Plan for Public Health Development

The most recent strategic plan is the Strategic Plan for Public Health Development 2017-2020. 

Health care activities are defined by the Health Care Act. The main carrier and coordinator at the national level is the CIPH, while county-level activities are coordinated and implemented by public health institutes. The core tasks of the CIPH are to monitor, analyse, and evaluate the health status of the population and to plan, propose, and implement measures to preserve and improve the health of the population. These tasks are realised through activities at the state level, and at the regional level, through cooperation with county public health institutes. The basic activities of public health institutes include the epidemiology of infectious and chronic non-communicable diseases, microbiology, health promotion, public health, ecology, school medicine, and prevention of addiction and mental health issues.

The Action Plan for the Prevention and Control of Non-communicable Diseases 2015-2020

The Action plan for the Prevention and Control of Non-communicable Diseases 2015-2020 is based on a series of international and Croatian strategic documents, prioritising the prevention of chronic non-communicable diseases (NCDs). Health 2020 serves as a strategic framework for the development of healthcare policies, emphasising the prevention of NCDs as one of the four priorities in shaping health policies. The goal of developing a healthcare policy for NCDs prevention is to establish efficient public health interventions that involve coordinated actions in the broadest sense. This includes collaboration among the healthcare system, the civil sector, and other governmental departments. In this context, the Public Health system has an important role in advocating, proposing, and collaborating in the implementation of interventions. These interventions must ensure health equality, consider the social determinants of health, and address the need for a healthy environment. The goal is to empower and support both the individual and the community in maintaining and improving their health. These interventions, which must be mutually compatible, require a combination of different management approaches – centralised, decentralised, and participative – with the purpose of ensuring health and well-being for all.

The National Programme “Healthy Living”

The National Programme Healthy Living is in accordance with the following documents: 

• WHO Health for All 
• The Ottawa Charter for Health Promotion 
• Health in All Policies
• UN Political Declaration on Prevention and Control of Non-communicable Diseases
• UN Millennium Declaration, Millennium Development Goals (MDGs) 
• the National Health Care Strategy 2012-2020
• the Ministry of Health Strategic Plan 2014-2016 
• the Strategic Plan for Public Health Development 2013-2015 
• the National Youth Strategy 2013-2017

To curb the rising rates of illness and death linked to chronic NCDs, the MH initiated a public health project Healthy Living. In October 2002, the MH established the Committee to promote healthy nutrition and physical activity. The aim is to prevent two of the three main behavioural risks (improper diet and lack of physical activity, the third being smoking) associated with the leading causes of current diseases and deaths. The basic goal is to foster societal awareness in protecting population health from the harmful effects of poor nutrition and physical inactivity. This will be achieved through the development, implementation, and evaluation of a programme promoting healthy nutrition and physical activity.

Considering that, in addition to chronic NCDs, other public health priorities include measures implemented in the field of mental health protection and improvement, as well as sexual and reproductive health, the National Programme Healthy Living encompasses all four priority areas: 

• healthy nutrition
• physical activity
• mental health
• sexual and reproductive health 

The goals of the Programme are: 

• promoting healthy lifestyles
• taking a comprehensive approach to improving the health of the Croatian population 
• enhancing the quality of life and demographic situation 

While the measures and activities of this National Programme pertain to the entire populace, a significant focus is placed on youth as a target group due to their higher prevalence of behavioural, biomedical, and socio-medical risk factors.

Activity implementation was structured in a five-year period logic, followed by an evaluation. The National Programme Healthy Living was established to promote and enhance the health of citizens in the Republic of Croatia. The programme focuses on promoting proper nutrition and physical activity, aiming to prevent issues related to overweight and obesity, while also preserving mental and sexual health in various environments.

The carriers of the National Programme are the MH and the CIPH. Implementation is entrusted to the CIPH, public health institutes, non-governmental organisations, and civil society associations at the local level. The National Programme activities will be implemented following the priorities adopted, and based on evaluating the health conditions in each county.

The National Programme Healthy Living focuses on three priority areas:

• proper nutrition, physical activity, and prevention of obesity: promoting proper nutrition through education, informing, and campaigns; stimulating the building of necessary infrastructure in kindergartens, schools, and workplaces; advocating for the adoption of legislative frameworks regulating this domain in all environments; motivating food manufacturers to appropriately label and produce healthy foods; monitoring and controlling issues related to overweight and obesity; implementing campaigns and initiatives to promote breastfeeding, etc.
• mental health: enhancing the mental health of the population by developing and strengthening self-protective mechanisms within the community; implementing stress reduction programmes, smoking prevention initiatives, and primary prevention programmes addressing psychoactive substance use and early alcohol use; promoting mental health in older age groups; preventing violence through the promotion of non-violence
• sexual health: contributing to the protection and improvement of sexual and reproductive health in the general population and target groups by raising awareness, educating, and informing the public about the importance of responsible sexual behaviour and the protection of sexual and reproductive health; promoting the adoption of responsible sexual behaviour and lifestyles to protect and enhance sexual and reproductive health; stimulating, implementing, and supporting research and preventive programmes in the areas of sexual and reproductive health protection, HIV and sexually transmitted diseases (STDs) prevention, as well as preventing unwanted and teenage pregnancies

The National Programme Healthy Living influences the development of the aforementioned priorities by proposing legislative frameworks to regulate health promotion across all environments. Additionally, it includes continuous media promotion and supports the implementation of effective interventions at the local level, with a particular focus on vulnerable target groups.