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1. Governance

2. Cross-sectorial cooperation

Governance

The main governmental authority responsible for youth health and well-being is the Ministry of Health. There are also many public actors involved in the creation of public policies, advisory bodies, agencies and other governmental bodies, with their appropriate roles as listed:

•    The Ministry of Health is responsible for health care and welfare, health-enhancing physical activity and health policy, initiation and delivery of frameworks for action plans/programmes, guidelines and subsidies. In addition, creating and maintaining links with other ministries and sectors concerning physical activity promotion is one of their tasks.

•    The Croatian Health Insurance Fund is a public institution whose rights, obligations and responsibilities are defined by the Mandatory Health Insurance Act and CHIF’s Statute, with the Croatian Ministry of health in charge of legal oversight. The CHIF structure consists of the Directorate and four regional offices (Zagreb, Osijek, Split, Rijeka) which administer the operation of 16 regional branches on 134 locations. The framework of mandatory health insurance covers around 4 300 000 insured persons (99.7%), while the supplemental health insurance covers around 2 500 000 insured persons. The vision of the healthcare system from the CHIF perspective is to become a health system where quality healthcare is available to everyone, according to the principles of comprehensiveness, accessibility and solidarity, and the mission is to rationally invest the funds of insured persons in quality and efficient health services and programmes that will add years to life and health to years

•    The Croatian Institute of Public Health is a central public health institution in Croatia and the region. This development vision is a commitment arising from the role the Institute has within and beyond the framework of the healthcare system, and it is enabled by the high level of knowledge, professionalism and work dedication of professionals, scientists and employees. The way to this development vision of the Croatian Institute of Public Health was paved by its long history. The Institute’s fundamental mission is to enable clear and efficient recognition of current population public health problems and anticipation of future trends while ensuring prerequisites for their efficient management, all with the basic goal of preserving and enhancing the health of the population. The Croatian Institute of Public Health performs activities relating to the epidemiology of infectious diseases and mass non-communicable diseases, public health, health education, promotion and disease prevention, health ecology, microbiology, school medicine, mental health and addiction prevention. In order to achieve the fundamental purpose of a public health system, the preservation and enhancement of population health, it is essential to have good cooperation, coordination, and partnership between stakeholders on national, regional and local levels, which is where the public health institutes network becomes crucial. Internationally the institute cooperates with the World Health Organisation as well as other relevant international and European bodies, institutions, and organisations. Achieving the fundamental purpose of a public health system requires a general acceptance of the equally available health concept, reducing inequality in all polyclinics and sectors, as well as perceiving health investment as the most cost-effective investment into society’s growth and development.

•    Regional Public Health Institutes – There are 21 regional public health institutes. According to the Health Care Act, a regional self-administration Institute of Public Health is the dedicated health institution for public health in the area under that regional self-administration. Among the services the institute offers in the area of the regional self-administration are an epidemiological service, microbiology, public health, health ecology, school medicine, mental health protection and addiction prevention and outpatient care.

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

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

Besides the listed institutions, numerous other governmental bodies, offices, state institutes and agencies, as well as educational institutions, regional and local self-administration bodies and other actors have a significant role in implementing measures within their jurisdiction which partially overlap with the measures implemented by the Croatian health system.

The civil society and a number of NGOs participate greatly at the operative level. Many of the NGO's representatives are involved both in the processes of creating the strategic frameworks and at the operative level by performing the activities directly with the 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 those sources can also provide statistical health information on youth, although it’s worth noting that there is no comprehensive and targeted monitoring of the youth population aged 15-30 years old health through 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 Croatian Institute of Public Health. In publicly available publications detailing health statistics results, due to the routine age group distribution, the youth group is mostly presented divided between other groups – children and adult populations. The care of sick school-age children and students in the primary health care is the responsibility of family medicine physicians, while the 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. The secondary and tertiary health care is provided to the youth through their mandatory health insurance provided by the Croatian Health Insurance Fund.

Cross-sectoral cooperation

The cross-sectional cooperation in the health sector is defined through the constant information exchange and inclusion of many authority bodies, depending on the topics and area of health protection of youth in Croatia. Many of the abovementioned governmental, academic and many other institutions are involved in the processes of decision-making, creation of the legislative framework, etc.

Numerous action and strategic plans, strategies and other documents on the national level include a significant number of actors which are the carriers of individual measures, meaning that they are in charge of their implementation and have the obligation 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; a basis on facts established by research and evidence; the coordination of several sectors and disciplines on numerous levels; the education of public policy creators and their implementers; securing funds to enable long-term sustainability of the system; drawing up a sustainability framework by using revision and adaption mechanisms; continuous data collection and support in planning, implementing, monitoring, and evaluating strategies of prevention of particular youth problems.

Below are listed several of the most important strategic documents creating the political direction of public policies development which, among others, include youth health, although many of them relate to a significantly wider population and/or relates to several age groups which also include youth.

The National Health Development Plan 2021 - 2027

National Health Development Plan for the period from 2021 to 2027  (NN 147/2021) is an extremely significant document for the field of vulnerable groups, and especially youth, health protection. This strategy includes a wide circle of measure and activities carriers, and it contains the following basic goals:

• Better healthy living habits and more effective disease prevention
• Improving the health care system
• Improving care model for key health challenges
• Make the health care system a desirable place to work
• Improving the financial sustainability of the health system

Strategic Plan for Public Health Development

The last developed strategic plan is Strategic Plan for Public Health Development 2017-2020.

Health care activities are defined by the Health Care Act (Zakon o zdravstvenoj zaštiti, NN 100/18, 125/19, 147/20). The main carrier and the coordinator at the national level is the Croatian Institute for Public Health, while county-level activities are coordinated and implemented by County Public Health Institutes. The core tasks of the Croatian Institute for Public Health 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, which are realized through activities at the state level, and with the cooperation of County Public Health Institutes at the county level. The basic activities of public health institutes include epidemiology of infectious and chronic non-communicable diseases, microbiology, health promotion, public health, ecology, school medicine and prevention of addiction and mental health.

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 placing the prevention of chronic non-communicable diseases (NCDs) in a foreground position. The Health 2020 represents a strategic framework for developing a health care policy which would include NCDs prevention among the four priorities of developing health care policies. The goal of developing health care policy for NCDs prevention is the development of efficient public health interventions representing coordinated action in the widest sense, and including the cooperation of the health care system, the civil sector, and other governmental departments. In this context, the Public Health system has an important role in advocating, proposing and cooperating in the implementation of interventions which have to ensure health equality, take into account the social determinants of health and the need of ensuring a healthy environment to empower and support both the individual and the community in maintaining and improving their health. These interventions, which have to 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

In order to stop the growing rates of morbidity and mortality trend connected to chronic non-communicative diseases, the Ministry of Health has launched a public health project entitled “Healthy Living”. In October 2002, the Ministry founded the Committee for promoting healthy nutrition and physical activity with the goal of preventing two (proper diet, physical activity) out of three (healthy diet, physical activity, smoking) greatest behavioural risks for developing current leading causes of disease and death. The basic goal is achieving social concern for protecting the population health from the harmful effects of poor nutrition and physical inactivity by drawing up, implementing and evaluating a programme of healthy nutrition and physical activity promotion.

Taking into account that besides chronic non-communicable diseases, another public health priority are measures being implemented in the field of mental health protection and improvement, as well as the field of sexual and reproductive health, the National Programme “Healthy Living” encompasses all four priority fields:

• healthy nutrition

• physical activity
• mental health
• sexual and reproductive health.

The goal of the programme is:

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

Even though the measures and activities of this national programme relate to the entire populace, almost all activities take the youth into account as a target group with greater behavioural, biomedical and socio-medical risk factors.

Activity implementation was designed in five years periods, followed by an evaluation. The National Programme “Healthy Living” was developed as a programme of promoting and improving the health of the citizens of the Republic of Croatia by promoting proper nutrition and physical activity with the goal of preventing overweight problems and obesity as well as preserving mental and sexual health in different environments.

The carriers of the National Programme are the Ministry of Health and the Croatian Public Health Institute, and the implementation is the responsibility of the Croatian Public Health Institute, county public health institutes, non-governmental organisations and civil society associations on the local level. The National Programme activities will be implemented in accordance with the priorities adopted on the basis of evaluating the health condition in each county.

The National Programme “Healthy Living“ focuses on three priority areas:

1. Proper nutrition, physical activity and obesity prevention – this implies promoting proper nutrition through education, informing and campaigns; stimulating the building of needed infrastructure in kindergartens, schools and workplaces; stimulating the adoption of legislative frameworks regulating this field in all environments; stimulating food manufacturers to properly label and manufacture healthy foods; monitoring and control of overweight problems and obesity; implementing campaigns and initiatives promoting breastfeeding, etc.
2. Mental health – this implies improving the mental health of the population by developing and strengthening self-protective mechanisms within the community; implementing stress reduction programmes, smoking prevention programmes, programmes of primary prevention of psychoactive substance use and early alcohol use; promoting mental health in older age groups; violence prevention by non-violence promotion.
3. Sexual health – this implies 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 on the importance of responsible sexual behaviour as well as protecting sexual and reproductive health; promoting the acquisition of responsible sexual behaviour and lifestyle aimed at protecting and improving sexual and reproductive health; stimulating, implementing and supporting research and preventive programmes in the field of sexual and reproductive health protection, HIV and STDs prevention, as well as preventing unwanted and teenage pregnancies.

The National Programme “Healthy Living” affects the development of above-mentioned priorities by proposing legislative frameworks to regulate the area of health promotion in all environments, by continuous media promotion and by supporting the implementation of effective interventions on a local level with special focus on vulnerable target groups.