Content:• Demografy data• Natality, Fertility, Life expectancy, Mortality • Infant mortality• Health care system for children• Children morbidity• Children mortality• Children injuries• Conclusions
THE CZECH REPUBLIC
Population in the Czech Republic by age
inhabitants 10 287 189
children 0-14 14,4 %
adult 71,2 %
old people over 65 14,4 %
Population in the Czech Republic
• Population is ageing:low natality + decreasing mortality + survival of older persons
• Low natality:Natality and fertility are slowly increasing, 1.33 children per 1 woman at fertile age
Population by age to 1.7.
100 000 75 000 50 000 25 000 0 25 000 50 000 75 000 100 0000
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
85
90
95
males females
Source: Czech Statistical Office
Trend of proportion of population aged 0-14 years, 65 and more years and Age preference index, in 1950 - 2006
0
6
12
18
24
30
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
2005
%
0
20
40
60
80
100
Proportion of age group 0-14 Proportion of age group 65+ Age preference index
Source: Czech Statistical Office
Age preference index, in Europe
30
40
50
60
70
80
90
100
110
120
130
Alb
ania
Icel
and
Irela
ndC
ypru
sS
lova
kia
Mal
taN
orw
ayN
ethe
rland
sLu
xem
bour
gP
olan
dLi
thua
nia
Rus
sian
Fed
erat
ion
Uni
ted
Kin
gdom
Fran
ceFi
nlan
dR
oman
iaB
elar
usC
zech
Rep
ublic
Sw
itzer
land
Aus
tria
Sw
eden
Hun
gary
Cro
atia
Est
onia
Ukr
aine
Slo
veni
aP
ortu
gal
Latv
iaS
pain
Bul
garia
Gre
ece
Ger
man
y
Source: databaze Health for All - WHO
Trend of Age preference index in selected european countries, in 1990 - 2006
0
25
50
75
100
12519
90
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
United Kingdom Czech RepublicFrance GermanyHungary PolandSpain
Source: databaze Health for All - WHO
Crude birth rate, in Europe
0
4
8
12
16G
erm
any
Latv
iaLi
thua
nia
Slov
enia
Bulg
aria
Ukr
aine
Bela
rus
Cro
atia
Pola
ndH
unga
ryG
reec
eC
zech
Rep
ublic
Aust
ria Italy
Mal
taSw
itzer
land
Rom
ania
Slov
akia
Esto
nia
Portu
gal
Rus
sian
Fed
erat
ion
Spai
nFi
nlan
dBe
lgiu
mSw
eden
Cyp
rus
Den
mar
kN
ethe
rland
sU
nite
d Ki
ngdo
mLu
xem
bour
gN
orw
ayFr
ance
Icel
and
Irela
nd
Source: databaze Health for All - WHO
Trend of Crude natality rate in selected european countries, in 1990 - 2006
8,0
10,0
12,0
14,0
16,019
90
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Czech Republic FranceGermany HungaryPoland SpainUnited Kingdom
Source: databaze Health for All - WHO
Total fertility rate
0,9
1,2
1,5
1,8
2,1U
krai
neSl
oven
iaBe
laru
sPo
land
Slov
akia
Lith
uani
aC
zech
Rep
ublic
Gre
ece
Rus
sian
Fed
erat
ion
Bulg
aria
Latv
iaH
unga
ryIta
lyR
oman
iaSp
ain
Ger
man
yM
alta
Portu
gal
Aust
riaC
roat
iaC
ypru
sSw
itzer
land
Esto
nia
Luxe
mbo
urg
Belg
ium
Net
herla
nds
Swed
enAl
bani
aD
enm
ark
Finl
and
Uni
ted
King
dom
Nor
way
Irela
ndFr
ance
Icel
and
Source: databaze Health for All - WHO
Trend of Total fertility rate in selected european countries, in 1990 - 2006
1,0
1,5
2,0
2,519
90
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Czech Republic FranceGermany HungaryPoland SpainUnited Kingdom
Source: databaze Health for All - WHO
0
0,5
1
1,5
2
2,5
3
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
AustriaCRFranceGermanyHungaryNetherlandsPolandSlovakiaSwedenUK
Fertility in Fertility in thethe CR CR andand selectedselected countriescountries
Source: WHO Euro Velebil 2007
Life expectancy
73.45 for men79.67 for women
Life expectancy at birth
55 60 65 70 75 80 85
ICE (2001)
SWI (2001)
CYP (2001)
NOR (2001)
MAT (2002)
AUT (2002)
NET (2000)
LUX (2002)
IRE (2001)
POR (2002)
CZE (2002)
POL (2002)
BUL (2002)
ROM (2002)
LVA (2002)
RUS (2002)
muži / males
ženy / females
Mortality rate
• Half of all deaths were caused by diseases of the circulatory system, while neoplasm, was the second most frequent, caused 27% deaths (men - MN of respiratory system, women –MN of breast)
Standardized mortality rate - males
0 200 400 600 800 1 000 1 200 1 400 1 600 1 800 2 000 2 200
ICE (2001)
SWE (2001)
GRE (2001)
NOR (2001)
FRA (2000)
DEU (2001)
LUX (2002)
FIN (2002)
IRE (2001)
SVN (2002)
POL (2002)
SVK (2002)
HUN (2002)
LTU (2002)
UKR (2002)
RUS (2002)
zhoubné novotvary
nemoci oběhové soustavy
vnější příčiny
ostatní
Standardized mortality rate - females
0 200 400 600 800 1 000 1 200
SPA (2001)
ITA (2001)
ICE (2001)
NOR (2001)
FIN (2002)
GRE (2001)
MAT (2002)
POR (2002)
SVN (2002)
POL (2002)
CZE (2002)
CRO (2002)
HUN (2002)
BUL (2002)
BLR (2002)
RUS (2002)
malign. neoplasms
dis. of the circulatory system
external causes
other
Infant mortality
• Infant mortality 3,3 per millPer 1000 live born children only 3,3 died in the 1st year of life.(Low neonatal mortality - in the first 6 days of life)
• This level is historically the lowest.
Infant mortality rate by age in days
0 2 4 6 8 10 12 14 16 18
FIN (2003)
SWE (2002)
NOR (2003)
CZE (2003)
GRE (2003)
SVN (2003)
SPA (2002)
DEU (2001)
FRA (2001)
AUT (2003)
SWI (2002)
ITA (2001)
NET (2003)
IRE (2002)
POR (2002)
UNK (2002)
MAT (2003)
CRO (2003)
LTU (2003)
POL (2003)
HUN (2003)
SVK (2002)
LVA (2003)
BUL (2003)
RUS (2003)
ROM (2003)
0-6 dnů / days
7-27 dnů / days
28-364 dnů / days
per 1 000 live births
Infant mortality rate
0
2
4
6
8
10
12Sw
eden
Nor
way
Finl
and
Slov
enia
Cze
ch R
epub
licFr
ance
Portu
gal
Spai
nG
reec
eG
erm
any
Switz
erla
ndN
ethe
rland
sAu
stria
Irela
ndU
nite
d Ki
ngdo
mM
alta
Cro
atia
Esto
nia
Hun
gary
Slov
akia
Pola
ndBe
laru
sAl
bani
aLi
thua
nia
Latv
iaU
krai
neR
ussi
an F
eder
atio
nBu
lgar
ia
Source: databaze Health for All - WHO
Trend of infant mortality rate in selected european countries, in 1990 - 2006
3456789
10111213141516
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Czech Republic FranceGermany HungaryPoland SpainUnited Kingdom
Source: databaze Health for All - WHO
0
5
10
15
20
25
30
3519
70
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
AustriaCRFranceGermanyHungaryNetherlandsPolandSlovakiaSwedenUK
Infant deaths per 1000 live birthsInfant deaths per 1000 live births
Source: WHO Euro Velebil 2007
Trend of infant mortality rate, in 1950 - 2006
0
15
30
45
60
7519
50
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
2005
Infant mortality rate
Source: Czech Statistical Office
Trend of mortality rates of children till 1 year of age in 1960 - 2006
0
5
10
15
20
2519
60
1965
1970
1975
1980
1985
1990
1995
2000
2005
0-364 days0-6 days28-364 days7-27 dnů
Source: Czech Statistical Office
84
86
88
90
92
94
96
98
100
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
AustriaCRFranceGermanyHungaryNetherlandsPolandSlovakiaSwedenUK
Percent Percent ofof normalnormal birthweightbirthweight babiesbabies in in thethe CR CR andand selectedselected countriescountries
Source: WHO Euro Velebil 2007
0
50
100
150
200
250
300
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
AustriaCRFranceGermanyHungaryNetherlandsPolandSlovakiaSwedenUK
CesareanCesarean sectionssections in in thethe CR CR andand selectedselectedcountriescountries
Source: WHO Euro Velebil 2007
1
1,2
1,4
1,6
1,8
2
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
ProportionProportion ofof twintwin deliveriesdeliveriesin in thethe CzechCzech RepublicRepublic
in 1995in 1995--20062006
%No of twindeliveries
2004: 18222005: 19272006: 2074
Source: WHO CC in Perinatal Medicne, Prague Velebil 2007
0
100
200
300
400
500
600
700
800
900
1000
1970
1973
1976
1979
1982
1985
1988
1991
1994
1997
2000
2003
AustriaCRFranceGermanyHungaryNetherlandsPolandSlovakiaSwedenUK
Abortions per 1000 live birthsAbortions per 1000 live births
Source: WHO Euro Velebil 2007
Low infant mortality - causesThe high quality of prenatal and neonatal care.• Preventive care about pregnant women – paid from public health
insurance– High coverage (98.6% receiving prenatal care). – Early registration (81.8% in Ist trimester)– More than 6 visits– Ultrasound screeening
• Hospital deliveries (99.8% of all births)
• 12 perinatal centres, equipped with top-quality diagnostic and therapeutic technology and highly educated staff.These workplaces are closely connected with specialized intermediary centres of neonatal care for premature newborns or newborns with low birth weight.
• Frequency of LBW 7.2%
Perinatal mortality is at very low level despite of influence of changing conditions:
• Aging population, increasing proportion of older mothers
• increasing proportion of LBW• Increasing proportion of multiple pragnancies• Increasing proportion of woman without
pregnant care
Medical Care in the CR
• Medical care in the CR is mostly paid by public medical insurance, which is obligatory by law.
Medical care for children
• Medical care for children in the CR was and is still at a high level.
• Essential medical care for children is covered by public health insurance. The state pays insurance premiums for children and adolescents until the time of completion of preparation for a profession (maximally to 26 years of age).
• Practically all children are born in maternity hospitals and are (mostly) examined by a pediatrician immediately after birth.
• During their stay in the maternity hospital, all children undergo screening tests for phenylketonuria, hypothyroidism, cararacts, congenital adrenal hyperplasia – and are vaccinated against TBC.
• Screening examinations are also performed on the hip joints and on the hearing in children with congenital hypothyroidism
• Newborn screening is being gradually extended.
• Preventive care for children begins in the prenatal and perinatal period with cooperation between obstetricians, geneticists and pediatricians.
• General practitioners for children and adolescentsprovide primary medical care for children in the CR.
• Chronically ill or handicapped children are included in dispensary groups, in which they are monitored to a greater degree by a pediatrician and the relevant specialists. Roughly every fifth child is examined annually in the dispensary care of pediatricians.
• Contemporary pediatrics has a well-introduced system of preventive examinations and an immunization program based on a vaccination calendar paid from public medical insurance
• The law enables /stipulates 11 preventive examinations up to the age of 18 months and then two-year intervals as the frequency of preventive medical examinations from 3 years of age of the child.
Health of Children of the CR• In spite of the very good level of medical care for the children, the
state of health of the child population of the CR is not improving substantially.
• There is no apparent reduction in sickness rate of children and adolescents. There is an extremely high rate of sickness from acute respiratory diseases, especially amongst children attending preschool facilities.
• There are a lot of serious injuries, increasing number of allergic diseases, diabetes, diseases of the nervous system and behavioural disorders.
• Reduced physical activity and unhealthy eating habits are also leading to greater numbers of obese children and adolescents in the CR.
• There is no reduction in the numbers of neglected, maltreated and abused children – including commercially and sexually abused children.
• An increase has occurred in the syndrome of hazardous behaviour amongst adolescents.
The proportion of diseases followed up in children by chapters of ICD - 10,age group 0 - 14
Nervous system...22,8%
Endocrine...7,2% other
32,8%
Diseases of the skin
11,9%
Respiratory system25,3%
Source: The Institute of Health Information and Statistics of the Czech Republic
The proportion of diseases followed up in children by chapters of ICD - 10,age group 15 - 18
Respiratory system21,6%
Musculoskeletal system9,7%
other33,6%Endocrine...
9,6%
Nervous system...25,5%
Source: The Institute of Health Information and Statistics of the Czech Republic
Trend of the number of followed up children for Diabetes mellitus per 100 000 registered pacients in age group 0 - 14 and 15 - 18
0102030405060708090
100110120130140150160170180190200
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
age group 0 - 14age group 15 - 19
Source: The Institute of Health Information and Statistics of the Czech Republic
Trend of the number of alergic children per 1 000 registered pacients in age group 0 - 14 and 15 - 18
0
25
50
75
100
125
150
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005Source: The Institute of Health Information and Statistics of the Czech Republic
Trend of the number of followed up children for Asthma per 100 000 registered pacients in age group 0 - 14 and 15 - 18
0
800
1 600
2 400
3 200
4 000
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005Source: The Institute of Health Information and Statistics of the Czech Republic
Trend of the number of followed up children for Obesity per 100 000 registered pacients in age group 0 - 14 and 15 - 18
0
220
440
660
880
1 100
1 320
1 540
1 760
1 980
2 200
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005Source: The Institute of Health Information and Statistics of the Czech Republic
Trend of regular smoking of boys
in the period of 1994 – 2006
Vývoj pravidelného kuřáctví u chlapců v období 1994 až 2006
15,9
22,4
28,6
19,7
7,310,1
13,8
7,8
2,3 1,9 31,6
1994 1998 2002 2006 0
5
10
15
20
25
30
35%
11 let 13 let 15 let
Trend of regular boys‘ beer drinking
in the period of 1994 – 2006
Vývoj pravidelného pití piva u chlapců v období 1994 až 2006
35,4
29,3
36,9 35,8
16,4 15
21,1
14,910,5
14,19,3 9,1
1994 1998 2002 2006 0
10
20
30
40
50%
11 let 13 let 15 let
Beer drinking 6x and more during last 30 days
Girls / Boys
Age structure of first narcotics experience
Beer / Cigarettes / Marihuana / Ecstasy
Zdroj dat: Deaths - CZSO
Othersothers
1.1.1.1.3.Injury, poisoning and certain other consequences of external causesXIX.
8.7.9.10.5.Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classifiedXVIII.
6.6.4.4.2.Congenital malformations, deformations and chromosomal abnormalitiesXVII.
xxxx1.Certain conditions originating in the perinatal periodXVI.
5.4.5.5.6.Diseases of the respiratory systemX.
4.5.6.7.7.Diseases of the circulatory systemIX.
3.2.3.2.4.Diseases of the nervous systemVI.
2.3.2.3.9.NeoplasmsII.
Order of causes of death
15-1910-145-9 1-4 0
ageDeaths
Specific mortality rates - infants
0,02,0
4,06,0
8,010,012,0
14,016,0
18,020,0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
boysgirlstotal
per 1 000 inhabitants in corresponding age group
Source: Czech Statistical Office
Specific mortality rates - boys
0,0
0,2
0,4
0,6
0,8
1,0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
1-45-910-1415-19
per 1 000 inhabitants in corresponding age group
Source: Czech Statistical Office
Specific mortality rates - girls
0,0
0,2
0,4
0,6
0,8
1,019
8019
8119
8219
8319
8419
8519
8619
8719
8819
8919
9019
9119
9219
9319
9419
9519
9619
9719
9819
9920
0020
0120
0220
0320
0420
0520
06
1-45-910-1415-19
per 1 000 inhabitants in corresponding age group
Source: Czech Statistical Office
The proportion of causes of death in children till 1 year of ageby chapters of ICD - 10 Congenital
malformations18,8%
Symptoms, signs...4,0%
Injury, poisoning...5,4%other
9,9%
Nervous system4,0%
Of perinatal period58,0%
Source: The Institute of Health Information and Statistics of the Czech Republic
The proportion of causes of death in children 1 - 14 years oldby chapters of ICD - 10
Nervous system15,5%
Neoplasms19,3%
Injury, poisoning...36,2%
Congenital malformations
9,7%
Respiratory system5,8%
Circulatory system7,2%
other6,3%
Source: The Institute of Health Information and Statistics of the Czech Republic
The proportion of causes of death in children 15 - 19 years oldby chapters of ICD - 10
Circulatory system4,0%
Respiratory system2,8%
Injury, poisoning...73,8%
other5,6%
Neoplasms9,3%
Nervous system4,4%
Source: The Institute of Health Information and Statistics of the Czech Republic
Child Injury Mortality in the Czech Republic
• The Czech Republic ranges among countries with high rate of injuries.
• In the Czech Republic accidents are the most common cause of death of children and young adults .
• According to statistics, more than 100 children die each year as a result of accidents.
• Of these - more than 30% die as a result of traffic accidents
Injuries mortality – main causes, 2005
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Children (0-14) Adults (15-64) Seniors (65+)
Falls
Traffic accidents
Suicides
Drawing and notspecified
Other
0 1_4 5_9 10_14 15_19 0 1_4 5_9 10_1415_19Vniknuvší tělesa 14 1 2 1 4 10 1 1 3 3Popáleniny 1 1 0 2 0 0 1 0 1 4Otrava léky aj. 0 0 0 1 7 0 1 0 1 4Toxické účinky 0 1 0 0 11 1 1 0 5 12Syndromy týrání 0 0 0 0 0 1 0 0 0 0Omrzliny aj. nespecif. 3 7 6 10 40 3 7 6 10 31Dopravní nehody 2 6 12 9 100 1 7 15 21 118Pády 1 0 1 1 8 1 3 1 1 4Mechan.síly 0 1 0 0 4 0 1 1 1 1Tonutí 0 6 5 4 5 0 5 4 3 6Život.mechan.silám 0 0 0 0 0 0 1 0 0 0Kontakt s jed.živočichy,rostl. 0 0 0 1 0 0 0 0 0 0El. proud, plamen, kouř 1 3 0 2 2 0 1 0 0 4Úmyslné sebepoškození 0 0 0 8 43 0 0 1 8 43Napadení (útok) 3 0 1 2 3 2 1 0 2 2Komplikace zdravotní péče 0 0 0 0 0 0 0 0 0 0
20032004
0%
01_4Other 20 1 4 7 41 15 8 3 10 32
0% 20% 40% 60% 80% 100%
01_45_9
10_1415_19
01_45_9
10_1415_19
2005
2004
The most frequent causes of death in 2004 and 2005, children and youth people
Foreign bodyenteringPoisonning
Toxic effects
Frostbite andnot specifiedTrafficaccidentsFalls
Drowning
Other
National Action Plan on Child Injury Prevention for 2007-2017 (NAP)
• NAP is a systematic solution of the intentional and unintentional child injury prevention in children aged 0 - 18 years in the Czech Republic.
• NAP maps the current activities of the Czech Republic in the area of child injury prevention, it evaluates these activities in terms of the strengths and weaknesses, the utilisation of opportunities and diversion of threats, and it establishes the most important tasks of individual ministries for the period of 2007-2017.
• NAP was endorced by the Czech government on 22 August 2007
• One of the major tasks of the Ministry of Health is the development of the National Registry of Childhood injuries.
Conclusions• Medical care for children in the CR is at
hight level• Infant mortality is very low thanks of hight
level of perinatal care• The main cause of children deaths are
injuries• In the CR there is increasing trend of some
diseases (diabetes, allergic, asthma, obesity..)
Aimes• To keep a current level of perinatal care• To improve a preventive health care systém• To focus on social aspects of health• To deal with child injuries mortality and
morbidity. – Health of Children / Child Violence and Injury
Prevention will be proposed as one of priorities of the Czech Republic chairmanship of the EU in 2009
This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on thesubject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the dataincluded in this paper, nor does it accept responsibility for any use made thereof.