2007 Administrative Plan (Draft) Bureau of Health Promotion, DOH, Executive Yuan I. Introduction Healthy population is a part of national competitiveness and promoting power of national sustainable development as well. Due to changes in society, globalization of the economy, and steady improvement of education, sanitation, and health care standards, people's lifestyles and the demographic structure of Taiwan have begun changing rapidly in recent years. For instance, the proportion of elderly persons 65 years of age and over has risen from 3.49% at the end of 1975 to 9.74% at the end of 2005, and is expected to increase to 21.1% by 2016. With the aging of the population, the pattern of diseases had changed from acute infectious disease to chronic diseases. Cancer became the leading cause of death in 1982--more than twenty years ago--and has held that position until the present. According to potential years of life lost (PYLL) analysis of major causes of death among persons aged less than 70 in Taiwan in 2004, 24.5% of PYLL were attributed to malignant tumors, 17.8% to unintentional injuries, 15.2% to chronic diseases such as hypertension, diabetes, heart disease, cerebrovascular diseases, and kidney diseases (nephritis, nephrotic syndrome, and nephrosis). Most of the causes of death resulting in the greatest loss of potential years of life, apart from those connected with inheritable biological factors, are mainly connected with individual lifestyle factors such as exercise, smoking, dietary habits, and participation in regular disease screening. In line with DOH’s vision of “A Healthy Taiwan-Providing the Public a Healthy and Safe Lifestyle,” we hoped by way of prevention-oriented public health strategies of primary and secondary prevention to promote healthy living, improve self-management and construct e healthy lifestyles. Meanwhile, the early screening and appropriate treatment can reduce the incidence of chronic diseases and their complication, lessen the morbidity, disability, and death rates, and achieve the goal of promoting a healthy and high quality of life. The BHP will further promote healthy families, schools, workplaces, and communities, supporting citizens' wish to lead healthy and vigorous lives. The BHP's administrative goals and focal points for 2007 are as follows: 116098297 1/17 II. Administrative Goals and Focal Points for 2007 Promoting healthy life, enhancing self-management 1. Protecting people’s health via early detection and treatment of health problems by strengthening preventive health care services, providing screening for common cancers such as cervical and breast cancer; providing prenatal check-ups for pregnant women, fluoride protection on children's teeth, preventive health care services for children, and health check-ups for persons over 40 years of age. 2. Building healthy communities, healthy behaviors, and realizing the sustainable goal of autonomous health management by establishing diverse grassroots basic health care networks in conjunction with the Taiwan Six-Star Healthy Community Program, joining forces with private groups to train seed volunteers, and establishing localized assistance mechanisms via the cooperative training of city and county public health personnel. 3. Creating a healthy, smoke-free environment by promoting all-round tobacco control work, using marketing methods to strengthen anti-smoking awareness, establishing diverse smoking cessation services and support networks, strengthening healthy behavior maintenance and management, and working in concert with international anti-smoking campaigns. 4. Encouraging citizens to build healthy lifestyles to avoid cancer; promoting screening for cervical cancer, breast cancer, oral cancer, colon cancer, and other common cancers; establishing key indicators for major types of cancer; urging cancer centers to uphold treatment quality improvement guidelines; training cancer control manpower; and safeguarding treatment quality. 5. Establishing a genetic and rare disease control service network protecting the public's right to good health; implementing measures to improve the quality of eugenic health services; helping create healthy and safe campuses and promoting the healthy physical and mental development of children and adolescents in conjunction with the Ministry of Education; conducting referral, tracking, and management of high risk diabetes, hypertension, hyperlipidemia, and kidney disease patients, and establishing a comprehensive service network for these conditions. 116098297 2/17 III. Assessment Indicators Strategy performance goals Promoting healthy life, enhancing self-management 116098297 Assessment Indicators Assessment Assessment Assessment Weight indicators system method 1. Smoking rate 2 1 Questionnaire among persons 18 survey years of age and older 2. Standardized death rate due to cervical cancer 3 1 Statistical data 3. Mammogram rate among women 50-69 years of age 2 1 Statistical data 4. Colon cancer screening rate among persons 50-69 years of age 1 1 Statistical data 5. Standardized death rate due to accidental injury among persons 0-59 years of age 1 1 Statistical data 3/17 Assessment standards (Male smoking population 18 years of age and older + female smoking population 18 years of age and older /total population 18 years of age and older)x100 2007 Standardized death rate due to cervical cancer (the standardized death rate is based on the age structure of the 1981 mid-year female population in Taiwan) Mammogram rate among women 50-69 years of age (number of women 50-69 years of age who have received mammograms/total number of women 50-69 years of age)*100 Colon cancer screening rate among persons 50-69 years of age (number of persons 50-69 who have received colon cancer screening /total number of persons 50-69 of age) *100 2007 Standardized death rate due to accidental injury (the standardized death rate is based on the age structure of the mid-year 1981 population in Taiwan) 2007 Target value 20.4% 4.1 persons/ 100,000 population 9.5% 11% 23.75 persons/ 100,000 population Notes Strategy performance goals Assessment Indicators Assessment indicators 6. Establishment of an effective screening and abnormal case referral and tracking model 7. Willingness of married women 22-39 years of age to bear two children 8. Simplification of birth notification procedures 116098297 Weight 2 Assessment Assessment Assessment standards system method 1 Statistical data Community hypertension, high blood glucose and high cholesterol screening and abnormal case tracking success rate (number of persons receiving care after completion of tracking and referral/number of abnormal cases among persons 40 years of age and older screened for hypertension, high blood glucose, and high cholesterol)*100 2007 Target value 90% Notes Project implementation ended on Dec. 31, 2006 1 4/17 1 Statistical data Secure birth notification online transmission success rate (total number of hospitals and clinics using an online birth notification system incorporating a health certificate authentication (HCA) mechanism/total number of hospitals and clinics and public health bureaus/centers with delivery services during the year)*100 85% IV. Major Programs, 2007 Program name Program beginning and Management ending dates level (example: 1/1/07~12/31/07) 1. Community Executive Healthy Living Yuan Program 1/1/02~12/31/07 Subordinate projects Name No. 1. Taiwan Six-Star Healthy Community Program S020301 2. Challenge 2008 National Development Program 10.07.02 Estimated funding, 2007 Abstract of 2007 program content (in NT$ 1,000) 80,000 1. Establishment of diverse basic health care networks from the bottom up in conjunction with the Taiwan Six-Star Healthy Community Program, helping community residents to voluntarily undertake health-building work. 2. Realizing the sustainable development of health self-management by joining forces with private groups to train seed volunteers, and establishing localized assistance mechanisms via the cooperative training of city and county public health personnel. 3. Building on the certification of four communities (including Alishan Township in Chiayi County) as safe communities by the WHO by establishing safe community assistance centers, continuing to promote the safe community concept, and building a safe and livable community environment. 4. Building on Tainan City's experience as a member of the WHO's Western Pacific Healthy City Alliance by expanding implementation of healthy city demonstration projects, organizing a Taiwan 116098297 5/17 Program name Program beginning and Management ending dates level (example: 1/1/07~12/31/07) Subordinate projects Name No. Estimated funding, 2007 Abstract of 2007 program content (in NT$ 1,000) healthy city alliance, and adopting international health norms. 2.Five-year National Cancer Prevention Program DOH 1/1/05~12/31/09 - - 260,000 1. Appealing to the public to lead healthy lifestyles and prevent cancer. 2. Promoting screening for cervical cancer, breast cancer, oral cancer, colon cancer, and other common cancer. 3. Establishing key indicators for major types of cancer, urging cancer centers to uphold treatment quality improvement guidelines, and safeguarding treatment quality. 4. Working together with private groups to improve the quantity and quality of service to the sick and promote hospice and palliative care. 5. Using community resources to provide patients, the convalescing, and family members with a comprehensive support system. 6. Performing cancer research and training cancer prevention manpower. 3.Tobacco Control Program 116098297 BHP 1/1/07~12/31/07 6/17 - - 525,824 1. Using marketing methods to strengthen anti-smoking awareness, establishing diverse smoking cessation services and support networks, Program name Program beginning and Management ending dates level (example: 1/1/07~12/31/07) Subordinate projects Name No. Estimated funding, 2007 Abstract of 2007 program content (in NT$ 1,000) strengthening healthy behavior maintenance and management. 2. Implementing tobacco control assistance, investigations, and interdiction, training local government public health personnel in tobacco control skills. 3. Establishing a diverse smoking cessation service system, and continuing to provide the public with convenient, accessible smoking cessation advisory hotline services and outpatient smoking cessation treatment services in order to increase the smoking-cessation rate among smokers. 4. Conducting international tobacco control interchange and cooperation in conjunction with the WHO's anti-tobacco strategy. 4.Kidney Health Program BHP 1/1/07-12/31/07 - - 10,000 1. Conducting International Kidney Day awareness activities in conjunction with public health bureaus/centers and kidney health promotion organizations. 2. Using an integrated preventive health service platform to locate high-risk groups for kidney disease and abnormal cases, establish a kidney disease case management and tracking system, 116098297 7/17 Program name Program beginning and Management ending dates level (example: 1/1/07~12/31/07) Subordinate projects Name No. Estimated funding, 2007 Abstract of 2007 program content (in NT$ 1,000) and strengthen care quality. 3. Implementing a kidney health promotion organization establishment and quality monitoring program in order to establish a kidney health education system. 4. Establishing an integrated kidney disease joint care management system in order to improve case management, treatment and care, and referral data entry and query services. 5.Citizens Oral Health Program BHP 1/1/07-12/31/07 - - 130,500 1. Jointly promoting oral health and oral hygiene education in schools together with education units, and thereby enhancing public awareness of correct oral health knowledge. 2. Promoting use of fluoride as an anti-cavity measure, encouraging regular check-ups and early treatment of cavities. 3. Strengthening of oral self-care among the disabled and oral care skills among caregivers, establishment of an oral health care network for the disabled. 6.Genetic and Rare Disease Control Service 116098297 BHP 1/1/07-12/31/07 8/17 - - 104,146 1. Integrating rare disease prevention and treatment service networks, assistance, and early diagnosis and quick treatment. Program name Program beginning and Management ending dates level (example: 1/1/07~12/31/07) Network Program Subordinate projects Name No. Estimated funding, 2007 Abstract of 2007 program content (in NT$ 1,000) 2. Strengthening care for patients with rare diseases, providing subsidies or price reductions for eugenic health services, and helping patients to obtain drugs and special foods for rare diseases, easing the burden of patients' families. 3. Continuing to implement eugenic health service measures and rare disease check-up quality monitoring and QA measures. 4. Using diverse educational and awareness channels to promote correct knowledge of genetic and rare diseases, helping patients suffering from rare diseases to obtain public respect and acceptance. 116098297 9/17 V. Review of Implementation and Results during the Previous Two Years A. Administrative Performance and Achievements in 2005 2005 Administrative Programs (including tobacco control fund) Assessment indicators Original target value 1.Smoking rate 26.4% among persons 18 years of age and older Performance assessment and achievement analysis Smoking rate among persons 18 years of age and older fell to 22.63% in 2005. Key efforts during the year included: 1. Active promotion of outpatient smoking cessation services: Expansion of the hospital and clinic smoking cessation treatment service subsidy program was designed to boost system-level integration and provide service incentives. The BHP also increased subsidies for the "NT$100 Reward Program for Referring Pregnant Female Smokers to the Smoking Cessation Hotline." Output smoking cessation treatment services are now available in 358 of the 368 cities, towns, and townships in Taiwan, and 2,020 contracted hospitals and clinics are participating in outpatient smoking cessation services. Smoking cessation services are available in 97% of the country. Tracking of persons receiving smoking cessation services shows a smoking cessation success rate of 21.3% after six months, which shows the excellent smoking cessation support environment. 2. Promoting smoke-free restaurants: To protect the health and rights of consumers and ensure that citizens do not have to breathe second-hand smoke, the BHP worked to strengthen awareness and support of the public and restaurant owners, and used the "Tell everyone about it!" program to encourage restaurants to join the ranks of smoke-free establishments. This campaign reached and passed the goal of 10,000 smoke-free restaurants. Establishment of regular smoking monitoring mechanisms: The results of the second National Health Interview Survey show that, in 2005, among adults 18 years of age and older, the smoking rate for men was 39.88%, for women was 4.76%, and for all citizens was 22.63%. In addition, the smoking rate among adult men fell significantly from 48.2% in 2002 to 39.88% in 2005. This result indicates that smoking cessation activities and strategies are gradually having a positive effect. 116098297 10/17 2005 Administrative Programs (including tobacco control fund) Assessment indicators Original target value 2. Standardized 4.8 death rate due to persons/ cervical cancer 100,000 population Performance assessment and achievement analysis The standardized death rate due to cervical cancer was 4.4 persons per 100,000 population in 2004 (statistics for 2005 were not calculated before mid-2006). Key efforts during 2005 included: 1. Continued implementation of cancer screening, increasing the cervical smear screening rate among women 30 years old and over and reducing the standardized death rate due to cervical cancer; analysis of the cervical cancer death rate among women who received cervical smear screening during 1995-2001 shows that the cervical smear test has saved the lives of at least 7,600 women. 2. In a break with the conventional publicity and public health bureau station methods of public awareness, the BHP promoted an active reminder system at hospital outpatient departments, and established interdepartmental coordination mechanisms within hospitals. Hospital medical and nursing personnel actively remind women to receive cervical smear tests, and the rapid output test format has helped raise the screening rate. The BHP provided subsidies to 79 hospitals implementing this testing system. Furthermore, in consideration of the fact that hospitals on a total budget system are less willing to perform cervical smear tests, the BHP assists hospitals to remind women who have not had a test within three years; this approach improves efficiency, avoids redundant tests, and boosts hospitals' willingness to give the tests. The BHP integrated 27 cancer center programs so as to include output reminders of cervical smear tests among required cancer prevention items. 3. Screening in 2005 uncovered 56,126 positive cases; early discovery and treatment successfully stopped deterioration of symptoms in many cases. 3. Mammogram rate among women 50-69 years of age 6% 1. The mammogram rate among women 50-69 years of age was 7% as of the end of December 2005. The total number of women who had received mammograms since July 2002 passed 150,000 persons. 2. In order to promote the early discovery of breast cancer, the BHP induced the government to include mammograms among items eligible for health insurance payments, while 116098297 11/17 2005 Administrative Programs (including tobacco control fund) Assessment indicators Original target value Performance assessment and achievement analysis also strengthening media awareness and subsidizing breast cancer patient associations to conduct "awareness train" activities. The BHP also stepped up media awareness after the death from breast cancer of Shu-Ju Lin, the wife of the president of Hon Hai Precision Industry, and successfully brought about a dramatic short-term increase in the number of women receiving mammograms. 3. A total of 61,912 women 50~69 years of age received mammograms in 2005, resulting in 9,200 positive cases and 252 confirmed cases of breast cancer. The BHP actively provided follow-up tracking and referral services in these cases. 4.Colon cancer screening rate among persons 50-69 years of age 4% More than 210,000 persons received colon cancer screening in 2005, and this number was equivalent to 5% of all persons in the 50-69 age group. Key efforts during 2005 included: 1. In 2005 the BHP sent letters to 200,000 persons 50-69 years of age notifying them to receive fecal occult blood tests and also provided subsidies to persons with a family history of colon cancer receiving colonoscopic examination. 2. Following June 2005, thanks to the BHP's intensive media publicity campaign and public health bureaus' awareness efforts and prize drawings, etc., the public has had much greater awareness of the important of colon cancer screening and fecal occult blood tests. Citizens enthusiastically sought testing during the period of the campaign. 3. A total of 306,113 persons received the fecal occult blood tests for colon cancer during 2005, resulting in 12,503 positive cases and 289 confirmed cases of colon cancer. Early discovery and treatment successfully stopped deterioration of symptoms in many cases. 5.Standardized death rate due to accidental injury among persons 0-59 years of age 116098297 22.39 The standardized death rate due to accidental injury among persons/10 persons 0-59 years of age was 24.58 persons per 100,000 0,000 population in 2004. (statistics for 2005 were not calculated population before mid-2006). Key efforts during 2005 included: 1. Promotion of accidental injury prevention monitoring: The BHP provided assistance to 25 cities and counties for the 12/17 2005 Administrative Programs (including tobacco control fund) Assessment indicators Original target value Performance assessment and achievement analysis establishment of accidental injury prevention task forces responsible for improving the quality of accidental death statistics and using cause of death statistical workshops to help cities and counties to clarify the state of accidental injuries and prioritize the problems. 2. The BHP established an accidental injury monitoring network and promoted a Taiwan-wide accidental injury monitoring network. The BHP held explanatory meetings and seminars to encourage the recording and database storage of the injury mechanisms and external wounds of patients hospitalized for accidental injuries. 3. The BHP promoted safe communities and accepted certification from WHO personnel in Taiwan. The "Neihu District urban community, Taipei City," "Tungshih towns/townships community, Taichung County," "Alishan mountain aboriginal community, Chiayi County," and "Fengpin Township coastal aboriginal community, Hualien County" were certified as safe communities. These four communities joined the world's top 100 safest communities after the WHO conducted certification in October 2005. 6. Establishment of an effective screening and abnormal case referral and tracking model 88% 7.Willingness of married women 22-39 years of age to bear two children 61% Screening uncovered 233,637 cases of hypertension, high blood glucose, and hyperlipidemia in 2005. 1. The "2005 Survey of Citizens' Attitudes towards Marriage and Reproduction" (valid sampling of 2,240 persons, including 1,014 married individuals) revealed that, in 2005, 66.2% of women 22-39 years of age indicated willingness to bear two children. 2. The BHP conducted a vigorous awareness campaign aimed at boosting the public's concern for "rebuilding reproductive family values," "sharing of marriage and family responsibilities by men and women," and "cherishing life, respecting tradition." The BHP used radio, television, magazines, the Internet, bus, and light box advertisements to strengthen public awareness and understanding of this issue, 116098297 13/17 2005 Administrative Programs (including tobacco control fund) Assessment indicators Original target value Performance assessment and achievement analysis and thereby increasing willingness to raise more children. 3. The BHP actively promoted the Mother-Baby Friendly Hospital and Clinic Certification Program and encouraged regional hospitals and primary-level medical organizations and hospitals to participate. In 2005, 101 hospitals submitted applications and 81 passed certification. This program has helped create a superior reproductive health support environment. 8.Simplification of birth notification procedures 30% 1. As of the end of December 2005, the BHP had helped 502 hospitals and clinics (including public health bureaus and centers) providing delivery services adopt simplified birth notification procedures; of these, 156 hospitals and clinics currently employ the health certificate authentication (HCA) mechanism to implement online birth notification. 2. Starting in 2005, the information on the second leaf (residential administration leaf) of the birth notification form has been sent to the Ministry of the Interior via the Internet. Online transmission of birth notification information has shortened average notification time to less than four days, while improving correctness. This system allows the government to keep track of newborn data in real-time and analyze birth defect types, etc. 3. In 2005, the BHP trained personnel from 200 hospitals and clinics offering delivery services how to use the HCA mechanism to perform online transmission of birth notification information. 116098297 14/17 B. Administrative Performance and Achievement thus far in 2006 2006 Administrative Programs (including tobacco control funding) Assessment indicators Performance assessment and achievement analysis 1. Smoking rate 1. With regard to smoking cessation consulting hotline (0800-636363) among persons services, thus far this year the BHP has provided services to 7,976 18 years of persons and telephone counseling services to 1,938 persons. Persons who age and older received counseling several times after six months had a smoking cessation success rate of 26.06%. 2. With regard to training of tobacco control manpower, the BHP conducted "City and County Tobacco Monitoring Data Application Workshops" attended by more than 100 personnel from 25 city and county public health bureaus. 3. With regard to smoking behavior surveys, the BHP completed amending a questionnaire for the "2006 Adult Smoking Behavior Survey," and has begun implementing adult smoking behavior survey and monitoring work. It is expected that data analysis will be completed by the end of 2006. The adult smoking data obtained this year will be used for administrative reference. 2. Standardized death rate due to cervical cancer 1. Cervical smear tests are provided to women 30 years of age and over by contracted medical organizations, city and county public health bureaus/centers, and community stations. At least three million women had received at least one test within the previous three years as of the end of April 2006. 2. A comparison of standardized death rates due to cervical cancer (the standardized death rate is based on the age structure of the 1981 year-end female population in Taiwan) shows that the death rate fell from 7.0 persons per 100,000 population in 1995 to 4.4 persons per 100,000 population in 2004 (statistics for 2005 were not calculated before mid-2006). 3. Mammogram rate among women 50-69 years of age 116098297 1. Mammograms are provided to women 50-69 years of age by contracted medical organizations, city and county public health bureaus/centers, and community stations. A total of more than 170,000 women received mammograms from July 2002 to the present (not including repeated mammograms). The BHP expects to easily reach its mammogram target 15/17 2006 Administrative Programs (including tobacco control funding) Assessment indicators Performance assessment and achievement analysis by the end of the year. 2. The BHP has been actively taking advantage of various media and major holidays to promote awareness of screening for women's cancers. 4. Colon cancer 1. Fecal occult blood tests are provided to persons 50-69 years of age by city screening rate and county public health bureaus/centers and community stations. Colon among persons cancer screening services have been provided to a total of more than 50-69 years of 280,000 persons since the BHP began promoting this work in January age 2005 (not including repeated tests); 6.9% of persons 50-69 years of age have now received colon cancer screening services. The BHP expects to easily reach its target by the end of the year. 2. The BHP has been actively taking advantage of various media and major holidays to promote awareness of screening for colon cancer. 3. The BHP is continuing to implement fecal occult blood test quality improvement program in conjunction with the Taiwan Society of Laboratory Medicine. 5. Standardized death rate due to accidental injury among persons 0-59 years of age 1. The BHP has been promoting the certification of the Neihu District of Taipei City, Tungshih in Taichung County, Alishan Township in Chiayi County, and Fengpin Township in Hualien County as safe communities by the WHO in 2005. The BHP has been continuing to help the foregoing safe communities to perform relevant tasks and create safe and livable communities. The BHP has also expanded the scope of this program to nine communities this year, and has been jointly implementing an accidental injury and safety promotion program with the goal of establishing a Taiwan-wide safe community network. 2. The BHP continued to implement the "Child Accidental Injury Prevention Program for Foreign and Chinese Spouses," and recruited and trained volunteers to serve in "mountain town work teams." The BHP is currently conducting residential environment inspection work to protect the safety of the children of foreign and Chinese spouses. 6. Establishment of an effective screening and 116098297 1. The BHP held the "Conference on Cases and Suspected Cases of Hypertension, High Blood Glucose and High Cholesterol" in order to improve the service skills of county and city public health bureaus 16/17 2006 Administrative Programs (including tobacco control funding) Assessment Performance assessment and achievement analysis indicators abnormal case performing three-in-one screening. Around 50 persons attended this referral and conference, at which the issues screening and referral and tracking of tracking model abnormal cases were discussed. The conference helped the participants establish a standard working model facilitating effective communication and policy transmission between local and central government units. 2. The BHP is conducting three-in-one screening services in all counties and cities. It is projected that a total of 390,000 persons will receive this screening this year. However, since cases and suspected cases of hypertension, high blood glucose, and high cholesterol are not tracked until after the diagnosis is confirmed, the ultimate referral and care completion rate for 2006 will not be known until final statistical analysis is performed at the end of the year. 7. Willingness of married women 22-39 years of age to bear two children 1. The BHP held the "Darling Baby Birth Convention--Birth Encouragement Slogan Contest," at which 122 slogans were entered. 2. The BHP's "Project for Assessment of Health Education and Awareness Strategies Encouraging Reproduction" assessed the effectiveness of the "Health Education and Awareness Program Encouraging Reproduction" (implemented 2004-2006) in order to guide future administrative planning and help the Ministry of the Interior implement population policies. 3. The BHP is currently using advertising media including MSN, radio, Taipei buses, Watson's TV displays, magazines, and television to create awareness, and has invited media figure Shih-Ping Tsai to help encourage couples to have children. 8. Simplification of birth notification procedures 1. With regard to use of the HCA mechanism to implement online birth notification procedures, the BHP had promoted use of HCA notification at 180 hospitals and clinics by the end of May, and had achieved a success rate of 35.09% (180 out of 513 hospitals and clinics providing delivery services had adopted HCA notification). 2. The BHP began implementing health certificate authentication (HCA) training for online birth notification systems in May, and expects to complete 30 training sessions by October. 116098297 17/17