Εθνικό Σχέδιο Δράσης Για Τα Καρδιαγγειακά Νοσήματα

Objectives

Greece’s National Action Plan for the Prevention of Cardiovascular Diseases, within the 2008–2012 National Action Plan for Public Health and the wider chronic-disease plan, seeks a sustained national response that reduces cardiovascular morbidity, mortality, disability and socioeconomic burden while improving survival, quality of life and equitable access to effective prevention, treatment and rehabilitation.[1][2][3][4]The plan aims to reduce cardiovascular morbidity and mortality progressively by up to 10% by 2012 and narrow Greece’s gap with other Western European countries, particularly for ischaemic heart disease.[3][5][4]

• Strengthen population-wide primary prevention and risk-factor control, focusing on smoking and passive smoking, unhealthy diet, obesity, physical inactivity, harmful alcohol use, hypertension, diabetes and hypercholesterolaemia.[2][6][7][8]
• Promote healthy living through physical activity, healthier diets with reduced fat, sugar and salt, healthy weight maintenance, and health-promoting environments in schools, workplaces and communities.[9][10][11]
• Expand secondary prevention through organised population screening, early diagnosis and control of hypertension, diabetes and hypercholesterolaemia, especially through national, regional and local programmes.[5][6][8][12]
• Improve therapeutic and rehabilitation services by upgrading cardiology clinics, strengthening continuity between secondary care and follow-up, developing referral networks, and improving patients’ and families’ quality of life.[6][13][14][15]
• Reduce inequalities by applying universal access, equity, safety, patient empowerment and quality-service principles, while addressing the concentration of cardiovascular risks and mortality among disadvantaged groups.[16][10]
• Strengthen research, scientific evidence, public awareness, intersectoral cooperation and social participation to support cardiovascular prevention policy.[3][17][18]

Implementation

Implementation combines national coordination with multi-sectoral delivery across prevention, screening, clinical care, service quality, communication and research.[8][19]The Ministry of Health and Social Solidarity is a central implementing body, working with other ministries, regional health authorities, local government, National Health System hospitals and health centres, universities, professional associations, civil-society organisations, employers, trade unions and mass media.[20][21][22][13]Governance is to be led by a National Coordination Committee for Cardiovascular Diseases, supported by the National Public Health Council and the Secretary-General of Public Health, with responsibility for priorities, coordination, monitoring and reporting to the Minister of Health and Social Solidarity.[23][19]

• Deliver health education for children, young people, parents, teachers and school communities on nutrition, physical activity, obesity, alcohol and tobacco prevention, with planning and material development in 2008–2009, delivery from 2009–2012 and evaluation in 2012.[24][21]
• Implement workplace and population-wide information campaigns through occupational physicians, employers, trade unions, healthcare providers and mass media, with activities delivered during 2009–2012 and evaluations scheduled for 2012.[22][25]
• Promote physical activity through communication materials, local educational activities and local-authority programmes, while cooperating with the National Action Plan for Nutrition and Eating Disorders.[11]
• Deliver screening and intervention through primary and secondary care units, supported by professional awareness-raising, clinical guidance, diagnostic measurements and cooperation with local authorities and civil-society organisations.[12][13][14]
• Upgrade National Health System cardiology clinics through infrastructure, equipment and staffing improvements; link cardiology units with post-treatment follow-up; and establish university-hospital reference centres to support treatment, case recording and assessment.[14][15]
• Establish quality standards, accreditation and certification for private secondary cardiovascular-care units, including oversight of staff competence, equipment and consumable materials.[26][27]
• Coordinate nutrition, food safety, physical-activity, smoking and alcohol measures through cross-government and international cooperation, including engagement with the food industry, sports providers, the European Union, the World Health Organization, the Food and Agriculture Organization and Codex Alimentarius.[28][29][30]
• Commission prevention research during 2008–2011, assess interventions, develop good practice, connect evidence with a geographical health-information base, and disseminate evidence through internet-accessible national resources.[17][23][18]
• Monitor morbidity and mortality, screening participation, patient survival, quality of life, service quality and case patterns; conduct continuous evaluation, public consultation and accountability, although detailed indicators, reporting intervals and data-source requirements are not specified.[5][15][19][18]

Monitoring & Evaluation

The plan establishes continuous monitoring, evaluation and public accountability as core implementation functions, coordinated through national committees and supported by policy review, public consultation, research and epidemiological evidence.[20][31][17][19]It specifies outcome targets including reducing cardiovascular morbidity and mortality by up to 10% by 2012, reducing general smoking prevalence by 10%, reducing smoking among people aged over 15 by 15%, reducing per-capita alcohol consumption by 15%, and reducing alcohol consumption among adolescents and young people by 20%.[3][5][32][33]

• Monitor cardiovascular morbidity, mortality, patient survival, quality of life, uptake of organised population screening, and the quality and effectiveness of prevention, treatment and rehabilitation services.[3][5]
• Operate continuous monitoring, periodic review and revision of objectives and actions, with public consultation and accountability for progress and results.[20][19]
• Track changes in smoking behaviour and tobacco-control results, and use action-plan monitoring indicators to assess alcohol-related action, although the underlying numerical indicators, data sources and reporting frequency are not specified.[32][31]
• Undertake formal evaluations in 2012 for school-based cardiovascular prevention, workplace awareness, national health-promotion campaigns and physical-activity activities.[21][25][11]
• Record and assess cardiovascular cases through primary and secondary care, analyse statistical, temporal and geographical patterns, and use a central health chart to support quality certification of private cardiovascular-care units.[15][26]
• Support surveillance through school monitoring of nine adolescent cardiovascular risk factors, regular European and national statistical studies, risk assessment using HeartScore, and research data linked to a geographical health information base.[34][35][36][23]
• Assign national coordination and monitoring to the National Coordination Committee or National Coordinating Committee for Cardiovascular Diseases, with reporting to the Secretary-General of Public Health and the Minister of Health and Social Solidarity.[17][23][19]

Monitoring arrangements are therefore substantial in principle, but the document does not consistently specify a unified indicator framework, reporting timetable, data-quality procedures, independent evaluation method or formal accountability sanctions.[3][5][19][18]

Costing & Financing

The plan contains no explicit implementation budget, dedicated funding allocation, financing gap or comprehensive resource-mobilisation strategy for cardiovascular actions.[3][5][6][7]It nevertheless presents cardiovascular disease as a major economic burden and anticipates savings from prevention, early diagnosis and improved pharmaceutical management.[37][7][8]

• Mobilise financial resources through specialised European Union programmes and increase government support for research on cardiovascular disease prevention and treatment, although no allocations are specified.[38][9]
• Recognise that cardiovascular disease cost Greece an estimated 1,921.7 million euros in 2006, equivalent to 10% of total health expenditure; reported components were 810.342 million euros for hospital care, 990.169 million euros for pharmaceutical care, 93.554 million euros for outpatient and emergency care, and 27.645 million euros for primary care.[39][37]
• Anticipate a 15% reduction in pharmaceutical expenditure, estimated at 150 million euros, and a 5% to 7% reduction in hospital expenditure, estimated at 40 to 55 million euros, from prevention and improved pharmaceutical management.[37]
• Estimate Greek indirect cardiovascular costs at 669 million euros from productivity losses and 388 million euros for care of cardiac patients, totalling 1,057 million euros; total annual costs, including environmental expenditure, are estimated at approximately 3 billion euros.[7]
• Estimate that prevention and improved diagnosis could reduce productivity losses by 15%, corresponding to approximately 100 million euros annually in long-term economic benefit.[7]
• Report European annual cardiovascular costs of 192 billion euros, or 391 euros per person, with 57% attributed to healthcare-system expenditure, 21% to productivity losses and 22% to informal care.[40]
• Identify obesity and hypertension as material expenditure pressures, estimated to account for more than 7% and approximately 4.5% of health expenditure respectively.[41][42]

The cited costs serve primarily as economic rationale rather than as a costed investment plan. Detailed action-level costs and financing sources are intended for a separate economic-study volume, but are not provided in the available text.[43][7]