Health in Slovenia Health in Slovenia HEALTH IN SLOVENIA Editors: Metka Zaletel, Damjana Vardič, Marjana Hladnik, Mojca Simončič Authors: Sabina Bagar, Marjana Hladnik, Marjetka Hovnik Keršmanc, Natalija Kranjec, Tatjana Kofol Bric, Helena Koprivnikar, Tanja Kustec, Irena Majcan Kopilović, Barbara Mihevc Ponikvar, Maja Mrzel, Mojca Simončič, Jana Skrt, Lidija Stanković, Marina Sučić Vuković, Vili Prodan, Marija Pšeničnik, Maja Praprotnik, Sandra Radoš Krnel, Maja Roškar, Damjana Vardič, Anja Varga, Metka Zaletel, Klavdija Žalman Expert review of individual chapters: Ada Hočevar Grom, Ivan Eržen, Mateja Jandl, Nataša Kovač, Nevenka Kelšin, Dominika Novak-Mlakar, Petra Ogrin-Rehberger, Radivoje Pribaković Brinovec, Agnes Šömen Joksić, Irena Veninšek Perpar, Tina Zupanič, Tina Žagar Translation: Mihaela Törnar Proofreading: Amidas d.o.o., 1000 Ljubljana Design: Erna Pečan Publisher: National Institute of Public Health, Trubarjeva cesta 2, 1000 Ljubljana Place and year of publishing: Ljubljana, 2021 Web edition Publication is available at NIJZ website: www.nijz.si. Copyright: ©2021 NIJZ All rights reserved. Reproduction in whole or in part in any way or any medium is not allowed without written consent of the authors. Infringements are sanctioned in accordance with copyright and criminal law. Kataložni zapis o publikaciji (CIP) pripravili v Narodni in univerzitetni knjižnici v Ljubljani COBISS.SI-ID 69401603 ISBN 978-961-6945-39-4 (PDF) Colophon 2 27 45 Contents Health determinants Primary health care 3 Dietary habits 28 Health care of all population groups 46 Abbreviations and acronyms Overweight and obesity 29 4 Physical activity Community nursing and 30 home care 47 Introduction Alcohol use 31 6 Dental services 48 Tobacco smoking 32 Illicit drug use 33 Drinking water monitoring 34 Secondary and tertiary health care 49 Demography and Air pollution - Ground-level 7 Specialist outpatient service 50 socioeconomic data ozone 36 Air pollution - PM10 and PM2.5 Hospital discharges 37 52 Air pollution - Pollen Rehabilitation services 38 54 Health status 10 Deliveries and childbirths 11 Ambulatory prescribed medicines 55 Mortality 12 Preventive services 39 Fetal deaths 14 Vaccination coverage 40 Infectious diseases 15 Colorectal cancer screening Health care resources 58 Diseases of the circulatory programme 41 system 16 Cervical cancer screening Diabetes programme 18 42 Cancer Breast cancer screening Health expenditure and sources of 20 programme 43 funding 61 Accidents at work 22 Health education 44 Transport accidents 23 Sick leave 25 COVID-19 epidemic in Slovenia 63 4 Health in Slovenia Abbreviations and acronyms ARSO Slovenian Environment Agency ATC Anatomical Therapeutic Chemical Classification of Medicines The ATC classification of medicines is an international universal classification system for medicines. The ATC classification serves as a tool in research on the use of medicines, where the basic aim is to improve the quality of the use of medicines. The ATC classification system classifies medicines according to their main indication (in the case of several component medicinal products, the indication refers to the main active substance). BMI Body Mass Index BMI is the ratio of body weight to the square of body height, expressed in kg / m2. According to the BMI, the nutritional status of adults is divided into the following categories: up to 18.4 malnutrition, from 18.5 to 24.9 normal nutrition, from 25.0 to 29.9 overnutrition, from 30.0 to 34.9, obesity level I, from 35.0 to 39.9 obesity level II, 40.0 and over extreme obesity (level III). CINDI Health-Related Behavioural Style Survey The Health-Related Behavioural Style survey was conducted among the adult population of Slovenia in 2001, 2004, 2008, 2012 and 2016. It aims to identify the prevalence and interrelationship of risk factors for non-communicable diseases in adults, in terms of smoking, drinking, eating and exercise habits, as well as road safety behaviour and the use of certain health services. Based on the collected data, it will be easier to design future programmes for improving the health of all those who live in Slovenia inhabitants, and the data also help in meaningful planning of preventive health activities. DDD Defined Daily Dose By definition, a DDD is a statistical unit defined by the World Health Organization to determine the consumption of a medicine. DDDs are used for standardized comparisons of the consumption of different drugs with each other or between environments with different health care systems. DID Defined Daily Doses per 1,000 inhabitants per day DORA DORA is an organized population screening programme for early detection of breast cancer in women aged 50 to 69. ECDC European Centre for Disease Prevention and Control ECIS European Cancer Information System EEA European Environment Agency EHIS European Health Interview Survey The European Health Interview Survey asks about the health status of inhabitants, how often they use different health services and what their health-related lifestyle is. EMCDDA European Monitoring Centre for Drugs and Drug Addiction EU European Union EUR Euro EUROSTAT Eurostat is the European Union’s statistical service responsible for publishing high-quality, pan-European statistics and indicators that allow comparisons between countries and regions. GDP Gross Domestic Product GDP is equal to the value added at basic prices by activities, as increased by taxes on products and services and reduced by subsidies by products and services. GDP is therefore equal to the sum of value added at basic prices of all domestic (resident) production units and net taxes on products and services (taxes on products and services, less subsidies for them). Health in Slovenia 5 HBSC Health Behaviour in School-Aged Children study Health Behaviour in School-Aged Children is an international study conducted every four years. A survey was conducted by the National Institute of Public Health in 2002, 2006, 2010, 2014 and 2018. The international questionnaire includes a series of mandatory questions on demographic, behavioural and psychosocial aspects of health. In addition to these, participating countries can add a number of optional questions to help them observe individual content areas more closely. Mandatory questions cover the following content areas: demography, dietary habits, weight loss and physical self-image, physical activity, sedentary behaviours, risky behaviours, sexual health, injuries and violence, family, peers, school, health and well-being, social inequalities. HIV Human Immunodeficiency Virus ICD International Statistical Classification of Diseases and Related Health Problems is an international standard for health data, clinical documentation, and statistical aggregation. NIJZ National Institute of Public Health NLZOH National Laboratory of Health, Environment and Food OECD Organisation for Economic Co-operation and Development PM Particulate matter Atmospheric particles or aerosols are small solid and liquid particles that are suspended in the gas phase. Therefore, we say that an aerosol is a dispersion system. PM10 Particulate matter with an aerodynamic diameter of less than 10 µm PM2.5 Particulate matter with an aerodynamic diameter of less than 2.5 µm PPP Purchasing Power Parity PPP is a code for an artificial, fictitious currency, which is equal to one euro at the level of the EU average. At present, 1 PPP is equal to 1 euro at the EU-28 level. The PPP or “EU-28 Euro” is the “currency” that reflects the average price level in the EU-28. SARS-CoV-2 Virus that causes COVID-19 SDR Standardized death rate When standardizing by age in epidemiological analyses we use the European standard population (Doll 1976) in international comparisons when countries from Europe are included SHA System of Health Accounts SLO Slovenia SURS Statistical Office of the Republic of Slovenia Svit Programme The Svit Programme is a national screening and early detection programme for colorectal cancer, which has been operating at the national level since 2009. It runs under the auspices of the Ministry of Health of the Republic of Slovenia and is managed by the National Institute of Public Health. TB Tuberculosis TBE Tick-borne meningoencephalitis URI University Rehabilitation Institute of the Republic of Slovenia – Soča WHO World Health Organisation ZORA ZORA is a preventive programme for the detection of precancerous and early cancerous changes in the cervix. ZZZS Health Insurance Institute of Slovenia Health in Slovenia 6 Introduction Health has become the greatest value during the syndemic period, which is affecting all other aspects of life. Monitoring information on population health and health system use proved even more important during the COVID-19 epidemic than before. We measure health and performance of the health care system with a number of indicators that are internationally comparable, as only geography- and time-comparable quality indicators can provide an appropriate basis for decision-making on health and social policies. Slovenia has a well-developed health information system that draws data from regular databases, managed by the NIJZ, The Oncology Institute, ZZZS, SURS, University Clinic Golnik and many other institutions, as well as from national surveys also conducted by several institutions (NIJZ, SURS, IER, etc.) and in combination with some other databases, which further enrich the above with additional information. In 2019, the health information system was assessed by the World Health Organization as adequate, both in terms of the scope and completeness of information as well as the quality of data. This confirms that our system meets international data processing and reporting standards. In the last decade, the NIJZ has been building a system for the dissemination of health information, and we specially emphasise the following key cornerstones: • The data portal (podatki.nijz.si) is a single website for data in the field of health and health care, and thus enables the simplification of information retrieval and the re-use of already published data. Published data are free of charge and accessible to everybody. Links to other organizations that collect data related to health and health care of the population have been added to the portal (e.g., www.stat.si, www.slora.si, etc.). • The Health Statistical Yearbook of Slovenia is an extensive publication that presents information on population health, the health care system, health care financing and the importance of the environmental impact on population health in the broadest sense. The beginnings of the publication date back to 1965, and in 2013 it was thoroughly renewed and updated. • Health in the Municipality (obcine.nijz.si) is a portal aimed to serve local decision-makers. The portal provides health indicators at the municipal level and some related information such as thematic maps, thematic articles, etc. • Interactive displays of current data on COVID-19 and vaccination against COVID-19. All these cornerstones are created in cooperation with other institutions that manage databases in a quality manner and therefore their participation in the creation of health information is invaluable. Interinstitutional cooperation has also proved to be very important in this case. Last but not least, we must also thank all the data providers – health care providers at all levels and the people involved in national health and health care research. The present publication is a brief summary of all the dissemination cornerstones listed. The aim of the publication is to offer the reader a quick insight into various indicators of health and health care, to show a comparison with the European Union, and at the same time to direct them to find more information on one of the listed extensive portals and publications. We wish the publication to find its way among users – from policy makers, the general public, the professional public, to journalists, and direct them to where they can find even more detailed information and additional explanations. Milan Krek, MD The director of the National Institute of Public Health Health in Slovenia 7 1 DEMOGRAPHIC AND SOCIOECONOMIC DATA 8 Health in Slovenia BASIC DEMOGRAPHIC AND SOCIOECONOMIC DATA The population of Slovenia has increased by 39% since 1953 and in 2019 amounted to 2,089,310, while, in the same period, the number of live births per 1,000 population decreased by 59%. In 2019, a total of 19,054 live births occurred and 20,588 persons died. Life expectancy at birth was 78.7 years for men and 84.5 years for women in 2019. Socioeconomic factors have a significant impact on health status and health inequalities among the population in individual geographical areas. GDP per capita in Slovenia has been increasing over the years on average. The registered unemployment rate in Slovenia has been declining in recent years, standing at 7.7% in 2019. The Slovenian population has been slowly increasing since 1953, mainly due to immigration and longer lifespans, while the number of live births has been mostly decreasing. Due to major changes in the age structure of the population, the population Population: Population: pyramid no longer has the appearance of a pyramid. The share 2,089,310 513,093,556 of children and young people up to the age of 25 has decreased significantly, while the share of the population aged 50 and over GDP: GDP: has increased. The dynamics of population ageing are very fast, EUR 23,170 EUR 32,020 which needs to be considered when preparing country specific per capita per capita strategies. The comparison of Slovenian population pyramids for the years 1953 and 2019, and a projection for 2059 1953 2019 2059 (projection) 85+ 80-84 75-79 8% 20% 31% 70-74 65-69 60-64 55-59 50-54 45-49 40-44 51% 35-39 56% 60% 30-34 25-29 20-24 15-19 10-14 20% 5-9 37% 18% 0-4 years Men Women Men Women Men Women Demographic and socioeconomic data 9 Population aged 0-14 years and 65 years and over, Slovenia Life expectancy at birth, by gender, Slovenia and the EU, 2019 and the EU, 2019 and deviation from 2010 and deviation from 2010 2019 (%) Deviation from 2010 (percentage point) 2019 (years) Deviation from 2010 (years) SLOVENIA SLOVENIA 0-14 years 15.1 +1.1 Men 78.7 +2.3 65 years 19.8 +3.3 Women 84.5 +1.4 and over EU EU Men 78.5 +1.8 0-14 years 15.5 -0.2 84.0 +1.1 65 years 20.0 +2.5 Women and over Life expectancy at birth in Slovenia, as in other EU countries, is higher for women than for men. In Slovenia in 2019, we are still recording an increase in the life expectancy of men and women, but it is slowing down. The registered unemployment rate in Slovenia is higher for women than for men. In 2019, it was 6.9% for men and 8.5% for women. Natural increase, Slovenia and the EU, 1961-2019 Per 1,000 inhabitants 9.4 In the EU, natural In Slovenia, we increase has been Growth in consistently positive 8.4 first detected a natural over the last 50 years, Slovenia negative natural 5.8 increase in increase in 1993 and in 2015, negative Slovenia (more people natural increase was from 2003 died than detected for the to 2010. were born). first time. EU 1.9 1.8 -0.1 -0.2 -0.6 -0.2 -0.8 -1.1 1961 1970 1980 1990 1993 2000 2010 2019 Natural increase is the difference between the number of live births and the number of deaths in the observed period. Sources: SURS and EUROSTAT Health in Slovenia 10 2 HEALTH STATUS 11 Health in Slovenia DELIVERIES AND CHILDBIRTHS In 2019, a total of 18,794 deliveries or 19,141 childbirths occurred in Slovenia. 19,054 children were born alive, of which 52% were boys and 48% girls. Among live births in Slovenia, 96% were singletons and 4% were children from multiple pregnancies. Both the birth rate and overall fertility rate have declined compared to 2018. With 9.1 live births per 1,000 population, we are below the EU average. The overall birth rate has been relatively stable over the last decade, but not enough for the natural regeneration of the population. Premature birth and low birth weight are among the most More than 80% of fathers important causes of morbidity and mortality in newborns in the are present at births. developed world. In 2019, 0.9% of live births in Slovenia were born with a birth weight of less than 1,500 grams, and 5.0% of live births weighing between 1,500 and 2,499 grams, which is Health during pregnancy, childbirth and early childhood has comparable to previous years and the EU average. a key impact on adult health and is therefore a cornerstone of public health. The average age of pregnant women has increased by one year in the last decade and it exceeded 31 years in 2019. Total fertility rate, Slovenia and the EU, 1980-2016 The average age of primigravidae is a year and a half lower. The increasing trend of the average age of pregnant women has 2.1 Slovenia % been slowing down in recent years. 1.6 1.9 1.4 Live births, Slovenia, 2019 EU 1.6 18,373 1.2 675 6 1980 1986 1992 1998 2004 2010 2016 Perinatal mortality is one of the most significant health and health care indicators of mothers and newborns, and of the The most recent quadruplets general population. In 2019, the perinatal mortality of children were born in 2013. weighing 1,000 grams and over was 2.2 per 1,000 births. Perinatal mortality regardless of the birth weight of the child, was 5.3 per 1,000 births. Both values are comparable to previous years. The highest birth rate is typically for women aged 25 to 34 years. Stillbirth represented 85% of all perinatal mortality. In 2019, women in this age group gave birth to two-thirds of all In Slovenia, the share of children born by caesarean section has children. The birth rate among adolescents is low in Slovenia. risen sharply in the last two decades, with more than one in five children is born this way, but we still rank below the EU average. Sources: NIJZ and WHO Health status 12 MORTALITY In 2019, a total of 20,588 Slovenian inhabitants died, out of which 10,112 were men and 10,476 women, or 103 persons (0.5%) more than in the year before. The mean age at death is increasing. Thus, on average, men lived for 74 years and women for 82. The standardized death rate (SDR) has been declining in Slovenia over the last three decades. The leading causes of death in Slovenia remain diseases of In Slovenia, 3,288 persons died before the age of 65 in 2019 the circulatory system (among the most common are heart (representing 16% of all deaths). Among men, mortality (SDR) attack, stroke and other heart diseases) and neoplasms (lung, is 1.7 times higher, whereas premature mortality (0-64 years) is gastrointestinal, prostate and breast cancer), which were the more than twice as high (2.2 times) compared to women. cause of 69% of all deaths in 2019. This is followed by injuries, poisonings and other external causes, as well as diseases of the gastrointestinal tract and respiratory system. Regarding On average, we die older or live longer than the distribution of the underlying causes of death, Slovenia is thirty years ago. In 1990, the average age at comparable to other EU countries. death was 70, and in 2019 it was 78. Standardized death rate (general and premature), by gender, Slovenia, 2010-2019 SDR per 100,000 inhabitants Men Women 800.2 All ages 661.1 448.7 395.0 All ages 277.2 0-64 years 207.9 119.0 0-64 years 95.8 2010 '13 '16 2019 2010 '13 '16 2019 Infant mortality is an important indicator of the quality Premature standardized death rate (0-64 years), Slovenia and and accessibility of health care and of the impact of other the EU, 2015 determinants of population health and culture. In 2019, 40 infants died in Slovenia (2.1 per 1,000 live births). The infant Premature SDR per 100,000 inhabitants (0-64 years) mortality rate in Slovenia has been decreasing in the last decade Men Women TOTAL and is one of the lowest among EU Member States. SLOVENIA 238.1 106.7 173.4 EU 244.1 122.2 181.9 The premature standardized death rate is gradually decreasing, both in men and women. Leading causes of premature mortality in terms of age-standardized data are neoplasms, external mortality causes and diseases of the circulatory system. 13 Health in Slovenia Standardized death rate, by leading causes, Slovenia and the EU, 1985-2015 SDR per 100,000 inhabitants Diseases of the circulatory system Neoplasms External causes 530.5 452.7 Slovenia 211.8 104.8 197.8 185.1 EU 200.5 47.6 190.3 159.8 59.6 32.9 1985 '91 '97 '03 '09 2015 1985 '91 '97 '03 '09 2015 1985 '91 '97 '03 '09 2015 Standardized death rate, Slovenia and some EU countries, 2015 SDR per 100,000 inhabitants Lithuania 871.3 Romania 867.8 Latvia 850.5 Hungary 823.1 Croatia 749.4 Poland 715.1 Estonia 688.1 Czech Republic 673.4 EU 561.0 Germany 557.0 SLOVENIA 552.3 Denmark 551.3 United Kingdom 539.6 Belgium 537.7 Greece 536.9 Austria 527.9 Cyprus 523.7 Netherlands 517.1 Malta 494.4 Sweden 491.9 Italy 468.0 Spain 462.1 Luxembourg 460.0 Sources: NIJZ and WHO Health status 14 FETAL DEATHS Fetal deaths are deaths of embryos and fetuses that have not reached 500 grams and 22 weeks of gestation. These include ectopic pregnancies, miscarriages and other pathological pregnancies, and legal abortions. In 2019, 5,972 fetal deaths or 14 cases of fetal deaths per The ratio between the number of legal abortions and 1,000 women of childbearing age were recorded in Slovenia. the number of live births has been better in Slovenia in Of all fetal deaths, 5% were ectopic pregnancies, 40% were recent years than the EU average. miscarriages and other pathological forms of pregnancy, and 55% were legal abortions. Fetal deaths, by type, Slovenia, 2010-2019 The number of legal abortions, Slovenia and the EU, 1980-2017 Per 1,000 women aged (15-49 years) Per 1,000 live births 9.0 Legal abortions Slovenia718.7 7.6 Miscarriages and other 5.8 pathological pregnancies 5.6 610.2 EU 429.4 304.9 198.6 0.7 Ectopic pregnancies 0.7 177.8 2010 '11 '12 '13 '14 '15 '16 '17 '18 2019 1980 '86 '92 '98 '04 '11 2017 The number of ectopic pregnancies and number of miscarriages The ratio between the number of legal abortions and the number and other pathological forms of pregnancy per 1,000 women of live births fell by 12% between 2010 and 2019, which is better of childbearing age have been relatively stable over the last than the EU average. Legal abortions have declined in women decade. The legal abortion rate fell from 9.0 / 1,000 women of of all ages in the last decade, but are not declining in some age childbearing age in 2010 to 7.6 / 1,000 women of childbearing groups in recent years. We are also consistently recording large age in 2019. Three out of four fetal deaths were recorded in regional differences in this. women aged 25 to 39 years. Sources: NIJZ and WHO 15 Health in Slovenia INFECTIOUS DISEASES In 2019, a total of 47,853 cases of infectious diseases (excluding AIDS / HIV, sexually transmitted infections and tuberculosis) with a rate of 2,290.4 / 100,000 inhabitants were reported to the Register of Infectious Diseases at the National Institute of Public Health (NIJZ). In the same period, 101 newly diagnosed cases of tuberculosis were reported to the Central Tuberculosis Register, managed by the University Clinic Golnik, which is 2% more than in 2018. In 2019, as many as 1,951 cases of sexually transmitted infections (93.4 / 100,000 inhabitants) and 34 cases of new HIV diagnoses (1.6 / 100,000 inhabitants) were reported. Reporting incidence rates of infectious diseases, Slovenia, Reporting incidence rates of tick-borne meningoencephalitis 2015-2019 and 5-year averages (from 2011-2015 to 2015-and Lyme borreliosis, Slovenia, 2010-2019 2019) Per 100,000 inhabitants Per 100,000 inhabitants 364.4 4,268.5 Lyme borreliosis 4,103.4 b) 3,798.9 3,467.9 244.1 5-year 181.4 3,504.7 averages 187.5 2,878.4 Tick-borne meningoencephalitis 2,290.4 8.1 15.0 3.0 5.3 2010 '11 '12 '13 '14 '15 '16 '17 '18 2019 In 2019, 111 cases of tick-borne meningoencephalitis (TBE) 2015 '16 '17 '18 2019 Year were reported (5.3 / 100,000 inhabitants), which is less than '11–'15 '12–'16 '13–'17 '14–'18 '15–'19 the average in previous years. The incidence of TBE in 2019 in 5-year period Slovenia was one of the highest in the EU. Higher incidence rates of reported cases were only seen in Lithuania (25.4 / 100,000 b) A break in the time series due to a change in European data protection legis-inhabitants), the Czech Republic (7.3 / 100,000 inhabitants) lation that does not allow the collection of unspecified acute gastroenteritis. and Estonia (6.2 / 100,00 inhabitants). The incidence of TBE in Slovenia did not differ from the EU countries where TBE is Epidemiological data on individual communicable diseases endemic in terms of gender, age groups and months with the form the basis for situation analysis and contribute to the bases highest number of cases. for the development of preventive programmes (vaccination, screening) and other measures for the prevention and control of communicable diseases. In 2019, the incidence of TBE in Slovenia was one of the highest in the EU. Sources: NIJZ and ECDC Health status 16 DISEASES OF THE CIRCULATORY SYSTEM Despite a significant decline in recent decades, diseases of the circulatory system remain the leading cause of death in Slovenia, accounting for 38% of all deaths in 2019 (45% in women and 31% in men). Since 2009, diseases of the circulatory system in men are no longer the leading cause of death but are in the 2nd place, following neoplasms. Among the causes of premature mortality, diseases of the circulatory system occupy the third place. Among heart diseases, most deaths are due to acute myocardial Acute myocardial infarction and stroke are important and infarction (also called heart attack or cardiac arrest), while preventable causes of premature mortality (before the age of among cerebrovascular diseases, most deaths occur due to 65). stroke. In Slovenia, the SDR due to diseases of the circulatory system More women than men died of diseases of the circulatory system exceeded the EU average in the 1980s and 1990s but it decreased in 2019, with the highest number of deaths in the age group of in both genders and has been at the level of the EU average since 75 years and over in both genders. In women, such deaths were 2000 and continues to decline. mainly caused by cerebrovascular diseases, while in men they were more often the consequences of ischaemic heart disease. SDR due to diseases of the circulatory system is 1.5 times higher in men compared to women, while the age-specific mortality is In the age groups up to 74 years, more men than women died higher in women. from diseases of the circulatory system. Standardized death rate due to diseases of the circulatory system, by gender, Slovenia and the EU, 1988-2017 SDR per 100,000 inhabitants Men Women 604.6 Slovenia 516.3 392.8 EU 222.4 338.0 219.8 153.1 220.7 142.6 1988 '93 '97 '01 '05 '09 '13 2017 1988 '93 '97 '01 '05 '09 '13 2017 Diseases of the circulatory system are classified as diseases with due to diseases of the circulatory system was observed. The a higher age-standardized hospitalization rate, which equalled most common causes of hospitalization due to the diseases of 12.4 per 100,000 inhabitants in 2019. In the period 2010-2019, circulatory system are ischaemic heart diseases, heart failure a downward trend in the age-standardized hospitalization rate and cardiac arrhythmias. 17 Health in Slovenia The most common reasons for outpatient visits, both in specialist Diseases of the circulatory system are the most common reason outpatient treatment and at the primary level, are hypertensive for visiting specialist clinics among the older population, aged diseases, peripheral vascular diseases and cardiac arrhythmias. 65 years and over. Hospitalizations and visits to outpatient health care due to diseases of the circulatory system, by gender, Slovenia 2010-2019 Per 1,000 inhabitants Hospitalizations Outpatient treatments – Outpatient treatments – specialist outpatient service primary level1) 177.0 Women 156.0 138.5 105.7 149.2 142.8 Women Men 125.5 73.9 79.9 96.9 21.6 23.5 22.4 Men 70.1 77.9 Men 18.4 19.2 Women 16.6 2010 '13 '16 2019 2010 '13 '16 2019 2010 '13 '16 2019 1) Community health service not included. Days off due to sick leave per employee due to diseases of the Diseases of the circulatory system are more often the cause of sick circulatory system, by gender, Slovenia, 2010-2019 leave in men than in women. From 2012 to 2014, the frequency of absences from work due to diseases of the circulatory system Disability index decreased and then remained at approximately the same level 0.94 until 2017, whereas in 2018 and 2019, it increased significantly. Men 0.93 0.87 In 2019, as many as 4,740,545 prescriptions were issued for 0.70 cardiovascular system medicines, which represents more than a quarter of all prescription medicines (26%), or the largest share Women among all other classifications of medicines. 0.57 0.50 0.46 2010 '11 '12 '13 '14 '15 '16 '17 '18 2019 In Slovenia, most prescriptions were issued for medicines for cardiovascular system (26% of all prescriptions worth 79 million euros). Sources: NIJZ and WHO Health status 18 DIABETES Diabetes with the accompanying morbidity, social and economic consequences for patients and their families, and burden on the health system and society as a whole, is a major challenge in developed countries. The number of patients is increasing each year. At the end of 2019, more than 116,000 people (5.5% of the total population) in Slovenia were receiving medicines for lowering blood sugar levels. In addition to these patients, there are patients who have been able to control their blood glucose levels without medications (especially through diet), and those who are still unaware that they have developed diabetes. In the 2016 Health-Related Behavioural Style (CINDI) survey, 7% of respondents aged 25-74 answered affirmative to the The incidence of men with diabetes has increased question about the presence of diabetes in the last 12 months. faster than that of women (2010-2019). The prevalence of diabetes and trends can be described with the help of data on recipients of blood glucose lowering medicines, which in 2019 were received by approximately 116,370 people. Age-standardized prevalence rate of pharmacologically-Between 2010 and 2019, the number of diabetic patients treated diabetes in adults (20-79 years), by gender, Slovenia, receiving blood glucose lowering medicines increased by 26%. 2010-2019 The largest increase was among the population aged 60 years Age-standardized prevalence rate per 100 inhabitants (20-79 years) and over. 7.1 6.3 Men The recipients of blood glucose lowering medicines, by age groups, Slovenia, 2010, 2015 and 2019 Women 116,374 TOTAL 4.7 5.0 106,318 92,466 2010 '11 '12 '13 '14 '15 '16 '17 '18 2019 65 years 61,263 71,738 50,277 and over New cases of diabetes treated with blood glucose lowering medicines, by gender, Slovenia, 2019 and deviation from 12,631 16,488 16,453 60-64 2015 12,026 11,480 11,076 55-59 Incidence 7,423 6,940 6,722 50-54 2019 Deviation from 2015 10,109 10,147 10,385 Up to 50 years Men 5,319 +558 2010 2015 2019 Women 4,830 +113 TOTAL 10,149 +671 The risk of developing type 2 diabetes is higher in men and older people. After the age of 40, the proportion of those with diabetes In Slovenia, there are around 10,000 new recipients of blood is higher among men than women, and in those aged between glucose lowering medicines every year. There are more men 50 and 69 diabetes is 1.6 times more common in men than in than women among the newly diagnosed patients. In men women. over the age of 40, the incidence rate is higher in all age groups compared to women. 19 Health in Slovenia Anti-diabetic drug consumption A101), Slovenia and some EU countries, 2018 Defined daily doses per 1,000 inhabitants per day Finland 95.8 Czech Republic 90.5 Germany 83.2 Spain 78.1 Slovakia 76.8 Netherlands 75.5 Hungary 75.4 Belgium 72.8 Portugal 70.4 Sweden 64.9 Estonia 64.9 Luxemburg 2) 63.2 Italy 63.2 SLOVENIA 62.5 Lithuania 53.6 Latvia 46.7 Austria 46.3 1) Data refer to ATC class A10-drugs used in diabetes. 2) Temporary value. Slovenia ranked 14th among 17 EU countries in terms of medicines prescribed for diabetes. The WHO estimates that 65 to 80% of new type 2 diabetes cases are attributed to being overweight. Sources: NIJZ and OECD Health status 20 CANCER According to the Cancer Registry of the Republic of Slovenia, in 2017 a total of 14,987 people (7,974 men and 7,013 women) were newly diagnosed (incidence) with cancer, and 6,365 (3,570 men and 2,795 women) died of cancer (mortality). At the end of December 2017, there were 111,696 people alive who at some point during their lifetime had been diagnosed with cancer (prevalence). Among these there are typically more women (60,755), as more men (50,941) suffer from cancers with a worse prognosis. The number of cancer patients has been increasing by an average of 2% per year over the last decade. Prostate cancer is the most common among men (20%), and non-melanoma skin cancer among women (23%). The five most frequent cancers in Slovenia – non-melanoma skin, prostate, colorectal, breast and lung – account for 60% of all new cancer cases. The survival of Slovenian cancer patients is improving over time, and in recent years the five-year net survival is more than 58%. Cancer burden, Slovenia, 2017 The incidence of cancer is increasing. More Men Women TOTAL than half of the increase in incidence can be Incidence 7,974 7,013 14,987 attributed to the ageing of the population. It is Deaths 3,570 2,795 6,365 encouraging, however, that cancer mortality Prevalence 50,941 60,755 111,696 (after adjusting for ageing) is declining. The age structure of cancer patients in Slovenia in 2017 illustrates that cancer is a disease of older people, as 90% of patients are The most frequent cancers, by gender, Slovenia, 2017 diagnosed at the age of 50 or over, whereas 62% of them are % aged 65 years or over. 20.0 Prostate 19.4 Skin, non-melanoma 11.1 Trachea and lungs The percentage of new cancer cases, by age group, Slovenia, 9.9 Colorectum 2017 4.6 Head and neck % 35.0 Other 0-19 years 0.5 20-34 1.6 35-49 7.8 50-64 28.1 22.9 Skin, non-melanoma 65-74 28.4 19.9 Breast 75+ 33.6 8.1 Trachea and lungs 7.6 Colorectum In men, prostate cancer was most frequent, accounting for 20% 5.0 Corpus uteri of all cancers, followed by skin cancer (excluding melanoma), 36.5 Other lung cancer, and colorectal cancer. In women, non-melanoma skin cancer and breast cancer each accounted for one-fifth of all cancers, followed by lung cancer and colorectal cancer. 21 Health in Slovenia Estimated age-standardized incidence rate of all cancers The estimated age-standardized incidence rate of all cancers (excluding non-melanoma skin cancer), Slovenia and the EU, (excluding non-melanoma skin cancer) for Slovenia for 2020 is 2020 higher than the EU average. Per 100,000 inhabitants 498.3-552.8 443.8-498.2 389.3-443.7 334.8-389.2 280.3-334.7 Standardized death rate due to cancer, by gender, Slovenia and the EU, 1985-2017 SDR per 100,000 inhabitants Men Women 298.4 Slovenia 239.6 272.6 EU 155.4 201.4 140.6 151.1 123.8 1985 '89 '93 '97 '01 '05 '09 '13 2017 1985 '89 '93 '97 '01 '05 '09 '13 2017 The SDR due to cancer is slowly declining in both Europe and Slovenia. In Slovenia, it is higher than the European average, with the difference being even larger for men. Sources: CANCER REGISTRY OF THE REPUBLIC OF SLOVENIA, ECIS and WHO Health status 22 ACCIDENTS AT WORK In Slovenia, 13,927 accidents at work were reported in 2019, or 15 accidents per 1,000 employees. Of these, 15 resulted in death. Men represent three quarters of all reported injured workers, and women the remaining quarter. Every year, around 2.5 million employed people in the EU Member States are affected by accidents at work that require more than three days of absence from work. In the EU Member States, around 3,500 employed people die each year due to accidents at work. There are far fewer fatal accidents at work among women than among men. According to age and gender, the younger male population Accidents at work, Slovenia, 2019 is more at risk. In all age groups, accidents at work are more common among men than among women. The severity and frequency of accidents at work is indicated by sick leave. In 2019, 1.4 % of all cases of sick leave were caused by accidents at work, and thus 805,871 working days were lost (5% of all days of sick leave). The percentage of sick leave days 13,927 per person due to accidents at work was 0.24%, and the average ACCIDENTS AT WORK duration of one absence was 54 calendar days. 15 FATAL 3 TIMES MORE INJURED Accidents at work, by gender, Slovenia, 2010-2019 MEN THAN WOMEN Per 1,000 employed persons b) The drop in the curve 31.5 in 2013 is partly due Men to a change in the definition of 25.2 accident at work. TOTAL 20.2 17.4 Women 15.2 9.0 2010 '11 '12 '13 '14 '15 '16 '17 '18 2019 b⁾ A break in the time series due to a change in the definition of an accident at work. 23 Health in Slovenia The most frequent accidents at work, by gender, cause, Accidents at work1) with sick leave longer than three days, economic service and injured body part, Slovenia, 2019 Slovenia and the EU, 2008-2018 Young males are Age-standardized incidence rate of accidents at work per 100,000 most exposed to employed persons accidents at work. Men get injured app. 3 times 2,006.8 1,870.6 Slovenia more than women. 1,615.3 1,898.4 1,805.6 EU 1,556.7 1,567.2 2009 '10 '11 '12 '13 '14 '15 '16 '17 2018 Fingers are the 1) The figure does not include accidents that occur on the way to and from work, most frequently as Eurostat is not monitoring them. injured of the Accidents at work are most body part. common in mining industry. In 2019, fingers were the most affected body parts in injuries at work. The main causes of all accidents, including fatal, are slips and falls. In 2019, the most fatal accidents at work occurred in manufacturing and construction (53% of all fatalities). In terms of frequency of accidents at work, Slovenia ranks 10th, close to the EU average. Sources: NIJZ and EUROSTAT Health status 24 TRANSPORT ACCIDENTS In Slovenia, 121 people died in transport accidents in 2019, the majority of them men. The most common are road accidents. In 2019, there were 18,945 such accidents in Slovenia, in which 102 people died. Thus, 11 more people died in road accidents in 2019 than in the year before. The data on mortality due to transport accidents include deaths from accidents involving a means of transporting people or According to the European Commission, the number of goods by land, water or air. fatalities in road accidents in Slovenia fell by 26% in the period 2010-2019, and by 23% in the EU as a whole. There is a significant difference in the mortality rate due to transport accidents between the genders, as four times more men than women die in this way, and this rose to six times more Premature standardized death rate (0-64 years) due to in 2019. The high mortality rate due to traffic accidents is also transport accidents, by gender, Slovenia and some EU affected by drink-driving. In 2019, 31% of all fatal road accidents countries, 20171) were caused by drink-drivers, which is five percentage points SDR per 100,000 population (0-64 years) more than in 2018. Men Women In 2019, most people who died in traffic accidents were in a car, Romania 17.4 4.9 followed by motorcyclists. The majority of deaths due to other Croatia 14.4 2.6 accidents during transport by land were suffered by persons in a Poland 13.8 3.3 special agricultural vehicle. Lithuania 13.3 3.3 Greece 12.9 1.9 Latvia 12.4 3.4 Deaths due to some land transport accidents according to Bulgaria 12.1 3.5 ICD-10, Slovenia, 2019 Slovakia 11.4 3.1 Portugal 11.2 1.9 Hungary 11.1 3.1 Czech Republic 10.0 2.4 SLOVENIA 9.2 2.5 22 Cyprus 8.9 1.4 Belgium 7.8 2.1 MOTORCYCLISTS Italy 7.7 1.8 Estonia 7.7 1.5 47 12 14 Austria 7.1 1.8 Finland 6.8 1.3 PERSONS IN CARS CYCLISTS PEDESTRIANS Spain 6.3 1.6 Germany 5.5 1.6 Luxemburg 4.8 1.2 Denmark 4.6 1.2 Netherlands 4.2 1.3 Sweden 3.9 0.9 United Kingdom 3.6 0.8 Malta 3.3 2.4 1) Temporary data. Sources: NIJZ and EUROSTAT 25 Health in Slovenia SICK LEAVE In 2019, a total of 16,242,330 sick leave days were recorded among employed and the self-employed persons. The proportion of sick leave was 59% higher in women than in men. Illnesses (62% of days) and injuries (19% of days) contributed the most to absence from work, namely 14% of injuries outside work and 5% of injuries at work. In the period 2010-2019 we can see a gradual decline in sick In Slovenia, there were 17.7 calendar days of sick leave per leave until 2014, after which sick leave starts increasing again. employed person in 2019 (women 22, men 14). In 2019, the percentage of sick leave was 4.86%, or 19% higher than in 2010. In most cases (71%), the absence was short and lasted no more Average number of calendar days of sick-leave days per than seven days, while 7% of cases lasted more than 30 days and person, by gender, Slovenia, 2019 required 68% of all days lost due to sick leave. For many years, we have been noticing that the proportion of absences from work due to health reasons is higher for women 22.3 than for men. Women spent twice as many days on sick leave as men, and the average duration of one absence was almost five days longer for men than for women. days 53% of employed persons were never on sick leave in 2019. The percentage of sick leave days per employed person, 14.0 Slovenia, 2010-2019 % of sick leave 6.11 days Women 4.80 4.52 4.86 4.09 TOTAL 3.84 The most frequent causes of sick leave in men are injuries, 3.53 3.75 Men 3.12 among which injuries outside of work predominate, followed by diseases of the musculoskeletal system and connective tissue, and diseases of the circulatory system. In women, absences due to diseases of the musculoskeletal 2010 '11 '12 '13 '14 '15 '16 '17 '18 2019 system and connective tissue predominate, followed by injuries, followed by mental and behavioural disorders. Younger women are most commonly absent from work due to pregnancy and caring for family members. Employed women were on sick leave more often, but for a shorter period of time, compared to employed men. Health status 26 Leading causes of sick leave – number of calendar days of sick-leave days per full-time employee, by gender, Slovenia, 2010-2019 Disability index Musculoskeletal system and Injuries and poisonings Respiratory diseases connective tissue diseases 5.14 4.44 4.17 3.34 Women 3.13 2.60 Men 2.33 2.50 1.37 1.38 0.87 0.80 2010 '13 '16 2019 2010 '13 '16 2019 2010 '13 '16 2019 Number of working days1) of sick leave per employed person, Data on sick leave are published in international databases, but Slovenia and the EU, 2008-2017 the comparison of Slovenian data with data from other European countries is very difficult and unreliable due to large differences Disability index in health and social care systems. Slovenia 13.11 11.54 EU 11.90 10.80 2008 '09 '10 '11 '12 '13 '14 '15 '16 2017 1) Reporting methodology for international databases: the number of working days per employed person is reported. Sources: NIJZ and WHO Health in Slovenia 27 3 HEALTH DETERMINANTS 28 Health in Slovenia DIETARY HABITS Surveys on dietary habits in Slovenia show that a large proportion of the population only partially follows the recommendations of a healthy diet. One third of the adult population aged 25 to 64 consumed three meals a day, and 58% ate breakfast every day. Only 37% of adolescents aged 11, 13 and 15 consumed fresh vegetables every day, and 43% consumed fresh fruit every day. Data show that among the adult population, dietary recommendations were more often followed by women than men, people with a higher level of educational attainment and those aged 55 and over. Healthy nutrition is very important for human health. Diet and The results of Health-Related Behavioural Style survey from dietary habits have a significant impact on an individual’s health 2001-2004-2008-2012-2016 show an improvement in some and quality of life, as they can either protect health or increase dietary habits of the Slovenian population (increasing the use of the risk of developing a disease. According to available data, olive oil and other vegetable oils in food preparation, reducing as many as 41% of chronic diseases are related to dietary risk the consumption of flavoured carbonated and non-carbonated factors. soft drinks, reducing daily consumption of fried dishes). An The proportion of adolescents who consumed breakfast every unfavourable trend in decreasing the consumption of fresh fruit day during the school week in 2018 was 42%. On average, boys was also discovered, while for the first time since 2012 the daily consumed breakfast every day in a higher proportion (44%) consumption of fresh vegetables increased. compared to girls (40%). The proportion of population (25-64 years) who consumed Adolescents who eat breakfast every day during the school fresh vegetables or fruits every day, Slovenia, 2001, 2004, week, by gender, at the ages of 11, 13 and 15, Slovenia, 2018 2008, 2012, 2016 % % Age Boys Girls TOTAL Daily consumption Daily consumption 11 years 52.6 48.7 50.7 of fresh vegetables of fresh fruit 13 years 42.0 38.7 40.4 15 years 36.9 32.7 34.9 67.7 11, 13, 15 1) 44.0 40.4 42.2 60.7 56.2 55.6 56.6 54.3 53.4 52.8 1) The average of all three ages. 42.9 39.1 In Slovenian adolescent boys and girls aged 11, 13 and 15 years, the daily consumption of vegetables decreases with age. This is also the case for most peers from countries included in the HBSC survey. 2001 '04 '08 '12 2016 2001 '04 '08 '12 2016 Sources: NIJZ and HBSC Health determinants 29 OVERWEIGHT AND OBESITY According to the national Health-Related Behavioural Style (CINDI) survey, approximately 42% of adult respondents (aged 25-64 years) had normal weight in Slovenia in 2016, 39% were overweight and approximately 17% were obese. Clear differences were recorded in gender, age and education. A higher proportion of overweight and obesity were observed in men, the less educated and the elderly. Since the first survey in 2001, the proportion of adults with the The proportion of adolescents (11, 13, 15 years) who are recommended body mass index (BMI 18.5-24.9) generally did overweight and obese, by gender, Slovenia, 2018 not change significantly. Compared to the results of the 2012 research, in 2016 an increase in the proportion of the overweight % population (BMI 25-29.9) was observed, amounting to 38.9%. Age Boys Girls 11 years 27 17 The proportions of overweight respondents and obese people 29 17 were higher in the older age group (55-64 years) and in men. The 13 years increasing trend in the proportion of obese men in 2016 flattened 15 years 26 16 at the value seen in 2012. The proportion of obese women remained approximately the same in all years of research. According to the international Health Behaviour in School-Aged Children (HBSC) survey, 27% of 11-year-old, 29% of 13-year-old and 26% of 15-year-old boys were overweight and obese in 2018. The proportion of the population (25-64 years) with normal There was an obvious difference between the genders, as the weight according to body mass index1), by gender, Slovenia, proportion of overweight and obese girls was 17% in 11-year-2001, 2004, 2008, 2012, 2016 olds, 17% in 13-year-olds and 16% in 15-year-olds. % Year Men Women TOTAL 2001 33.7 53.5 43.5 2004 34.1 55.1 44.4 According to BMI, Slovenian adolescents 2008 32.9 52.7 42.5 (aged 11, 13 and 15 years) rank close to the average of overweight and obese 2012 33.0 54.8 43.7 peers from the countries included in the 2016 30.8 54.9 42.4 HBSC survey. 1) BMI is between 18.5 and 24.9. Sources: NIJZ and HBSC 30 Health in Slovenia PHYSICAL ACTIVITY In 2016, approximately 56% of the population was vigorous- and moderate-intensity physically active in accordance with WHO recommendations for physical activity to promote adult health. The proportion was higher for men (59%) than for women (52%), but increased slightly with the level of education. Walking is a widespread physical activity, and 46% of adult men and 49% of adult women walked for 30 minutes a day for at least five days a week. The proportion of the physically active population increased in The proportions of adolescents by frequency of physical the years from 2001 to 2012, and slightly decreased in the years activity1), at the ages of 11, 13 and 15, Slovenia, 2018 from 2012 to 2016, in terms of total and moderate-intensity % physical activity and walking, while it remained the same with regard to vigorous-intensity physical activity. Every day At least 2 to 3 times per week 11 years 26.6 86.6 The proportion of the population (25-64 years) who achieved 13 years 22.6 79.2 a sufficient amount of physical activity1) of vigorous- and 15 years 18.0 64.4 moderate intensity and walking, by gender, Slovenia, 2001, 11, 13, 15 years2) 22.6 77.3 2012, 2016 1) According to the WHO recommendation for physical activity of children and Overall Walking3) % adolescents. physical activity2) 2) The average of all three ages. 60.6 55.9 59.3 The proportions of adolescents who engage in moderate- or Men 50.6 49.0 vigorous-intensity physical activity for at least one hour every 56.9 day is 27% for 11-year-olds, 23% for 13-year-olds and 18% for Women 52.4 15-year-olds, whereas the average for all three age groups 43.9 47.1 46.5 equals 23%. The proportion of adolescents engaged in intense 25.0 physical activity at least two to three times a week between the ages of 11 and 15 is 77% on average. 22.0 2001 2012 2016 2001 2012 2016 1) According to WHO recommendations for physical activity to promote adult health. 2) Vigorous- and moderate intensity physical activity combined in different combinations. 3) Walking for 30 minutes a day at least five days a week. The proportion of adolescents aged 13 years who were physically active four or more times a week was 44% for girls and 59% for boys. Compared to the 27 countries included in the data, Slovenia ranks 4th (HBSC). Sources: NIJZ and HBSC Health determinants 31 ALCOHOL USE Alcohol is the most commonly used drug in Slovenia, and is used at least occasionally by the majority of the adult population. The society is dominated by a tolerant attitude towards consuming alcoholic beverages, which accompany many personal and social events. As many as 45% of Slovenian inhabitants, aged 25 to 64, drink excessively at least once a year. A significant proportion of adolescents also have experience with alcohol, as they encounter it for the first time at a very early age. Alcohol use is one of the key risk factors for premature mortality and disease burden, and contributes significantly to health inequalities. Slovenia ranks above the international average in terms of adverse health consequences attributable to alcohol. In 2019, a total of 1,077 deaths were recorded due to causes Deceased due to causes exclusively attributable to alcohol attributable to alcohol use. Among those who died of these use, Slovenia, 2019 causes, there were 3.8 times more men than women, and almost half (47.5%) of those who died were under the age of 65, which is classified as a premature mortality. ON AVERAGE 3 PERSONS / DAY DIED DUE TO CAUSES EXCLUSIVELY ATTRIBUTABLE TO ALCOHOL USE In Slovenia, the registered consumption of pure alcohol in 2019 amounted to just over 11 litres per capita aged 15 and over. This represents as much as 91 litres of beer and 48 litres of wine and 3 litres of spirits per capita. Standardized death rate due to selected alcohol-attributable causes of death1), Slovenia and the EU average, 2008-2017 SDR per 100,000 inhabitants TOTAL Men Women 149.7 113.1 122.3 94.995.6 Slovenia 72.0 78.1 95.2 79.4 47.4 45.0 38.3 61.7 33.4 EU 52.1 31.5 27.2 27.5 2008 '11 '14 2017 2008 '11 '14 2017 2008 '11 '14 2017 1) The following causes are taken into account: throat and oesophageal cancer, alcohol dependence syndrome, chronic liver disease and cirrhosis, all external causes. Mortality due to selected alcohol-attributable causes of death in Slovenia in the period 2008-2017 exceeded the EU average and was higher for men compared to women throughout the observed period, both in the EU and in Slovenia. Sources: NIJZ and WHO 32 Health in Slovenia TOBACCO SMOKING In Slovenia, tobacco smoking is one of the leading preventable risk factors for death and healthy life-years lost. Every year, 3,123 inhabitants of Slovenia die from diseases attributable to tobacco smoking, i.e. around 60 every week, of which more than 40% before the age of 70. The proportion of smokers among the population aged 18-74, Smoking is initiated mainly in teenagers and young adults. Nearly total and by gender, Slovenia, 2020 two thirds of ever smokers started smoking before the age of 18, and 99% before the age of 25. Smoking initiation after the age of 25 is thus very rare. There are no significant differences between the genders in the prevalence of smoking among adolescents. The prevalence of smoking among adolescents aged 11, 13, 15 and 17, Slovenia, 2018 One fifth (19.9%) of the adult population smokes, most every Ever smokers % day. Men smoke in a higher percentage (21.3%) compared to women (18.5%). The percentage of smokers also varies by age 11 years 2.2 and education. 13 years 10.4 15 years 28.6 The percentage of smokers in Slovenia 17 years 47.4 decreased between 2016 and 2020 in Weekly smokers total and for both genders. 11 years 0.8 The proportion of non-smokers1) (aged 15 years and over) 13 years 1.8 exposed to second-hand tobacco smoke, total and by gender, 15 years 8.8 Slovenia, 2019 17 years 19.8 % Daily smokers Men Women TOTAL Daily 11 years 0.4 4.4 3.6 4.0 Weekly 5.1 3.6 4.3 13 years 0.9 Monthly 10.9 7.0 8.9 15 years 5.4 17 years 15.6 1) Non-smokers includes never-smokers and ex-smokers. The exposure of those who live in Slovenia to tobacco smoke In Slovenia, the prevalence of smoking among adolescents has decreased significantly in 2007 after the introduction of a ban been declining since 2002, and a decline was also recorded on smoking in all enclosed public and work spaces. It has also between 2014 and 2018, when the last HBSC surveys were decreased in living quarters, but is still present in significant conducted. proportions. According to the prevalence of smoking, Slovenian adolescents aged 11, 13 and 15 rank close to the average of their peers from the countries included in the HBSC survey. Sources: NIJZ and HBSC Health determinants 33 ILLICIT DRUG USE In Slovenia, 3,792 users were included in the drug addiction treatment programme in 2019. The most widespread illicit drug in Slovenia is cannabis. In 2019, 74 deaths related to drug use were registered in Slovenia (19 deaths due to drug addiction, 53 deaths due to drug poisoning and two deaths related to cannabis use). Heroin and cocaine were the most common causes of fatal poisoning. Heroin remains the main drug that led drug users to enter the The average age of drug users involved in the programmes of treatment programme, despite a declining proportion of users the centres for the drug addiction prevention and treatment is seeking help for heroin addiction. increasing. As this population ages, health problems also increase, which puts a strain on the network of these programmes. Users who entered the treatment programme, by main drug and type of treatment (never previously treated, previously Average age of users, who entered a treatment programme treated), Slovenia, 2013 and 2019 (never previously treated and previously treated), Slovenia and some EU countries, 2018 % 2013 2019 Age Drug First visit Recurring visit First visit Recurring visit Luxembourg 38 Heroin 52.1 84.9 52.9 80.0 Spain1) 36 Methadone 4.3 1.6 2.9 1.5 SLOVENIA 35 Other opioids 1.1 - 2.0 1.4 Sweden 34 Great Britain 34 Cocaine 6.4 2.1 3.9 4.4 Belgium 33 Amphetamines 1.1 0.5 2.0 0.7 Bulgaria 33 Benzodiazepines - 1.6 - 1.5 Netherlands 2) 32 Cannabis 31.9 3.1 25.5 2.2 Cyprus 31 Other 3.2 6.3 10.8 8.3 Czech Republic 31 Finland 31 France 31 Illicit drug use-related deaths, by type of drug, Slovenia, 2019 Ireland 31 Slovakia 31 Cause / Type of drug Number of deaths Austria 30 Addiction 1) 19 Denmark 30 Heroin 17 Italy 30 Methadone 7 Germany 29 Other opioids / narcotics 9 Hungary 28 Poland 28 Cocaine 17 Romania 28 Cannabis 2 Greece 21 Psychostimulants 3 TOTAL 74 1) Last available data from 2017. 2) Last available data from 2015. 1) Addiction to one or more illicit drugs (ICD-10). In Slovenia, 21% of the population aged 15 to 64 have used an illicit drug at least once in their life. Sources: NIJZ and EMCDDA 34 Health in Slovenia DRINKING WATER MONITORING In 2019, 93% of the Slovenian inhabitants were supplied from drinking water supply systems or in supply areas where drinking water monitoring (quality monitoring) was carried out at the place of use (user faucet, public facilities, food production and trade facilities, drinking water packaging facilities). The quality of drinking water was not known for about 7% of the population, i.e. drinking water supply systems that supply less than 50 people (own drinking water supply, self-supply (e.g. rainwater)). Access to safe drinking water supply and drinking water quality improved slightly between 2010 and 2019. In 2019, a total of 3,147 samples were taken in 858 supply values. In individual years the limit values were also exceeded areas, which supply 93% of the population, as part of regular for the following pesticides: bromacil, dicamba, dimethenamid, testing. Faecal contamination is important as an indicator of chlortoluron, mecoprop, metazachlor, mesotrione, permethrin microbiological quality, non-compliance is shown due to the and terbuthylazine. presence of Escherichia coli, which is tested for in all samples taken and in all supply areas; 11.4% of the samples were non-compliant In 2019, as many as 1,130 water users were exposed to pesticides. due to at least one of the microbiological parameters, and in 1.7% Nitrates constantly exceeded the limit value in some places, of the samples due to Escherichia coli. except in 2016-2017 and 2019, and in some years also nickel and lead as well as indicator chemical parameters such as aluminium, Out of chemical parameters, the pesticide desethylatrazine manganese and iron. Pesticides and nitrates are present in water exceeded the limit value in drinking water in the period 2010- resources mainly in areas with intensive agriculture, especially in 2019, and until 2017 atrazine and occasionally bentazone, north-eastern Slovenia. metolachlor and the sum of all pesticides also exceeded the limit Inconsistent samples due to the presence of Escherichia coli, Slovenia, 2019 Inconsistent samples due to the presence of Escherichia coli by size classes of supply areas, 2019 Escherichia coli not present Less than 500 users 501 to 1,000 users 1,001 to 10,000 users Over 10,000 users Health determinants 35 Inconsistent samples due to the presence of chemical parameters, Slovenia, 2019 Exceeded limit values of chemical parameters in drinking water samples in 2019 Aluminium Manganese Iron Desethyl-atrazine Drinking water monitoring in Slovenia is prescribed by the Rules on Drinking Water and is carried out according to the annual monitoring programme. Sources: NLZOH 36 Health in Slovenia AIR POLLUTION – GROUND-LEVEL OZONE In 2019, ground-level ozone values were similar to in previous years and slightly higher than in 2018. The maximum daily eight-hour average value was exceeded at all measuring sites. The information threshold was exceeded thirty-five times. The alert threshold was not exceeded at any measuring sites. value was seen in 2017 due to above-average high temperatures Slovenia belongs to the group of EU countries in all three summer months. that are more burdened with ozone. The information value (180 µg / m3) and alert values (240 µg / m3) are also set to protect human health. In 2019, the information Average annual ground-level ozone concentrations in Slovenia value was exceeded at three measuring points, a total of thirty-do not show a pronounced trend in recent years. The years 2012 five times. The alert value was not exceeded in 2019. In Slovenia, and 2013 stand out regarding high concentrations. Differences in general, the alert value for ozone is rarely exceeded. in individual years are a consequence of weather conditions. In the period 2011-2018, maximum one-hour concentrations of The maximum daily eight-hour target value is exceeded at most ozone in Slovenia ranged between 172 µg / m3 (2016) and 216 measuring sites, with the exception of those at busy traffic µg / m3 (2017), for an average of 198 µg / m3. During the same locations, especially in the warm half of the year (between April period, maximum hourly ozone concentrations elsewhere in and September). At traffic measuring sites, ozone levels are Europe ranged between 251 µg / m3 (2012) and 414 µg / m3 lower because it reacts rapidly with the nitrogen monoxide from (2018), for an average of 310 µg / m3. exhaust gases. High levels of ozone are particularly characteristic of hot days, when temperatures exceed 30°C for extended periods of time and especially with western air circulation, Maximum one-hour ozone concentrations, Slovenia and some which can bring more polluted air from Italy. EU countries 1), 2011–2018 Short-term (several hours or days) or long-term (several months In µg/m3 or years) human exposure to ozone can cause a number of Italy harmful structural, functional and biochemical changes in the 414 respiratory system. Recent research has also shown systemic adverse effects of ozone (effects on heart function, development Italy of atherosclerosis), and due to the effect of accumulation also Italy 342 an impact on higher morbidity and mortality due to respiratory Spain Italy Greece 315 diseases and diseases of the circulatory system. 301 Spain 296 Italy 301 Air pollution with ozone is the highest in the Primorska region, 251 262 mainly due to the influence of favourable weather conditions 216 and the transport of ozone and its precursors from Italy. On 199 205 210 211 average, the highest values are measured at the measuring site 177 190 172 on Krvavec, which is typical for locations in the highlands. Slovenia To protect human health, a target value for ozone is set at 120 µg / m3 as the maximum daily eight-hour mean value, and must not be exceeded more than 25 days within a calendar 2011 '12 '13 '14 '15 '16 2017 2018 year (calculated as the average for the last three years). The annual limit value of 25 days, however, was exceeded at most 1) Selected EU Member States that recorded the highest values of ozone concen-measuring sites. The worst situation with regard to the target tration in a given year. Sources: ARSO and EEA Health determinants 37 AIR POLLUTION – PM10 AND PM2.5 The data show that air pollution with particulate matter is decreasing. Nevertheless, the population is still exposed to exceeded values, mainly due to pollution from small combustion plants and in larger cities also due to road transport. Children and the elderly are most at risk due to the negative effects of particles on human health. Air pollution with particulate matter affects the development of health problems such as asthma, bronchitis, cardiovascular diseases, lung damage and cancer. The air in Slovenia is among the most polluted in Europe due to Europe. Slovenia has been estimated at 1,016 lost years of life PM10. The average annual concentration of PM10 did not exceed per 100,000 inhabitants – one of the most affected countries the permitted annual limit value for environmental protection within the EU. (40 µg / m3) in 2019. In bigger cities where the majority of people live, the average annual limit value for the protection of human health (20 µg / m3), which is recommended by the WHO, was Due to the decline in economic activities, including the exceeded. decline in road transport in many cities, concentrations of PM throughout the EU dropped significantly during the Instances of exceeding the daily limit values of PM10 are pandemic. almost exclusively limited to the cold part of the year, when meteorological conditions are particularly unfavourable and at the same time air is polluted by small combustion plants. Lost years of life due to air pollution with PM2.5, per 100,000 The annual limit value of PM2.5 (20 µg / m3) was not exceeded inhabitants, Slovenia and some European countries, 2018 at any measuring station in 2019. The WHO proposes 10 µg / m3 as the recommended limit value of PM2.5 for the protection of YLL/100,000 human health. < 478 479-634 Prolonged exposure to particles increases the risk of morbidity 634-894 and mortality from lung and cardiovascular diseases. The effects 894-1,517 ≥ 1,517 of exposure are determined by the concentration and duration No data of exposure. Smaller particles are especially dangerous to health Countries / Regions not included in the process because they penetrate deeper into the lungs. of data exchange Children are especially exposed to particulate matter (PM). Data for the period 2010-2019 show that the largest proportion of children aged 0-15 years were on average exposed to PM10 concentrations in the range between 21 and 30 µg / m3. According to data on hospital admissions in children, admissions due to respiratory diseases represent a good 15% of all their admissions. According to WHO calculations, the number of hospital admissions in children due to respiratory diseases would decrease by around 200 per year if the average annual concentration of PM10 was 20 µg / m3 (or less). In 2018, the highest number of life-years was lost due to air pollution with PM2.5 per 100,000 inhabitants in the countries of Central and Eastern Europe, where the highest concentrations of PM2.5 are observed. The lowest impact of air pollution due Slovenia is well on its way to achieving the WHO goals. to PM2.5 are in the countries of Northern and North-western Sources: ARSO and EEA 38 Health in Slovenia AIR POLLUTION – POLLEN For Slovenia, the map of the most important groups of allergenic pollen lists plant species typical of Central Europe, the Mediterranean area and the non-native genus of ragweed. Most pollen in the air is released by plants in our environment, but it is also brought by the winds. In addition to natural influences, people also impact air pollution through activities that introduce long-term changes in the environment at the level of climate, land use, environmental pollution, changes in the cultivation of agricultural and industrial crops and forest cover, as well as the planting of new allergenic species. Annual pollen total, by measuring stations, Slovenia, 2010-Pollen measurements have been carried out since 1996 by 2019 the National Laboratory of Health, Environment and Food. In 2019, year-round measurements took place at four measuring Obala Nr. of grains per year stations (Obala, Ljubljana, Maribor and Lendava) and during the 80,000 flowering of ragweed in the Brežice basin. In 2019, the course 40,000 of the season at the measuring points differed according to 0 the periods of the highest burdens and the type of pollen. The 2010 '11 '12 '13 '14 '15 '16 '17 '181) 2019 highest burdens were recorded on the coast in March during the flowering of cypress, in Maribor in February with the flowering 80,000 Ljubljana of hazel and alder and in April with the flowering of birch and 40,000 hornbeam, while in Ljubljana, April was the most affected 0 month. A special feature of the season in Ljubljana was the high 2010 '11 '12 '13 '14 '15 '16 '17 '18 2019 grass burdens in the beginning of May, while on the Obala the olive pollen season developed in June. Maribor 80,000 In Europe, aerobiological measurements of pollen in individual 40,000 countries have been carried out for decades. The European Pollen 0 Pollution Map and links to national measurement networks are 2010 '11 '12 '13 '14 '15 '16 '17 '18 2019 available at https://www.polleninfo.org/en/links/europe.html. For allergy sufferers with hay fever, the website polleninfo.org X – No data. (https://www.polleninfo.org/country-choose.html) is available, 1) Obala: in 2018, data for one month are missing. which provides links to the websites of national measurement networks. In Slovenia, we follow 60 types of pollen with allergenic potential. Sources: NLZOH Health in Slovenia 39 4 PREVENTIVE SERVICES 40 Health in Slovenia VACCINATION COVERAGE The vaccination rate of preschool children against diphtheria, tetanus, whooping cough, poliomyelitis, and haemophilus influenza type b (94.7%), measles, mumps and rubella (93.6%) was relatively high in Slovenia in 2019, and the downward trend has stopped. In Slovenia, the low vaccination rate of the population against seasonal influenza is still a big problem, but it has been increasing for three seasons in a row and was the highest for the last ten years in the last season. The vaccination rate of preschool, primary school and high Vaccination rate against influenza, Slovenia and some EU school children (compulsory vaccinations), Slovenia, 2019 or countries, 2018 2019/20 % (Aged 65 and over) The share of vaccinated (%) United Kingdom 1) Vaccination rate of preschool children Year 2019 72.0 Ireland Diphtheria, tetanus, whooping cough, 68.5 Netherlands haemophilus influenzae type b, polio 94.7 62.7 Belgium 59.1 Measles, mumps, rubella 93.6 Greece 56.2 Vaccination rate of school-aged children School year 2019/20 Spain 54.3 Hepatitis b (3rd dose of vaccine) Italy 79.9 52.7 Sweden 52.2 Measles, mumps, rubella (2nd dose of vaccine) 91.0 Denmark 52.0 Diphtheria, tetanus, whooping cough France 51.0 (3rd grade of primary school) 90.0 Finland 49.5 Luxembourg 1) 39.8 In the 2019/20 season, the number of people vaccinated against Hungary 24.1 influenza increased slightly compared to previous seasons, and Czech Republic 21.5 6.8% of the population were vaccinated. A particular problem is Lithuania 14.8 the still low vaccination rate against influenza in people aged 65 SLOVENIA 12.9 years and over, who are often also chronic patients. The share of vaccinated persons in the age group 65 and over in Slovenia Slovakia 12.5 in the 2019/20 season was only 18.8%. We are thus far from the Estonia 10.2 goal set by the World Health Organization, according to which Latvia 7.7 the vaccination rate of the elderly against influenza should be at 1) Temporary data. least 75%. Vaccination against influenza of the population aged 65 and over was lower in Slovenia in 2018 than in most EU countries that provided data. Sources: NIJZ and OECD Preventive services 41 COLORECTAL CANCER SCREENING PROGRAMME In Slovenia, 308,155 people were invited to the national screening and early detection programme for colorectal cancer in 2019. The statement of participation was returned by 201,352 persons. This share represents 66% of those invited, which is almost nine percentage points more than at the beginning of the programme, but still around four percentage points less than the desired share (70%) of the respondents in the target population. The Svit Programme is the national screening and early detection programme for colorectal cancer, which has been operating on In Slovenia, colorectal cancer is among a national level since 2009. In Slovenia, 66% of those invited the five most common cancers in both participated in the Svit Programme in 2019. Since the beginning genders combined, and at the same of the programme in 2009, we have been monitoring the time it is one of the few cancers that can growing trend of responsiveness of invited persons. In 2019, the be prevented by screening. responsiveness to the screening programme increased by one percentage point compared to 2018, when the responsiveness to invitations was almost nine percentage points higher than at the beginning of the programme (57%). Positive screening tests in the Svit Programme, by gender, Slovenia, 2010-2019 The responsiveness of those invited to the Svit Programme, % by gender, Slovenia, 2019 8.7 7.8 Men 7.1 7.4 7.1 6.3 TOTAL 6.1 71% Svit Programme 60% 5.9 66% 5.8 responsiveness 5.0 5.1 4.7 Women In 2019, more women (71%) than men (60%) returned the Statement of participation in the Svit Programme. A higher 2010 '11 '12 '13 '14 '15 '16 '17 '18 2019 responsiveness of women by about 10 percentage points can be traced throughout the programme operation period. Among those screened in 2019, a total of 168,949 (94%) persons In 2019, a total of 10,736 colonoscopies tested negative and 10,950 (6%) tested positive for faecal occult were performed in the screening blood. As usual, the share of persons with a positive faecal programme. 172 cancers and 2,016 occult blood test is higher in men (7%) than women (5%). Men advanced adenomas, posing a higher are more at risk of developing colorectal cancer, but are less risk of cancer, were identified. likely to participate in the screening. Sources: NIJZ 42 Health in Slovenia CERVICAL CANCER SCREENING PROGRAMME The screening of the female target group (20-64 years) in the ZORA programme in the last three-year period (1 July 2016 – 30 June 2019) exceeds the internationally recommended participation rate of 70%, and amounts to 72.4%. Of all 158,916 registered cervical smear results of the target population in 2019, 89.1% were defined as normal, while 5.2% had non-neoplastic changes. There were 5.5% of pathological findings dictating additional diagnostics. The Slovenian cervical cancer screening programme and Screening rate1) of the female target group, Slovenia and registry, ZORA, is a prevention programme for the detection some European countries, 2018 of precancerous and early cancerous changes in the cervix. Screening in the ZORA programme has stabilized above the % limit of the recommended screening rate, which ensures the Ireland 2), 3) 77.8 effectiveness of the programme, and amounts to 72.4% (three-Netherlands 76.3 year screening cycle from 1 July 2016 to 30 June 2019). Sweden2) 75.9 The highest percentage of screening is in the lower age groups Czech Republic 75.8 up to 49 years. In other age groups (50-54, 55-59 and 60-64 Great Britain4) 74.8 years), a slow but steady increase in the screening is noticeable Luxembourg3) 74.3 from the first to the last observed period. SLOVENIA 72.4 The proportion of women who need additional testing after Finland 2), 4) 71.4 screening has been declining since the beginning of the ZORA Netherlands 2) 57.6 programme. In 2010, the proportion of pathological swabs was Lihuania2) 5.9%, then it decreased and then again increased slightly to 51.0 5.5% in 2019, which is 0.4% less than in 2010. The proportion Slovakia2) 45.6 of pathological swabs is largest in young women and decreases Estonia 2) 45.3 with age. Latvia 43.8 Italiy 39.6 Pathological screening swabs of the cervix, Slovenia, 2010-Hungary 32.2 2019 1) The implementation of the cervical cancer screening programme varies between countries, the data shown do not take into account the specifics of each % country's programme. 5.9 5.5 2) The difference in the methodology. 3) Temporary value. 4.3 4) Estimated value. 2010 '11 '12 '13 '14 '15 '16 '17 '18 2019 The proportion of women who need additional testing after screening has been declining since the beginning of the ZORA programme. Sources: INSTITUTE OF ONCOLOGY LJUBLJANA and OECD Preventive services 43 BREAST CANCER SCREENING PROGRAMME DORA is an organized population screening programme for early detection of breast cancer for women aged 50 to 69 years. Within the programme, female target groups are invited every two years for screening mammography, which aims to detect early, atypical cancer changes. The organizer of the programme is the Institute of Oncology The participation rate of women in breast cancer screening Ljubljana. The DORA screening programme has been established programmes1), Slovenia and some EU countries, 2018 throughout Slovenia since December 2017. % The DORA programme is a national breast cancer screening Finland 83.6 programme, which is the most common cancer in women in Denmark 83.2 addition to non-melanoma skin cancer. The programme is aimed Netherland 77.0 at early detection and thus reduction of breast cancer mortality. Great Britain The screening method is x-ray imaging – mammography, to 75.2 SLOVENIA which all suitable women in Slovenia aged 50 to 69 are invited. 74.3 Although the beginning of the DORA screening programme Ireland 74.3 dates back to 2008, the territorial coverage or involvement in Croatia 64.0 the programme has developed gradually and has been available Malta 61.0 in all Slovenian regions since 2017. Women of relevant age Czech Republic 60.9 are actively invited to mammography imaging at one of 22 Italy 60.5 mammography units in Slovenia. The number of imaged women Luxenbourg 54.5 or mammograms performed in the screening programme has Estonia 52.8 gradually increased since the beginning of the programme, France 50.2 with the expansion of the screening programme to all regions Lithuania 50.0 of Slovenia. Latvia 42.1 Hungary In 2019, as many as 107,887 screening mammograms were 40.0 Cyprus performed in the DORA programme. 33.2 Slovakia 30.4 1) The implementation of the breast cancer screening programme varies be-The participation rate in the DORA programme, Slovenia, 2019 tween countries, the data shown do not take into account the specifics of each country's programme. Screening programmes in different countries of the EU are not exactly the same, so the data cannot be compared directly. A rough comparison of countries with officially published data shows that the participation of women in the screening Slovenia programme in Slovenia is among the highest in the EU. 78.2% The participation of women in the DORA screening programme in Slovenia is among the highest in the EU. Sources: INSTITUTE OF ONCOLOGY LJUBLJANA and EUROSTAT 44 Health in Slovenia HEALTH EDUCATION In 2019, 29,559 different health education activities and 62,737 activities in the field of dental education for children, adolescents, parents and pedagogical workers were carried out. Preparations for childbirth and parenthood were attended by 10,095 pregnant women and 7,143 partners. Data for 2019 show that most activities are carried out for the Through various health education programmes, we primary school population. With the basic health education enable the individual to acquire knowledge, and to programme for primary school children, providers cover most form attitudes and behaviours for a healthy lifestyle. primary schools and most departments (95%). In Slovenia, Preparation for Childbirth and Parenthood takes Health education is provided in health care centres, educational place within primary health care (in most health care centres) and institutions or local communities. Activities for children and in maternity hospitals. Preparation for Childbirth and Parenthood adolescents also take into account activities for parents and consists of several meetings, with one meeting lasting two hours. professionals in kindergartens and schools. In 2019, there were a total of 17,238 participants. Health education activities for children and adolescents, by content and age, Slovenia, 2019 Implementation by content Number % Healthy lifestyle 711 11.0 Safety and injury prevention 298 4.6 Prevention of infectious diseases and personal hygiene 1,128 17.5 Other contents in kindergartens for children 3,720 57.7 Lectures for educators of preschool children 330 5.1 Preschool period Lectures for parents of preschool children 260 4.0 TOTAL 6,447 100.0 Basic health education programme 8,990 50.4 Other contents for primary school children 7,443 41.7 Lectures for primary school professionals 226 1.3 period Lectures for parents of primary school children 613 3.4 Basic resuscitation procedures for primary school children 583 3.3 Primary school TOTAL 17,855 100.0 Cancer 180 3.4 Personal hygiene and attitude towards the body 222 4.2 Interpersonal relations and self-image 193 3.7 The impact of substances on the body 179 3.4 Basic resuscitation procedures for secondary school students 365 6.9 period Other contents for secondary school students 4,028 76.6 Secondary school Lectures for secondary school professionals 70 1.3 Lectures for parents of secondary school students 20 0.4 TOTAL 5,257 100.0 Sources: ZZZS Health in Slovenia 45 5 PRIMARY HEALTH CARE 46 Health in Slovenia HEALTH CARE OF ALL POPULATION GROUPS In 2019, a total of 9,383,936 visits were recorded in primary health care. Preventive check-ups were mostly performed on children up to the age of 5, while curative check-ups were most often used by inhabitants aged 65 and over. In 2019, as many as 1,435,374 preventive and 7,790,297 curative Preventive visits in 2019 were dominated by visits of preschool visits were performed in the primary health care among the children aged 0 to 5 (2,086 visits per 1,000 children of that age). entire population, which means 687 preventive visits and 3,729 curative visits per 1,000 inhabitants. The highest number of curative visits was achieved by the population aged 65 and over (5,547 per 1,000 inhabitants of this In this chapter, we present primary level health services age group), and slightly lower by children aged 0 to 5 (5,489 per (health care of preschool and school children and adolescents, 1,000 children of this age group). women’s reproductive health care, general or family medicine and occupational medicine, on-call emergency service and emergency medical care). Preventive and curative visits to outpatient primary level The total number of visits in the last ten years was declining in health care, by age groups, Slovenia, 2019 the initial period, but in recent years we have seen an increase Per 1,000 inhabitants of the age group again. The decrease was due to curative visits, as the frequency of preventive visits increased in all age groups throughout Prevention visits1) Curative visits the period, especially in the group over 65 years of age due to 0-5 years 2,085.9 5,489.2 changes in the organization of the health system. Preventive 6-19 733.9 2,299.2 examinations to identify risk factors and risks due to chronic non-20-64 669.9 3,277.3 communicable diseases are carried out within the Programme of Integrated Prevention of Chronic Non-Communicable Diseases 65+ 295.2 5,547.0 in Adults. This includes men and women aged 30 years and over. TOTAL 687.0 3,728.6 1) Group treatments, consultations and other preventive activities are not Preventive and curative visits to outpatient primary level included. health care, Slovenia, 2010 and 2019 In 2019, respiratory diseases were the most commonly diagnosed Per 1,000 inhabitants diseases and health conditions in children and adolescents at primary level. In the population aged 20 to 64, diseases of the Prevention visits 1) musculoskeletal system and connective tissue were in the first 2010 603.8 place, followed by respiratory diseases. Visits due to diseases 2019 687.0 of circulatory and musculoskeletal systems and diseases of connective tissue predominated in persons aged 65 and over. Curative visits 2010 3,602.8 2019 3,728.6 1) Group treatments, consultations and other preventive activities are not included. In 2018, Slovenia was in the middle of the EU countries with 6.6 consultations with medical doctors per capita. Sources: NIJZ and EUROSTAT Primary health care 47 COMMUNITY NURSING AND HOME CARE In 2019, community nurses made a total of 1,212,633 home visits, of which 1,032,100 (85.1%) were curative and 180,533 (14.9%) were preventive. Over a ten-year period, the number of all community visits per 1,000 population has not changed significantly. The ratio between the number of preventive and curative visits has changed markedly in favour of the latter. According to professional guidelines, preventive activity in Preventive visits in the service of community nursing, by community nursing should represent at least 40% of total patients, Slovenia, 2019 services, which has not been realized in practice for many years. In the last decade alone (2010-2019), 4.5% more curative visits Patients by Deviation from 2018 (%) were made, while the volume of preventive visits decreased by groups Number % Newborns 79,218 43.9 19.9%, but compared to 2018 the number of preventive visits in -4.0 Puerpera 33,923 18.8 2019 increased by 3.7%. -0.6 Chronic disease and others27,816 15.4 +33.1 Infants 19,387 10.7 +16.3 Preventive and curative visits in community nursing, Pregnant women 4,820 2.7 +11.1 Slovenia, 2000-2019 Children 1-6 years 4,633 2.6 -4.8 Elderly 3,069 1.7 % Oncologic patients 2,057 1.1 +0.5 Curative Other patients 1,619 0.9 +7.7 85.4 85.1 Diabetics 1,467 0.8 +10.6 76.6 Disabled people 1,425 0.8 -14.5 Mental patients 822 0.5 +0.7 Oxygen therapy 219 0.1 +35.2 TBC patients 34 0.0 +161.5 Schoolchildren 24 0.0 -72.4 Preventive TOTAL 180,533 100.0 23.4 14.9 14.6 Among the treated patients, there is an increase in the proportion of the elderly, burdened with polymorbidity. Nursing care for the elderly is specific and, above all, long-lasting. 2000 2004 2009 2014 2019 For many years, diseases of the circulatory system, skin and subcutaneous diseases, and diseases of the musculoskeletal Preventive treatments in community nursing are largely (76%) system and connective tissue have been the most common intended for newborns, neonatal mothers, infants and pregnant reasons for the visit of a community nurse to a patient’s home. women. Compared to previous year, the number of visits to school-aged children decreased the most in 2019 (72%), and the number of preventive treatments of TB patients increased the The primary mission of community nursing and home most (162%), but in both cases the number of treatments is very care is preventive activity and care for particularly small. vulnerable groups of the population. The accessibility of the population to community nursing services in Slovenia is improving from year to year. Sources: NIJZ 48 Health in Slovenia DENTAL SERVICES In 2019, a total of 3,102,865 visits were recorded in the dental care service. Of these, 69% of visits were within the framework of services for adults, where we recorded 1,275 visits per 1,000 population aged 20 and over. In dental care service for children and adolescents, 2,351 visits per 1,000 children and adolescents up to 19 years of age were recorded. A total of 4,279,950 dental services were provided. There was 23% of repair services. In the dental care of children and adolescents, services include Visits to dental care service, Slovenia, 2010-2019 the detection and treatment of dental and oral diseases in children and adolescents up to 19 years of age, and regular Per 1,000 inhabitants preventive dental examinations in preschool, primary and high Children and adolescents school children and students. 2,659.3 2,350.5 The services of adult dental care include the detection and treatment of dental and oral diseases, as well as dental prosthetic and aesthetic rehabilitation for people aged 20 and over. When reviewing the data for the ten-year period (2010-2019) on Adults the number of all visits to the dental care service for children and adolescents, we have seen a decrease in the number of visits per 1,228.7 1,224.3 1,275.0 1,000 population aged 0-19 since 2015, which is largely due to decrease in the number of curative visits. A comparison to the number of all visits recorded in adult dental care service shows that they have remained at the same level for 2010 '11 '12 '13 '14 '15 '16 '17 '18 2019 many years. Comparison of Slovenian data with data from other European countries is not possible due to large differences in dental care systems. In Slovenia, only seven out of ten adults aged 18-74 brush their teeth regularly (at least twice a day), of which eight out of ten women and six out of ten men. Sources: NIJZ Health in Slovenia 49 6 SECONDARY AND TERTIARY HEALTH CARE 50 Health in Slovenia SPECIALIST OUTPATIENT SERVICE In 2019, a total of 4,723,916 visits were made in the specialist outpatient service, most of them curative. Preventive services in triage visits account for less than one percent of all visits in the service. 2,251 curative visits were made to specialist dispensaries per 1,000 inhabitants. Most of them were performed in internal medicine (24%) surgical (14%) and ophthalmology clinics (11%), while the most frequently identified diseases and conditions were injuries and poisonings (12%), eye and adnexa diseases (11%) and musculoskeletal system and connective tissue (9%) diseases. In the last ten years, the number of visits increased until 2016. The rate of curative visits in the last decade has been higher for In 2016 (compared to 2010), this increase was 11%, mainly due women than for men. In 2019, we recorded 2,443 visits per 1,000 to an increase in the number of recurrent curative visits, where women, which is 19% more than the rate of curative visits for a 45% increase was recorded. In 2017 and 2018, we recorded a men (2,060 visits per 1,000 men). In 2019, the highest number of slight decline in all curative visits. curative visits was recorded in the population aged 65 and over, In 2019, compared to the previous year, we recorded a smaller namely 4,193 visits per 1,000 inhabitants or 4.2 visits per capita increase in visits to specialist outpatient services. 1,097 first and in this age group. 2,251 total curative visits were made per 1,000 inhabitants. The ratio of first and recurring visits shows a marked increase in recurring visits with age. In 2019, the ratio between the first and recurring curative visits in the youngest age group was 10 to 4 in favour of the first visits, and in the highest age group 10 to 13 in Injuries and poisonings are among favour of recurring visits. the most common reasons for visiting specialist clinics in all age groups up to the age of 64. Curative visits to specialist outpatient services, by age groups, Slovenia, 2019 Curative visits to specialist outpatient services, Slovenia, Per 1,000 inhabitants of the age group 2010-2019 First1) curative visits TOTAL curative visits Per 1,000 inhabitants 0-5 years 973.0 1,395.2 TOTAL curative visits 2,355.0 2,251.3 6-19 712.8 1,273.8 2,113.2 20-64 944.6 1,912.0 65+ 1,856.3 4,193.2 TOTAL 1,097.2 2,251.3 First curative visits 1) 1) The first curative visits include the first curative visits and first curative visits 1,259.8 for chronic disease control. 1,074.2 1,097.2 2010 '11 '12 '13 '14 '15 '16 '17 '18 2019 1) The first curative visits include the first curative visits and first curative visits for chronic disease control. Secondary and tertiary health care 51 Consultations with medical doctors1) per capita, Slovenia and There are large differences in the number of consultations with some EU countries, 2018 medical doctors per capita between European countries. In Slovakia, this number is the highest at 11 visits, which is five Slovakia 10.9 times higher than in Cyprus (two visits per capita). In 2018, Hungary 10.7 Slovenia was included in the middle part of the scale of EU Germany 9.9 Member States. Lithuania 9.9 Netherlands 9.0 Czech Republic 8.2 Poland 7.6 Belgium 7.2 Croatia 6.7 SLOVENIA 6.6 Austria 6.6 Bulgaria 6.3 Latvia 6.0 Luxembourg 5.8 Estonia 5.6 Romania 5.2 Ireland 5.0 Finland 4.4 Denmark 3.8 Greece 3.3 Sweden 2.7 Cyprus 2.1 1) All visits to health care at primary and secondary level and visits at patient’s home. Sources: NIJZ and EUROSTAT 52 Health in Slovenia HOSPITAL DISCHARGES The data show that in 2019 there were 421,259 hospital discharges of all types and all causes in all Slovenian hospitals (due to illness, injuries, poisonings, childbirths, fetal deaths and treatments of newborns), which is 6.6% more than in 2010 (395,056). There were 361,323 hospitalizations, 55,700 day treatments and 4,236 long-term day treatments. The average length of stay in hospitals for all reasons was 6.9 days, which is comparable to some EU countries. The age-standardized hospitalization rate decreased by 3% From 2010 to 2019, the age-standardized hospitalization rate from 2010 to 2019; it decreased by 9% in men, while it increased in Slovenia decreased for most reasons, and increased only by 3% in women. due to mental and behavioural disorders, diseases of the musculoskeletal system, pregnancy and childbirth, congenital malformations, conditions originating in the perinatal period, On average, Slovenians were and factors affecting health status. hospitalized longer due to illness The average length of stay in hospitals due to illness in 2019 was (7.7 days) than due to injuries 7.7 days, and due to injuries and poisonings 6.9 days. Mortality and poisonings (6.9 days). (per 100 hospitalizations) was 3.5 / 100 in illness and 1.9 / 100 in injuries and poisonings. The age-standardized hospitalization rate1), all causes2), by gender and total, Slovenia, 2010-2019 The average length of stay in hospitals, Slovenia, 2019 Age-standardized hospitalization rate per 1,000 inhabitants 7 DAYS Women 181.2 175.9 AVERAGE STAY IN HOSPITALS 161.5 TOTAL3) 157.3 151.4 138.4 Men ILLNESS 7.6 7.8 INJURIES AND POISONINGS 7.8 6.1 2010 '11 '12 '13 '14 '15 '16 '17 '18 2019 1) Without foreigners. In 2019, 29,080 hospitalizations were recorded due to injuries 2) Illness, injuries, poisonings, childbirths, fetal deaths, treatments of newborns, and poisonings, mainly due to falls (61%), transport accidents escort, sterilization and organ donation. (9%) and intentional injuries (self-injury, assault; 2%). Men have 3) Including cases where gender is undefinable or unknown. a higher age-standardized hospitalization rate (14.6 / 1,000 population) than women (9.1 / 1,000). In the period 2010-2019, the number of hospitalizations due to injuries and poisonings did not show significant changes, while the age-standardized hospitalization rate saw a statistically significant decrease. Secondary and tertiary health care 53 Hospital discharges, all causes, Slovenia and some EU In-patient average length of stay (days), all causes, Slovenia countries, 2018 and deviation from 2012 and some EU countries, 2018 and deviation from 2012 Per 100,000 inhabitants (%) Number of days 2018 Deviation from 2012 2018 Deviation from 2012 Hungary Bulgaria 9.6 34,188.6 +22.4 Czech Republic Romania 21,124.4 -4.4 9.4 -0.1 France Czech Republic 19,589.8 -2.3 8.8 +3.2 Croatia Hungary 19,254.7 -4.3 8.6 -1.1 Italy Slovakia 19,094.1 +0.3 7.9 +0.2 France 18,553.0 +10.7 Finland 7.7 -3.3 SLOVENIA 17,495.3 +2.3 Romania 7.3 -0.2 Poland 17,301.5 +6.7 Slovakia 7.1 -0.5 Belgium 16,833.3 -0.9 Poland 7.0 -0.1 Croatia 16,176.1 +4.0 SLOVENIA 7.0 -0.4 Finland 16,161.4 -8.9 Belgium 6.2 -0.5 Italy 11,414.6 -11.4 Bulgaria 5.2 -0.5 Netherlands 8,975.6 -24.3 Netherlands 4.5 -0.7 The hospitalization rate due to all causes was lower in 2018 than in 2012 in more than half of the countries for which both data are The average length of stay in all hospitals due to all causes in known (i.e., in seven countries out of 13). 2018 was shorter in most countries than in 2012 (including Slovenia), but longer in only two countries among those for which both data are known. Sources: NIJZ and EUROSTAT 54 Health in Slovenia REHABILITATION SERVICES In 2019, there were 34,746 rehabilitation services of all types and due to all causes (due to illness, injuries, etc.) at Slovenian health resorts and at the University Rehabilitation Institute of the Republic of Slovenia (URI Soča), which is 15% more than in 2010 (30,107). The average duration of hospitalizations in rehabilitation was 15.1 days, which is one day less than in 2010. Most rehabilitation services are inpatient, but the share of The number of hospitalizations, sick days and average outpatient services increased in the observed period 2010-2018; duration of hospitalizations in rehabilitation – inpatient however, it decreased in 2019 due to a change in recording treatments1), Slovenia, 2019 (they started reporting on completed outpatient treatments, no longer on individual treatments). Number of Average hospitalizations2) Sick days duration (days) There were 31,415 inpatient services (which is 57% more than 0-6 years 406 5,315 13.1 in 2010) and 3,331 outpatient services (which is three times less than in 2010 – due to another change in the reporting system in 7-19 788 11,691 14.8 2019). 20-64 14,793 226,031 15.3 65+ 14,651 221,075 15.1 TOTAL 30,638 464,112 15.1 In Slovenia, rehabilitation services are 1) Excluding day and long-term day treatments. performed at the University Rehabilitation 2) Including foreigners. Institute of the Republic of Slovenia – Soča and at 18 health resorts. The average age of patients in rehabilitation in 2019 was 58.7 years (56.2 years for men and 61.1 years for women), while in 2010 it was 56 years (53.5 years for men and 58.1 years for Rehabilitation services, by type of treatment and by age women). groups, Slovenia, 2019 In 2019, the most rehabilitation services were preformed due to diseases of the musculoskeletal system (40%), followed by Per 100,000 inhabitants1) injuries (22%) and diseases of the circulatory system (14%), in Outpatient Inpatient 4th place were the diseases of the nervous system (10%) and in 5 0-6 years th place neoplasms (7%). 188.6 344.0 7-19 91.5 322.3 20-64 160.1 1,204.2 65+ 189.3 3,545.1 TOTAL 159.2 1,502.2 1) Without foreigners. As many as 6% more women than men were treated in rehabilitation. The highest rate of rehabilitation services was at the age of 65 and over (3,545 per 100,000 inpatients and 189 per 100,000 outpatients). Sources: NIJZ Health in Slovenia 55 7 AMBULATORY PRESCRIBED MEDICINES 56 Health in Slovenia AMBULATORY PRESCRIBED MEDICINES In 2019, a total of 18.5 million prescriptions were issued for originator and generic medicines and main preparations worth 542 million euros. Each inhabitant of Slovenia received an average of 8.8 prescriptions with prescribed medicines worth 259 euros. Most prescriptions (25.6%) were issued for medicines with an effect on the cardiovascular system (ATC group C), followed by prescriptions for medicines with an effect on the nervous system (ATC group N) with 18.7%, and prescriptions for medicines to treat alimentary tract and metabolism (ATC group A) with 13.5%. Most frequently prescribed medicines, by main ATC On average, in 2019, each classification groups, Slovenia, 2019 woman received 10.1 prescriptions worth EUR 260, and each man received 7.6 prescriptions worth EUR 259. Medicines for cardiovascular system Data on medicine consumption are presented by 14 main groups of the anatomical-therapeutic-chemical (WHO ATC / DDD) classification of medicinal products, which is an 25.6% international universal medicinal products classification system. The frequency of prescribing is shown in the number of prescriptions per 1,000 population and increases with the age of the recipients. It rises noticeably after the age of 60, and after the age of 70 it begins to rise sharply. The highest prescribing of Medicines with medicines is among those over 85 years of age. an effect on the nervous system 18.7% Medicines for alimentary tract and metabolism 13.5% Ambulatory prescribed medicines 57 Medicines of all ATC groups, except ATC group V (various Most funds were spent to treat neoplasms and for antineoplastic medicines), were more often prescribed to women. and immunomodulating agents (ATC group L), followed by The total value of ambulatory prescriptions issued in 2019 was medicines for the cardiovascular system (ATC group C) and EUR 542 million. medicines for the alimentary tract and metabolism (ATC group A). Consumption of medicines in defined daily doses per 1,000 inhabitants per day (DID) by the two main ATC classification groups, Slovenia and some EU countries, 2018 DID C – cardiovascular system A – alimentary tract and metabolism Hungary 724 280 Germany 697 222 Czech Republic 605 305 Finland 591 293 SLOVENIA 556 233 Slovakia 534 270 Sweden 519 268 Italy 487 182 Belgium 475 181 Lithuania 457 138 Netherlands 451 321 Greece 1) 448 189 Spain 2) 445 301 Estonia 430 174 Portugal 392 228 Luxembourg 3) 323 439 Austria 320 144 Latvia 299 295 Denmark 4) 182 1) Deviation from the definition. 2) Time series break. 3) Estimated value. 4) No data. Sources: NIJZ and OECD Health in Slovenia 58 8 HEALTH CARE RESOURCES 59 Health in Slovenia HEALTH CARE RESOURCES At the end of 2019, there were 6,812 medical doctors, 1,514 dentists, 7,996 nurses and 13,468 nurses and midwives employed in health care. In the last ten years, the number of medical doctors has increased by 37%, dentists by 20%, nurses by 84% and nursing technicians by 8%. Organizational, human and other resources in health care make The number of public health care centres (63), hospital (27) and an important contribution to the capacity of the health system. pharmacies (24) has not changed in the last ten years. In the period 2010-2019, the number of all medical doctors There are few private hospital providers, which together perform in health care increased by 37%, and the number of general less than 3% of all hospital treatments. On the other hand, the practitioners and family doctors by 40%. number of private individual providers in outpatient care is The average annual increase was 4%, and the number of nurses still growing. Private outpatient services in general and family grew with an average annual rate of 7%. medicine include a quarter of all medical doctors in this service, and more than a half in dental care. The number of hospital beds has been declining since 1980, Personnel in health care, Slovenia, 2019 when there were 695 hospital beds per 100,000 population. In 326 2019, we had 443 hospital beds per 100,000 population. In terms of the number of hospital beds per capita, Slovenia is slightly below the average of the EU Member States. DOCTORS Hospital beds, Slovenia and the EU, 2009-2018 72 Per 100,000 inhabitants 550.7 DENTISTS EU 500.5 460.3 462.4 Slovenia 442.8 1,027 NURSES AND MIDWIVES Per 100,000 inhabitants 2009 '10 '11 '12 '13 '14 '15 '16 '17 2018 The number of medical doctors per 100,000 inhabitants in Slovenia, despite the growth in the last 20 years, is below the average of the EU Member States. Health care resources 60 Health personnel employed in hospital, Slovenia and some EU countries, 2018 Per 100,000 inhabitants Medical doctors Dentists Pharmacists Nurses Austria 524.1 56.9 71.8 685.2 Lithuania 459.8 98.5 102.8 777.9 Germany 431.1 85.8 65.7 1,106.1 Bulgaria 421.7 103.7 435.4 Denmark 419.4 71.8 54.0 1,009.9 Cyprus 407.3 112.2 91.7 532.1 Czech Republic 403.8 73.8 69.1 Spain 402.1 118.9 586.9 Italy 397.7 83.3 119.1 574.2 Malta 397.2 47.9 128.8 778.3 Netherlands 367.0 55.0 21.0 Estonia 348.3 96.6 72.2 629.1 Croatia 344.1 84.8 76.2 166.5 Hungary 338.4 70.3 80.2 494.4 Latvia 330.4 70.6 85.6 SLOVENIA 317.8 71.9 70.7 342.5 France 317.1 64.7 103.3 Belgium 313.0 75.4 125.0 Romania 304.7 83.5 90.1 73.9 United Kingdom 284.1 52.7 89.8 636.8 Sources: NIJZ and EUROSTAT Health in Slovenia 61 9 HEALTH EXPENDITURE AND SOURCES OF FUNDING 62 Health in Slovenia HEALTH EXPENDITURE AND SOURCES OF FUNDING In 2018, current expenditure on health care amounted to EUR 3,813 million, which was 8.3% more in nominal terms than in 2017. Slightly less than a third of current expenditures on health care was financed from private sources. Most funds, i.e. just over three-quarters, were spent on services for curative care and on medical goods. Expenditures on curative treatment services in 2018 increased by 9.1% compared to 2017, while expenditures on medicines and other medical goods also increased by 5.8%. called purchasing power parity (PPP) per capita (in EUR). The calculated value of this indicator for 2018 ranks Slovenia 15th among 25 EU countries that prepare data according to the same methodology. Current health Current health expenditure: expenditure: EUR 3,813 million EUR 1,573,543 million Current health expenditure per capita (in EUR), Slovenia and some EU countries1), 2018 8.3% BDP 9.9% BDP Current health expenditures have been steadily increasing in Purchasing power standard per inhabitant (in EUR) the period 2009-2018, except for 2012, when they were several Germany 4,473 million euros lower than in the previous year. Slightly less than a Austria 3,980 third of all health care funding is allocated annually from private Netherlands 3,907 funds. The structure of health care funding in 2018 was 73% Sweden 3,905 from public sources and 27% from private sources. Denmark 3,805 Luxembourg 3,749 Current health expenditure1), by sources of funding, Slovenia, France 3,704 2009-20182) Belgium 3,667 Ireland 3,530 In EUR 1,000,000 United Kingdom 3,083 3,813 Italy 2,504 3,096 TOTAL1) Spain 2,465 2,781 Czech Republic 2,279 2,263 Portugal 2,226 Public sector SLOVENIA 2,186 834 1,032 Cyprus 1,844 Lithuania 1,714 Private sector Estonia 1,702 Greece 1,628 2009 '10 '11 '12 '13 '14 '15 '16 '17 2018 Hungary 1,545 1) Excluding capital formation. Slovakia 1,539 2) Since 2014, the methodology of the health accounts system has been slightly Croatia revised, the so-called SHA 2011 methodology (previously, SHA 1.0 version was 1,348 in force). Latvia 1,334 Bulgaria 1,269 For a better comparison between countries, an indicator is Romania 1,212 used that excludes the effect of differences in the level of 1) Those EU Member States that have data prepared in accordance with the prices between countries – health care expenditures in so-internationally comparable methodology of the health accounts system are shown (SHA 2011). Sources: SURS and EUROSTAT COVID-19 epidemic in Slovenia 63 10 COVID-19 EPIDEMIC IN SLOVENIA 64 Health in Slovenia COVID-19 EPIDEMIC IN SLOVENIA In Slovenia, the first case of COVID-19 was confirmed on 4 March 2020 in a person who arrived from Morocco. The Government of the Republic of Slovenia declared an epidemic on 12 March 2020, along with a comprehensive set of measures to limit the spread of the virus. By 31 May 2020, when the first wave of the epidemic was formally Number of vaccinated persons ended, a total of 1,473 cases of SARS-CoV-2 infection had been confirmed, with the highest daily number of confirmed cases, 664,217 61, coming two weeks after the outbreak. In the period from 1 With 1 dose June 2020 to 18 October 2020, the number of confirmed cases 407,275 was 12,213. The highest number of daily confirmed cases was Fully vaccinated 898, on 16 October 2020. Three days later, an epidemic was Percent fully vaccinated declared once more. In the period from 19 October 2020 to 31 May 2021, the number of confirmed cases was 240,359, with the highest daily number of confirmed cases, 3,428, coming at the 60% beginning of January 2021. From the first confirmed case up 19.4% to and including 31 May 2021, a total of 254,045 cases of SARS-Slovenia CoV-2 infection were confirmed in Slovenia, and 4,694 deaths 0 100 recorded within 28 days of confirmation of the infection. Weekly number of confirmed SARS-CoV-2 cases with a timeline of measures, Slovenia, from 10th week in year 2020 to 21th week in year 2021 13,855 12,500 10,000 7,500 AX OF MEASURES AX OF MEASURES 5,000 AX OF MEASURES ONTROL MEASURES AX OF MEASURES ONTROL MEASURES AX OF MEASURES NEW CASES PER WEEK 2,500 TIAL REL 20 STAGGERED REL 3 1,954 INTENSE C STAGGERED TIGHTENING OF MEASURES ACTIVE TIGHTENING OF MEASURES PAR ACTIVE TIGHTENING OF MEASURES STAGGERED REL ACTIVE REL INTENSE C ACTIVE REL 00 2020-10 2020-12 2020-14 2020-16 2020-18 2020-20 2020-22 2020-24 2020-26 2020-28 2020-30 2020-32 2020-34 2020-36 2020-38 2020-40 2020-42 2020-44 2020-46 2020-48 2020-50 2020-52 2021-01 2021-03 2021-05 2021-07 2021-09 2021-11 2021-13 2021-15 2021-17 2021-19 2021-21 WEEK OF ILLNESS ONSET COVID-19 epidemic in Slovenia 65 When interpreting the epidemiological curve, it is necessary to Vaccination against COVID-19, by doses, gender and type of take into account a number of factors that affect the epidemi-vaccine, Slovenia, from 27 December 2020 to 31 May 2021 ological situation in the country, such as the commitment of the population to follow the measures, the method of testing, 664,217 laboratory capacity, etc. With 1 dose Vaccination against COVID-19, by age groups, Slovenia, from 27 December 2020 to 31 May 2021 407,275 % With 1 dose Fully vaccinated 0-17 0.2 0.1 18-24 13.7 4.0 25-29 14.4 5.6 6,089 Fully vaccinated 30-34 16.0 5.8 35-39 19.5 6.7 Jan 2021 Feb 2021 Mar 2021 Apr 2021 May 2021 40-44 25.2 8.3 45-49 31.2 10.1 With 1 dose Pfizer-BioNTech 50-54 40.1 18.1 351,453 312,764 407,019 288,503 55-59 46.6 23.5 Fully vaccinated Astra Zeneca 60-64 53.5 27.4 224,631 182,644 161,632 56,086 65-69 60.9 50.4 70-74 72.3 64.6 Moderna 74,713 41,833 75-79 65.7 59.4 80-84 67.6 61.6 Janssen 20,853 - 85-89 62.7 55.7 90+ 57.4 47.9 1st dose 2nd dose Up-to-date data on vaccination coverage are available at: https://tinyurl.com/nfdutrtf. 66 Health in Slovenia Measures to contain the spread of SARS-CoV-2 infections in Slovenia as declared by the Slovenian government in 2020 First case week number 10. 15. 20. 25. 30. 35. 40. 45. 50. WORKPLACE MEASURES Closure of workplaces Telecommuting 1500 1100 1500 150 MASS GATHERING > 500 All mass gatherings CANCELLATION O500 O5 O50 O500 Goods & services Goods & services Goods & services Non-essential shops CLOSURE OF Hairdressers & Beauty salons Hairdressers & Beauty salons PUBLIC SPACES R&B R&B 10.30 pm Restaurants & Bars, Hotels Restaurants & Bars tables Gyms, sport centers Gyms, sport centers Daycare-nursery Daycare-nursery Primary school P3 Primary school (holidays) P3 Primary school CLOSURE OF EDUCATIONAL FACILITIES Secondary school Secondary school (holidays) Secondary school Higher education Higher education (end of curriculum) Higher education CLOSURE OF PUBLIC TRANSPORT Public transport Public transport Public transport PROHIBITION OF Stay at home 9.00 pm - 6.00 am MOVEMENT Municipalities Municipalities PROTECTIVE MASK USE All public places CP3 All public places CP3 <2m Open and closed public spaces <2m SOCIAL DISTANCING MEASURES > 10 P3 > 6 persons Household Quarantine 10 days GENERAL MEASURES Q 10d/neg. test - from countries on an Orange or Red list Red regions measures Legend: Partial implementation of a measure Full implementation of a measure At the time of writing, the epidemiological picture is far from At the end of December 2020, Slovenia started vaccinating the resolved. Due to the deteriorating epidemiological situation, in population against COVID-19. Vaccination is one of the possible early April 2021 Slovenia is facing the reintroduction of stricter exit strategies from the COVID-19 epidemic. From the start restrictive measures to gain time to achieve higher vaccination of vaccination on 27 December 2020 to 31 May 2021, the fully coverage, and thus maintain the smooth functioning of the vaccinated population stood at 19.4% of the total. health system, which is threatened by an increase in infections. Sources: NIJZ