Bakgrunn: Forskning viser at tverrfaglig samarbeid er vanskelig. Folkehelsearbeid er sektorovergripene og krever ofte at ulike fag og sektorer samarbeider. Hensikt:Formålet med denne studien er å få større innsikt i hva roller og yrkesbakgrunn betyr for kommunikasjonen i samarbeideti folkehelse. Metode:Studien har benyttet triangulering som strategi med dokumentgranskning, tre teamobservasjoner og 12 individuelle semistrukturerte intervju. Det er benyttet en fenomenografisk tilnærming til analyse av intervjuene. Resultat: Dokumentgranskningen ga forståelse for sammensetningen i de observerte teamene.Observasjonen ga rom for å analysere den muntlige kommunikasjonen og metakommunikasjonen, mens intervjuene ga innblikk i kommunikasjonen som helhet og dens kompeksitet. Intervjuanalysen ga de fire hovedkategoriene; Representasjon av yrker og sektorer,Deltakere som samarbeider i team, Person og menneske i samarbeidet og Betydning av helhet. I analysen kom det fram at yrkesbakgrunn har betydning for kommunikasjon og samarbeid. En er preget av faget som yrkesutøver. Ulik kompetanse og bredde i representasjon bidrar til en rikere diskusjon og et breiere grunnlag for løsninger. Mange av faktorene var ellers uavhengig av yrke og kunne heller relateres til egenskaper hos den enkelte. Evne til å se utover eget fag og ha forståelse for betydningen av andre yrkesgrupper er vesentlig. Konklusjon: Studien viser tverrfaglig samarbeid og kommunikasjon som fungerer og synliggjorde betydningen av trygge fagpersoner med blikk for helhet og evne til refleksjon. Funnenepeker på ulike faktorer av betydning for roller og kommunikasjon slik som tillit, respekt, likeverd, læring og åpenhet. Rollen og hvordan den bekles harbetydning for kommunikasjonen. Yrkesbagrunnen får betydning gjennom den enkelte deltaker og dennes rolle,men da som en del av hele personenmed sine egenskaper, sin personlighet og innstilling. Folkehelsearbeid er et område ingen eier men alle har del i og ansvar for. / Background:Research shows that interdisciplinary collaboration is difficult. Public health work spansmany sectors and demands collaboration among different professionsand sectors. Purpose:This study aimed to gain greater insight into the impact of roles and professional backgrounds on communication in the collaborative process of public health. Method:This study used a triangulation strategy involving document analysis, three observations and 12 semi-structured interviews. A phenomenographic approach was used to analyze the interviews. Result: Document analysis enhanced understanding of the composition of the teams observedin this study. The observations allowed for analysis of verbal communication as wellas meta-communication, and the interviews offeredinsight into communication both as an entiretyandinits complexities. Interviewanalysis produced four main categories:representationof professionals and sectors, participants who collaborate in teams, the individual and the human in collaboration,and the meaning of the whole. Analysis showed that professional background plays a significantrole incommunication and collaboration (i.e.aperson is characterized by his/her profession). Differences in competence and breadth ofrepresentation contribute to richer discussion and a wider ground forsolutions. Many of the factors that emerged were otherwise independent ofprofession and related instead to individual characteristics.The ability to see beyond one`sown profession and understand the importance of other professional groups is essential. Conclusion: The study shows functionality of interprofessional collaboration and communication,it’s revealingthe meaning of confidentprofessionals who areable to see the big pictureand reflect upon its meaning. The findings point to various factors that are important for roles and communication such astrust, respect, dignity, learning and openness. Roles and their interpretation are important incommunication. Professional background derivesmeaningnot only through the individual participant andhis/herrole, but also through his/her properties, personality and perspectives. Public health is an area no one owns but everyone takes part in and has responsibility fo / <p>ISBN 978-91-86739-39-3</p>

Objectives: In recent decades, obesity reached epidemic proportions in western countries, while cigarette smoking decreased. Traditionally, smoking is associated with lower relative weight (body mass index, BMI) but high abdominal obesity (waist-hip ratio, WHR). However, several recent studies suggest that BMI is higher among today’s smokers compared with non-smokers. Therefore, the present study examined whether the relationship between smoking and each of the body measures, BMI and WHR, has changed over time. Material and Methods: Data were collected from 5907 male and female residents of Gothenburg, Sweden, aged 25-65 years, and drawn randomly in four sequential cross-sections (1985, 1990, 1995, 2002) from the city’s population register. The study used general linear models to test trends over time, and adjusted all differences for age. Results: The data reported here showed higher WHR in both male and female smokers compared with non-smokers. BMI was lower in female smokers compared with female non-smokers, but did not differ significantly between male smokers and male non-smokers. Among female participants, differences in WHR between smokers and non-smokers increased significantly throughout the study. Although male participants showed a similar tendency, the differences were not significant. Adjustment for educational level did not affect the results. Conclusions: WHR was higher among smokers compared with non-smokers; this difference increased over time. Thus, concern for obesity does not provide a valid reason to continue smoking; on the contrary, it may be a reason to quit. / <p>ISBN 978-91-86739-06-5</p>

Formålet med undersøkelsen er å beskrive og analysere, med utgagnspunkt i den tidligere kvinnelige heroinmisbrukers opplevelser, hvordan hun har erfart livet med heroinbruk og nå opplever livet uten rus. Metode: Studien er gjennomført med kvalitativ metode, narrativ kasusstudie. Syv kvinner har fortalt sine historier om prosessen fra de startet med rusbruk, ble avhengige av illegale rusmidler og veien fram mot en rusfri tilværelse. Ståstedet de har i dag som rusfrie er også beskrevet. Resultater: Et hovedtema i fortellingene er ulike relasjoners betydning for identitet og identitetsendringer. I historiene dokumenteres spesielt opplevelser av krenkelser og maktmisbruk av hjelpere innenfor sosial- og helsevesenet. Kampen for å få hjelp til å beholde relasjonen til og ansvaret for barn er sterkt preget av mistillit til barnevernet og skaper barrierer for konstruktive prosesser. Kvaliteten av hjelp eller om du får hjelp i det hele tatt synes å være avhengig av hvor du bor og hvem du møter. Relasjon til menn har vært preget av mishandling og avhengighet for å få tilgang til dop. Fedre er usynlige i historien. Overgangen til å være rusmisbruker til å bli nykter er smertefull. Livet som rusfri oppleves som meningsfylt, men hverdagslivet preges tildels av trange sosioøkonomiske rammebetingelser, psykiske og fysiske helseplager. Konklusjoner: Forståelse for rusproblematikk må knyttes til prosesser som går over tid og sees i et livsløpsperspektiv. Psykososiale støttetiltak må opprettholdes ut fra individuelle behov både når det gjelder omfang, innhold og tid. I forbindelse med oppbrudd fra rusmisbruk er kvinner spesielt avhengige av et godt utviklet nettverk. Nøkkelsituasjoner som graviditet og omsorgsoppgaver må ivaretas. Det er behov for å løfte fram kjønnperspektivet når det gjelder samfunnets inngripende over for tidligere og nåværende misbrukende kvinner og menn og deres barn. Kjønnsperspektivet når det gjelder støtte eller behandlingstiltak for kvinner, er et virksomt redskap når det gjelder å forstå, ikke bare kvinners, men også menns behov for spesifikk støtte og behandling. Når det gjelder samfunnsinnsats, er det derfor nødvendig å være lydhør for betydningen av nye maskuliniteten og femininiteten som utvikles. Det er behov for forskning som løfter fram tidligeres misbrukeres egne fortellinger om erfaringer og behov i prosessen fra å være hekta til å bli nykter. / Aim: Using the experiences of recovered, female heroine abusers, their lives as heroin users, process of rehabilitation and how they experience drug free lives will be described and analyzed. Method: The study, using qualitative methods/narrative case study, included seven women. They recounted their stories of the beginning of their drug use, their addiction to illegal drugs, their road to recovery and living a drug free life. Results: A main theme in their narratives was the significance their various relationships have for identity and identity changes. In particular, their stories document experienced violations/infringements and misuse of power of workers in the public health and social services. The battle to get help in maintaining relationships to and responsibility for their children is characterized by mistrust of the child welfare authorities; this creates barriers to constructive processes. The quality of assistance and whether one receives assistance seems to be dependent on where one lives and personal contacts. Relationships to men have been characterized by abuse and dependency on them for access to drugs. Fathers are invisible in their stories.The transition from drug abuser to drug free is painful. They experience a sense of purpose in life as a drug free person, but daily living holds its own problems such as tight socioeconomic framework conditions and mental and physical health problems. Conclusions: Understanding for drug abuse and recovery issues must be bound to long term processes and be seen in a life course perspective. Psychosocial support measures should be based on individual needs concerning scope, content and time. In regards to ending drug abuse, women are especially dependent on a developed network. Key situations must be attended to such as pregnancy and their role in care giving. Society’s interventions towards women and men who are past or current drug abusers and their children must be accomplished with a focus on a gender specific perspective. The gender perspective concerning support and treatment of/for women is of great importance in understanding both women and men’s need for specific types of support and treatment. This is especially true when society intervenes; it must be done in light of the changing roles of the masculine and the feminine in modern culture. Research that focuses on the personal story and experience of the drug abuser’s journey from becoming drug addicted to living drug free is necessary / <p>ISBN 978-91-85721-01-6</p>

Bakgrunn: Røyking blir fortsatt betraktet som den viktigste forebyggbare årsak til død i ge land. Praktiserende leger er nøkkelpersoner innen tobakksforebygging. Enkel rådgiving, som minimal intervensjon, gitt av allmennleger øker andelen røykfrie pasienter signifikant. Kan en oppsøkende intervensjon gjennomført av en likemann være en egnet metode for å få leger til å ta opp tobakksbruk oftere og på en bedre måte, og kan denne undersøkelsen påvise dette? Hensikt: Hensikten med denne studien er: 1) Vurdere om primærlegene i Agder har endret praksis i perioden 2001-2004 med hensyn til hvor ofte og hvordan de tar opp tobakksbruk med sine pasienter og eventuelle hindringer for dette. 2) Undersøke om oppsøkende intervensjon er en egnet metode for å få leger til å endre praksis ved at de bidrar mer og bedre med individuell røykeintervensjon. Metode: Randomisert kontrollert studie for å undersøke om oppsøkende intervensjon er en egnet metode for å få leger til å endre praksis. Denne studien er sett i lys av en sammenliknende analyse av legenes røykeintervensjon og hindringer for dette i perioden 2001-2004. Resultat: Allmennlegene i Agder har endret praksis i perioden 2001 til 2004. Legene tar oftere opp tobakksbruk uten av pasientene har røykerelaterte symptomer, og det er færre hindringer både for å spørre om røykevaner og for å tilby hjelp til røykeslutt. Studien kan ikke bekrefte at oppsøkende intervensjonen er en egnet metode for å få leger til endre praksis ved at de bidrar mer og bedre med individuell røykeintervensjon. Konklusjon: I perioden 2001-2004 har det vært en signifikant endring i legenes røykeintervensjon og hindringer for dette. Studien kan ikke påvise at legene som fikk opplæringen ”Røykeslutt i praksis” bidrar mer med individuell røykeintervensjon enn kontrollgruppen, og det er heller ikke signifikante forkjeller på hindringer for en slik intervensjon / Background: Cigarette smoking is still considered the leading preventable cause of death in the western world. Physicians constitutes a key personnel in tobacco prevention. Brief advising, such as minimal intervention, performed by general practitioners, GPs, increases the number of smoke free patients significantly. The potential effect of outreach visits performed by a peer educator is a question to be studied. Objective: The objective of this study is: 1) Assesswhether the primary physicians in Agder, during the period 2001 to 2004, have changed their professional practice as tohow often and in which way they discuss smoking habits with their patients and possible barriers to stop them. 2) The study also seeks to determine whether outreach visits constitute an effective method to make GPs change their professional practice by contributing more and better to individual smoking cessation. Method: Randomised controlled study to determine whether outreach visits constitute an effective method to make GPs change their practice. This study is also viewed in the light of a comparative analysis of doctors’ attitude to tobacco prevention over the period 2001-2004. Result: During the period 2001-2004 the GPs in Agder have changed their professional practice. They discuss more frequently tobacco use with patients without smoke-related symptoms, and there are fewer barriers that keep them from asking about smoking habits and from offering assistance with smoking cessation. The effect of outreach visits in improving professional practice cannot be ascertained through this study. Conclusion: During the period 2001-2004 there has been a significant change in the GPs intervention work and fewer barriers to stop them. The GPs who received training through the program “Røykeslutt i praksis” do not contribute to individual smoke intervention any more than the control group. We were unable to detect any significant differences regarding barriers to such intervention / <p>ISBN 91-7997-153-9</p>

Hensikten med studien var å få kunnskap fra ungdom om deres opplevelse av engasjement i hverdagen. Tilnærmingen var å gi ungdom selv mulighet til å beskrive og begrunne sin deltakelse i sine arenaer. Metode En kvalitativ studie med intervju av ti ungdommer i alderen 16 – 19 år, hvor alle er andre-års elever på videregående skole i Porsgrunn kommune. Analysemetoden er Grounded Theory. Resultat Ungdommene definerte seg inn på fire arenaer; hjem, skole, fritid og venner. Engasjement definerte de som; se på, høre om, snakke om eller gjøre noe med en sak. Ungdommene sitt engasjement inngår i en kjernekategori drivkraft som inneholder tre hovedkategorier. Det er nærhet til saken, anerkjennelse og opplevelsen av at dette er gøy. Analysen indikerer en sammenheng mellom medvirkning, anerkjennelse og gøy på alle de fire arenaene. Bruk av denne sammenhengen kan bidra til å utvikle det helsefremmende arbeidet for ungdom / The objective of this study was to achieve knowledge from the youth about their experience of involvement in every day life. The approach was to give the youth opportunity to describe and explain their participation in their chosen arenas. Method: The study was carried out using a qualitative approach, and was based on interviews with ten second-grade youths in the age from 16 to 19 years. They all attend secondary education in the municipality of Porsgrunn. The framework for analyze is Grounded Theory. Findings: The youths defined four areas for their involvement: Home, school, leisure-time and friends. They defined involvement as: "Watching, being informed about, discuss a case or actively do something about a case." The choice of involvement was motivated by the elements in the core category “drive”. “Drive” was made up by the three main categories: Closeness to the case. Receiving acknowledgement. And the experience of fun. The study indicates that there is a connection between participation, acknowledgement and the experience of fun in all the four areas of involvement. Making use of this connection can contribute in developing health promotion that is directed towards youth. / <p>ISBN 91-7997-156-3</p>

Background. There are a number of studies showing that general practice is oneof the most stressful workplaces for health care workers. Since the Baltic States regained independence in 1990, a reform of the health care systems took place in which a new role and more responsibilities were allocated to general practitioners. This study aimed to explore the psychosocial stress level among Lithuanian general practitioners (GPs) and examine the relationship between their psychosocial stress and work characteristics. Methods. A cross-sectional study was madeof 300 Lithuanian general practitioners. Psychosocial stress was investigated with a questionnaire based on the Reeder scale. Job demands were investigated with the Karasek scale. The analyses included descriptive statistics, interrelationship analysis between the different characteristics, and multivariate logistic regression to estimate odd ratios for each of the independent variables in the model. Results. The study shows that 48% of the respondents could be classified as suffering from work related psychosocial stress by the Reeder scale. The highest job strain prevalence was among widowed, single and female GPs. The lowest job strain prevalence was among males and GPs of older age. Job strain occurs when job demands are high and jobdecision latitude is low. Conclusions. The greatest risk tophysical and mental health from stress occurs to general practitioners facing high psychological workload demands combined with low decision latitude in meeting those demands. High job demands, patient load more than 18 patients per day and young age of general practitioners can predict a statistically significant effect on job strain. / <p>ISBN 91-7997-095-8</p>

Introduction: As jobdemands in the healthcare system increases, one of the main protective factors involves support within the work environment. Limited knowledge exists about the work environment of nurse assistants and their well-being at work. A relatively small number of studies on this topic in the Nordic countries, and their results indicate high job demands and risk for negative health outcomes. Purpose:This study aimed to investigate nurse assistants’ perception of job demands, the servant leadership of their next superior, job satisfaction, symptoms of emotional exhaustion, and physical well-being at work. It was also investigated whether perception of servant leadership of their next superior related to job satisfaction and symptoms of emotional exhaustion. Methods: Questionnaires sent to all nurse assistants with registered email addresses at the Icelandic Nurse Assistants Association yielded 588 participants (49% response rate). A new Dutch inventory on servant leadership (SLI) was used to measure perception of servant leadership in nursing; additional questions explored work environment, demands, control and support at work, symptoms of burnout, and job satisfaction. To answer the research questions, a cross-sectional descriptive designwas used Results: The majority of participants experienced high job demands and reported on control and support at work. Despite high levels of burnout, the majority of nurse assistants were satisfied at work. Servant leadership was practiced some what within nurse assistant’s workplaces. The correlation between perception of servant leadership, job satisfaction, and emotional exhaustion was significant for all SLI sub-factors except courage, and the strongest correlation was for empowerment, humility, and stewardship as sub-factors of servant leadership. Conclusion: This study highlights supportive factors within the work environment, particularly regarding the leadership-empowering role of servant leadership in nursing. Results showhow thissupportis related to nurse assistants ́ well-being at work andsuggeststhat servant leadership can support health promotion within the work environment of nurse assistants. These findings are valuable for nurse assistants, nurse managersand leadershipin the health care system, thus contributingto public health / <p>ISBN 978-91-86739-28-7</p>

The aim of this thesis was to investigate socio-economic status in relation to morbidity and mortality, in particular cardiovascular disease among women using data from two population based studies from Sweden. The secondary aim was to explore mechanisms potentially linking socio-economic status to health, assessing for example dental, dietary, and lifestyle factors. Samples: The Population Study of Women in Gothenburg Sweden was begun in 1968-69. A representative random sample of 1,622 women was selected according to date of birth and within the strata 38, 46, 50, 54, and 60 years of age; the participation rate was 90 percent. The Gerontological and Geriatric Population Studies in Gothenburg (H-70) are based on representative samples of 70-year olds from Göteborg, Sweden who participated in a series of cross sectional and longitudinal studies between1971 and 2000. Participation rates ranged from 86 percent for men and 83 percent for women in the 1901/2 birth cohort to 65 percent for men and 69 percent for women in the 1930 birth cohort. Main results: High socio-economic status was associated with a decreased risk for cardiovascular disease [RR 0.49; CI 0.24 – 0.99] in middle aged women independently of risk factors such as smoking and obesity;moreover opposing monotonic trends were seen for mortality from cancer and cardiovascular disease in relation to socio-economic status. Tooth loss, a proxy for cumulative lifetime oral infection was also associated with an increased risk for cardiovascular disease in women independently of socio-economic factors such as the husband’s occupational category, income, and educational level. Among 70-year old cohorts, later-born women were heavier and had higher body mass index than earlier-born women within the high education group only. However, secular increases in waist-hip ratio were seen in both educational groups. Compared to earlier-born cohorts of 70-year old men, later-born cohorts had higher body mass index and cholesterol levels across social strata, and heart disease and diabetes mellitus became more prevalent. Among the elderly, secular trends indicated greater improvements in cardiovascular risk factors among women than men, with exception to smoking and alcohol consumption. Diet quality and food selection were assessed in relation to socio-economic status in the youngest cohort of 70-year olds born in 1930. Socio-economic disparities in diet quality were detected in men but not in women. Conclusions: From a public health perspective, it is suggested that risk factor patterns should be investigated in association with socio-economic status in order to expose health inequalities, and to develop more equitable interventions for cardiovascular disease prevention.

Syfte. Avhandlingen syftar till att bidra med ökad kunskap om faktorer som kan antas påverka patientsäkerheten dels på system-, dels på individnivå. Metod.Det nationella rapporteringssystemet Lex Maria analyserades före och efter Socialstyrelsens regionalisering av tillsynsorganisationen 1990/91. I en av de två studierna analyserades särskilt ärenden som överförts till HSAN för prövning av disciplinär påföljd. I tre empiriska studier analyserades kompletterande metoder till rapportering för att få information om risker i hälso- och sjukvården. Personal har intervjuats om deras uppfattning av potentiella risker som skulle kunna hota patienternas säkerhet. Vårdbiträdens och undersköterskors kunskaper om diabetes undersöktes i en enkätstudie. Eventuella samband mellan vårdbiträdens och undersköterskors kunskapsnivå och medicinskt ansvariga sjuksköterskors uppfattning om säkerhetsrelaterade frågor undersöktes i en uppföljande enkätstudie. I en kvalitativ studie undersöktes flygets metoder för säkerhetsrelaterat arbete vilket jämfördes med motsvarande arbete inom hälso- och sjukvården. Resultat.Lex Maria-rapporteringen ökade efter regionaliseringen av tillsyns-verksamheten och en minskad andel ärenden överfördes till HSAN för disciplinär prövning. De kompletterande metoder för att identifiera risker som undersökts visade sig vara värdefulla tillägg till traditionell rapportering. Intervjuerna inom barnsjukvården uppvisade en annan riskbild än den som fås genom rapporteringssystemet Lex Maria. Enkäten till vårdbiträden och undersköterskor visade ett tydligt samband mellan bristande kunskap om diabetes och en ökad risk att vidta en riskfylld åtgärd. Studien indikerade brister på systemnivå, vilket bekräftades av resultaten från enkätstudien till medicinskt ansvariga sjuksköterskor i motsvarande kommuner. Studien visade på behovet av ökad uppmärksamhet på hur sjukvårdens stödsystem påverkar yrkesutövarna i frontlinjen. Jämförelsen mellan flyget och hälso- och sjukvården visade att flyget hade ett mera proaktivt och bredare förhållningssätt till säkerhet än vad hälso- och sjukvården uppvisade. Slutsatser. Studien har visat att yrkesutövare som befinner sig i frontlinjen och möter den enskilde vårdtagaren är särskilt sårbara när hälso- och sjukvårdens stödsystem uppvisar brister. Förebyggande säkerhetsanalyser som komplement till rapportering visade sig ge värdefull information för det förebyggande säkerhetsarbetet. En sammanhållen strategi baserad på aktuell säkerhetsforskning kan bidra till att utveckla hälso- och sjukvårdens säkerhetsarbete. Nyckelord: Patientsäkerhet, rapportering, prevention, händelseanalys, säkerhetsanalys, Lex Maria, ansvarsärenden, disciplinära åtgärder

Since the early 1990s, the Estonian health sector has been undergoing a number of reforms. At the same time, a number of legislative acts have also been established, forming a new legal basis for the health system. The introduction of a social health insurance in 1992 was the first reform in the Estonian health sector reorganisation, followed by a primary health care (PHC) reform, a hospital reform and a number of public health reforms. The aim of this thesis is to analyse these health sector reforms in Estonia, focusing on the outcomes of the health system from the population’s perspective. Proceeding from this general aim, the specific objectives of the thesis are as follows: 1) To analyse the PHC reform in terms of the access to the health services and the acceptability and satisfaction with these services. 2) To analyse the health insurance reform in terms of the acceptability and satisfaction with the new system. 3) To analyse the public health reforms and their impact on the health of the population. The empirical data were gathered with the following research methods: reviews of official health statistics and population surveys in 1998, 2002 and 2005 based on face-to-face interviews using structured questionnaires. The main results can be summarised in relation to the objectives of the thesis: 1) The primary health care reform has been implemented and most of the objectives have been achieved. In general, people accept the changes in the PHC system and the satisfaction with the family doctors has increased. Access to the PHC services is good. Based on the results of a population study in 2002 and 2005, more than half of the respondents could see the family doctor on the same day they made an appointment. Almost a half of the respondents (49%) were satisfied with the access to the health services. Satisfaction with the PHC services and family doctors were found to have positive effects on satisfaction with access to health services. Although people with chronic conditions were less satisfied with the access to the health services they did not experience organisational barriers in their access to such services. 2) The health insurance reform has been implemented and a high level of financial protection has been maintained. The solidarity principle of the health insurance system guarantees access to health services for all the insured people. About half of the population is satisfied with the present system. Compared to 2002, the percentage of satisfied people has increased in 2005, while the percentage of very dissatisfied persons has decreased. The most important predictor of satisfaction with the health insurance was the satisfaction with the existing PHC system. The satisfaction with the health insurance was higher in 2002 as well as 2005 among those respondents who had visited a family doctor or a specialist or were admitted in a hospital during the last 12 months before the survey, but lower among those who had visited a dentist. A small majority preferred the solidarity principles and comprehensive financing of health service by health insurance. The attitudes regarding financing principles were related to the personal contacts with the health services. The respondents who had used the PHC or ambulance services preferred a more comprehensive financing of health services, while those who had had contacts with a specialists or dentists would prefer less comprehensive financing if the waiting lists were short. More than three quarters of the respondents were informed about their rights concerning the access to the health services. Personal contacts with family doctors and specialists had positive impact on the level of awareness. 3) Some progress has been made in connection with the public health reforms. A number of national programs and projects to prevent the most essential health risks have been initiated. As a result, there is some evidence of a positive impact on the health of the population – positive trends in dietary habits and decreasing infant mortality, number of abortions, and incidences of sexually transmitted infections and tuberculosis. At the same time, however, the proportion of smokers and consumers of strong alcohol has not decreased. Moreover, there has been an explosive increase of new cases of HIV-infections in 2000, which is one of the most serious public health problems today. Greater progress has been achieved in the areas where health promotion and health education activities have been supported by political decisions to make a healthy choice for the population easier. However, a comprehensive national health policy and strategy is still lacking in Estonia. In public health, this is evidenced by a lack of long-term planning and understanding of the significance of intersectoral co-operation. Discussion. Up to now, the major reforms in the Estonian health system have been implemented. However, the environment is changing and the health system has to respond to these changes. The next step should therefore be to reach a public agreement about the common values of the health system and setting long-term health policy goals. To improve the effectiveness of policy implementation and reform, the importance of systematic research and evaluation should also be stressed.