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206 Economic crisis, health systems and health in Europe: country experience
At the same time, there was an increase in the incidence of mental health
disorders: after a decline from 417 per 100000 in 2008 to 364 in 2009, it
increased to 422 in 2010. There was also an increase in the number of new
invalidity/disability cases (from 570 in 2008 to 740 in 2010), almost matched
by an increase in the number of people receiving social/disability benefits (from
2929 to 3095) (WHO Regional Office for Europe, 2012).
Moreover, there is some evidence on changes to risk factors. For example, the
lifetime smoking prevalence among students aged 15–16 years seems to have
declined to 54% between 2007 and 2011 (from 80% in 2007). However,
the lifetime prevalence rate of cannabis consumption increased from 18% to
24%. The self-perceived ease of obtaining alcoholic beverages, which may be a
proxy for alcohol consumption, decreased slightly (in 2011, 84% of students
deemed alcohol to be easily or very easily available, compared with 90% in
2007) (Trapencieris et al., 2012). Consumption of sugar-sweetened beverages,
including soft drinks, decreased among schoolchildren aged 11–15 years:
in 2010, 9.7% of boys and 7% of girls drank sugar-sweetened beverages
compared with 13.5% and 12%, respectively, in 2006. Also, 24.4% of boys
and 16% of girls in the 11–15 age group reported weekly physical activity to
control their weight in 2010 compared with 27.6% of boys and 18.6% of girls
in 2006. Lastly, more children ate fruit more than once a day (22.7% of boys
and 31.6% of girls in 2010 compared with 18.7% and 27.3%, respectively, in
2006) (Pudule et al., 2012; Currie et al., 2012).
The shift in health spending to favour more intensive use of preventive and
day-care procedures is likely to better address the health problems of Latvians
in the future (World Bank, 2010a).
5. Discussion
5.1 Drivers of change
While necessary reforms, such as restructuring of hospitals, were previously
avoided despite recommendations from actors such as the World Bank and
WHO, as the country stood on the verge of bankruptcy, all stakeholders (the
Ministry of Health, health care providers, patients, etc.) were in agreement
that changes in the financing and organization of the health care system were
inevitable. National policy-makers regarded the crisis as an opportunity to
implement reforms that were difficult to implement previously.
The presence of external agents (IMF, World Bank, European Commission)
and Latvia's commitment to loan conditions provided a strong argument for
the Ministry of Health to push through less popular reforms. Although the
lenders were sometimes used as a scapegoat, it was the Ministry of Health