ZAGREB, January 21, 2020 - The Croatian non-profit association called "Životna linija" (Lifeline) on Monday marked Blue Monday, a day believed to be the most depressing day of the year, to warn that around 200,000 people in Croatia suffer from depression and are more at risk of suicide than the rest of the population.

The members of the association distributed chocolates and leaflets in Zagreb's central Ban Josip Jelačić Square under the slogan "Let's make the most depressing day of the year better." The leaflets warn that on average two people commit suicide in Croatia every day, which is around 700 people per year.

The president of the association, Tin Pongrac, pointed out that people suffering from depression were largely at risk of suicide. "Sometimes even just one kind word can mean the difference between life and death," he said.

According to World Health Organisation estimates, around 200,000 people suffer from depression in Croatia, but Pongrac thinks this is a conservative estimate. He thinks that as many as half a million people suffer from some form of depression.

Underscoring that depression is the second most serious problem in the Croatian public healthcare sector, he called on institutions to address the issue, which is becoming an increasingly great burden on the national health system.

He added that depression could be treated successfully. His association advocates a combination of antidepressants and psychotherapy. "The system prescribes antidepressants, but it should also provide patients with psychotherapy," he said.

More health news can be found in the Lifestyle section.

Croatian Doctor Alen Juginović, a recent graduate of the Faculty of Medicine in Split, will be leaving Croatia in two weeks to start a Postdoctoral Researcher position at the most prestigious college in the United States.

Dr. Juginović graduated from the Faculty of Medicine in Split in 2018. In September 2019, he was in Houston, Texas completing the second of two US observership programs. Then, he had an idea. Since he was in the US, why not visit the top universities with Neuroscience programs? So, he reached out to the Neuroscience departments at Stanford, MIT, Harvard and Columbia to arrange campus visits.

Harvard Campus Visit Leads to Instant Job Offer

He spent a day and a half in San Francisco and walked among the majestic red-roofed Romanesque sandstone buildings of Stanford University in perpetually sunny Palo Alto. Then he jetted across the country to Boston. After touring MIT, he set off for a visit of the Neuroscience Department at Harvard. With a name tag pinned to his lapel, he met Dr. Dragana Rogulja, an Assistant Professor of Neurobiology. Instead of leading him on a tour of the department, Rogulja, originally from Belgrade, brought Juginović to her office where she began inquiring about his academic background, interests and experience. Two hours later, she offered him a job in her lab.

“Everything was moving in slow motion,” the young medical school graduate recounts. He had a bus to catch to New York City for his planned visit to Columbia University, so he briefly toured his future employer’s lab. They parted ways, and Rogulja promised Juginović that she would give him all the time he needed to think about her job offer. “You’re not dreaming,” she assured him. Upon departing the Ivy League institution, however, the young Croatian doctor was in such a state of shock, that he sat motionless and in a daze while he rode the Boston Metro. Then he realized that he had missed his bus to New York.

Alen Juginović waited over a month to accept the Harvard professor's offer.

Three months later, Total Croatia News received a tip about Dr. Juginović’s job appointment at the most prestigious university in the United States, if not the world.

“I am reaching out to you with an exceptional success story about a young Croatian doctor who, as one of a very small number of Croatians in history, is leaving for the most prestigious university in the world – Harvard! I believe that this story, with all its successes, is very positive, incredibly unique and motivating for everyone in Croatia, especially the young. They will see how it is possible to reach the top of the world from tiny Croatia. I would ask you to consider this ultimate story of medical success for publication in your portal,” the source, overwhelmed with enthusiasm, wrote to us while insisting upon remaining anonymous.

Unique Story Follows Long-Lasting Croatian Tradition

Another story of a young talented Croatian leaving the county for better opportunities abroad; what makes this story so unique and motivating, I wondered. What’s the message for young people? Work hard for a future which only exists beyond your country? That scenario is so commonplace, so predictable – and has flourished without interruption since boatloads of young Croatian emigrants, housed in cramped steerage on majestic passenger steam ships, began making their way in masses across the Atlantic over 130 years ago. Croatian independence, secured in a hard-fought war 105 years later, was supposed to curb mass emigration, not accelerate it. It's worth noting that Alen Juginović was born just a year before the last war officially ended.

The doctor and I agreed to meet at Vincek at 6pm on Friday. I’d passed the dessert café on Ilica many times but had never been inside. Frankly, I could do without the extra calories. I knew that the young doctor would arrive on time, a policy which seems to be hit or miss in this country, so I entered the very bright crowded café right at 6pm. As I meandered past glass cases of cakes and tarts, a lean spry figure passed me on the left from behind. I recognized him immediately, so I quietly followed him to the corner empty table, and waited for him to turn around, so as not to surprise him.

We shook hands and laughed about our simultaneous on-time arrival. He insisted on paying for dessert and coffee, I protested but quickly capitulated, still not entirely confident in Croatian customs. Juginović is a bright, wiry and very energetic figure. We chose sumptuous chocolate desserts, both of which were packed with calories. However, the young doctor, who was comfortably draped in an Adriatic-blue sport coat, white pressed shirt and muted chinos, showed absolutely no evidence of caloric abuse.

Juginović Outlines ‘Hygiene’ of Healthy Sleep Habits

I was pleased to learn that Dr. Juginović’s area of interest is studying and treating sleep disorders, because I’ve read a little about the subject, and could ask a few informed questions. Somewhere during the onset of middle-age, I had become a finicky sleeper. Sleeping a consecutive 8 hours is no longer a given, it has become a much-valued gift. So, we launched into a discussion about “sleep hygiene” as he called it. Admittedly, I was amused by the word hygiene, especially as it relates to Croatia. Try riding a crowded Zagreb tram in July and you’ll immediately know what I’m talking about.

So the young doctor enthusiastically reviewed the necessary components for “sleep hygiene”, some of which I already knew: keep the same sleep schedule, afternoon naps are OK as long as they are shorter than 45 minutes, avoid computers and smartphones (blue light), the sleeping room should not house elements of daily awake life (work-related tools) etc. He then went on to review the stages of sleep, the mechanics of each stage and circadian rhythms. I mentioned that I had read, to my relief, that the concept of a consecutive 7 to 8-hour sleep pattern only came into existence at the turn of the 20^th century. Before that, many societies thrived on segmented sleep, with an interim wake period, which was integrated into daily life. He emphasized that sleep cycles are adaptable but that humans are not nocturnal by nature.

Dr. Juginović struck me as someone who lives fully scheduled days where every minute is accounted for, so I steered our discussion toward his autobiography. It unfolds like a resume every job recruiter dreams about (undoubtedly during REM sleep): President of Student Union, founder of NeuroSplit and member of the organizing committee for ISABS conferences.

Practical Knowledge for Students | Alen Juginović

Organizer of World Class Medical Conferences in Split

Most notably, he was instrumental in organizing two Split-based world conferences. The first, Practical Knowledge for Students, is an annual event which provides medical, dental and pharmacy students the opportunity to practice key physical functions in their chosen professions: like suturing. Suturing, I thought, don’t students practice how to suture in medical school? Apparently, not enough. As the young doctor pointed out, students only know how to perform many of these tasks in theory. I immediately wondered if this was true for US medical schools too. The conference has been a smashing success and participation has ballooned to over 400 students, who arrive in Split from all corners of the world.

The second conference, Nobel Days, brought together four Nobel Prize winners in one auditorium for panel discussions, which were free and open to the public. The panel comprised of Biochemist Richard Roberts, who received the Nobel Prize in Medicine in 1993; Biophysicist Joachim Frank, who received it in Chemistry in 2017; Physicist Georg Bednorz, who won the prestigious award in 1987; and Harald zur Hausen, a Virologist who received it for the discovery of the HPV virus and its association with cervical cancer. The 500-person capacity auditorium in Split was packed; with standing room only.

He also organized several fundraiser concerts with popular Croatian musicians to upgrade a home for children with special needs and finance improvements to pediatric and other medical facilities.

We briefly touched upon his observerships in Milwaukee and Houston, where he was impressed and surprised by the level of student involvement in extracurricular activities. Juginović considers participation in extracurricular activities essential for students’ well-being. It also brings balance to student life and takes the focus away from just attending classes and studying for exams. There are a lot of students who just spend their free time drinking coffee, he lamented, when they could be engaging with others in areas of personal interest and public concern. He also emphasized that he did not consider high grades to the most important criteria for success and even admitted that he didn’t have a perfect grade point average.

So, Juginović’s autobiography is full of significant and impactful achievements, which he shared with enthusiasm, energy and passion. It wasn’t at all difficult to imagine how he wowed that Serbian professor in Boston, who runs a lab at the most prestigious university in the world. And, their partnership suggests a promising overseas Serbo-Croatian collaboration, which is still a rarity in the homeland.

Nobel Days | Alen Juginović

The Croatian Journey to America Spans Over a Century

My grandfather arrived at Ellis Island on the SS Slavonia, which had departed Rijeka on a 19-day journey to America. The trans-Atlantic journey, which he had most likely spent in steerage, was long and grueling, but the young nation was open to everyone who arrived. One hundred fifteen years later, getting into America has become much more complex. One way is to successfully and illegally traverse an increasingly fortified Southern border. Another way is to obtain a H-1B visa, and eventually a Green Card, which can be a complicated affair, and is only expedited by possessing vast financial resources, outstanding individual talent or powerful connections.

In Dr. Juginović’s case, Dr. Rogulja and Harvard will likely process a H-1B visa application which allows a US employer to temporarily hire a foreign worker in a specialty occupation. For a world renown institution like Harvard, that process will likely be streamlined and accelerated, regardless of legal route. It’s worth noting that Croatia remains among just a handful of EU countries for which the US still requires a visa for entry, even as a tourist. However, US and Croatian efforts are now finally underway to abolish that requirement within the next few years.

So, in a little over two weeks the young Croatian doctor will board a plane bound for America. He’ll arrive in Boston in a matter of hours, not weeks, where he will immediately be taken under Harvard’s wing and will undoubtedly surpass their high-performance standards. His job offer comes with a three-year renewable contract, and from there the possibilities are boundless. In the meantime, he must pack for relocation to “The Hub of the Universe”. And HRT (Croatian Radio Television) has just contacted him for a news feature, which will be filmed at St. Catherine’s Hospital in Zagreb, where he remains employed until his departure.

No Long-Term Plans to Return to Croatia Permanently

For a young man who proceeds with such deliberate intention; like organizing significant world conferences with science visionaries and planning personal tours of America’s top universities, I wondered where Dr. Juginović saw himself in the future. Did he consider America a place to expand his knowledge, absorb her best practices, learn from her shortcomings, and return to his homeland to share that vision, knowledge and optimism? Or was America a more permanent destination?

“I don’t think that far ahead, and am open to all opportunities,” he responded, and emphasized that his focus was on the moment and never extended beyond the next day or two. One could not help but sense the empty space that someone, who had been such a daily inspiration to fellow students, would leave behind. Is he coming back to visit, I wondered. He replied that he’d be back during summer break. How does summer break work for a researcher at a university, I thought aloud. Does it follow the academic calendar? He’d probably come back for a week, he answered tentatively and emphasized that his primary passion is to motivate students. “Never underestimate the power of students,” he proclaimed with conviction.

Even if Alen Juginović’s return visits to Croatia are brief and rare, I’ll safely bet that a more refined version of his story, which he shared with me over coffee and dessert, will appear as a TED Talk on YouTube. It’s simply not even a matter of if; it’s a matter of when. And sure enough, it turns out that his future Serbian mentor has already given a TED Talk. Young Croatians seeking motivation will be able to locate inspirational footage of the soon-to-be former Split resident online by a Google search. Some will be enchanted by his fulfillment of the American Dream, a concept which has long ago achieved mythical proportions. Others, perhaps, might be inspired to stay and effect change in their homeland. Dr. Juginović emphasized that his parents and three close friends have been his main source of inspiration.

Saying Goodbye and Reaching Out for Something New

He admitted that the last few weeks have been emotional. Late one night he sat on a bench ten meters from the sea with a close friend and disclosed that he was leaving for America. Without saying a word, the friend simply hugged him. “Everglow” by Coldplay was playing on the car radio on their way home and that song will always commemorate the moment, he reveals. Then he showed me a stunning image of a sunset taken high up in the hills overlooking Split and the Adriatic Sea. The soft horizontal bars of deep blue and orange were broken up by the silhouette of a young man with mussed up hair and the roof of a car. Flickering lights of Croatia’s second largest city, a city that existed long before the arrival of Croatian tribes, dotted the lower right-hand corner of the image. These were among the reflections of a young man saying goodbye.

Near the end of our conversation, we spoke briefly about his favorite songs. In addition to “Everglow”, he mentioned “Purple Rain” by Prince. We immediately agreed that it was impossible to enjoy songs with meaningless lyrics. In that context, “Purple Rain” seemed like an improbable choice, not to mention that the song was a massive worldwide hit a decade before he was born.

Prince explained the meaning of his song to an interviewer as follows: “When there’s blood in the sky – red and blue = purple… purple rain pertains to the end of the world and being with the one you love and letting your faith/god guide you through the purple rain.”

At the beginning of the song, the late musician’s lyrics appear to be directed toward an individual and allude to the end of a friendship. Then he acknowledges that times are changing and “it’s time we all reach out for something new, that means you too.” Had the young Croatian doctor experienced the end of a friendship? We hadn’t gotten that personal, but I suspect that his affinity for this song hinted at a more collective, rather than personal experience. Near the end of the legendary anthem, Prince calls out to his audience:

You say you want a leader
But you can’t seem to make up your mind

If you know what I’m singing about up here
C’mon, raise your hand

Follow our Lifestyle page and Diaspora page for more information on Croatians and their successes abroad. For updates on Dr. Juginović’s pursuits and health advice, follow his Twitter page here.

ZAGREB, January 17, 2020 - The Dignitatis association of patients on Friday welcomed the National Lung Cancer Early Detection Programme, saying however that the programme was discriminatory because not all patients had equal access to the programme as only certain hospitals possess the necessary LDCT screening equipment.

"When the programme was being planned it should have taken account that all counties need that equipment as the majority of patients who would perhaps decide to participate in the programme will not be in a position to do so because of the distance and costs involved," Dignitatis said in a press release.

"We condemn this discrimination against patients in Croatia and ask that before the programme is implemented that the Health Ministry secured the necessary apparatus in all county centres for the programme to be able to be implemented in a quality way and be accessible to all patients," Marina Novaković Matanić of Dignitatis said.

The KoHOM association of family doctors on Thursday warned that conditions had not been established to implemented the screening programme.

With the announcement that the first screens could start as of Friday has put family doctors in an awkward situation because they have to explain to patients that the programme is not ready yet.

We welcome the national programme, which we helped prepare. We are prepared for cooperation in implementing it however the programme has not come to life nor will it tomorrow either as announced in the media, KoHOM said on Thursday in a press release.

KoHOM has asked that patients for their understanding and to approach the Croatian Health Insurance Institute and Health Ministry for any further information.

More health news can be found in the Lifestyle section.

ZAGREB, January 16, 2020 - The Dr. Andrija Štampar Teaching Institute for Public Health issued a health alert on Thursday due to increased levels of particulate matter in the air in Zagreb, saying that the short-term air pollution, usual for this time of the year, did not present a major threat to human health.

It said in a statement that increased levels of particulate matter were usual in the winter months because of coal-powered household and industrial heating systems being used at this time of the year, compounded by road transport and weather.

The Institute advised vulnerable people, such as children, pregnant women, the elderly, persons with chronic respiratory and cardiovascular diseases, persons with an impaired immune response and smokers to adjust their daily routines and avoid long and intensive physical activities outdoors, especially near roads.

People were also advised to use public transport and avoid or reduce the use of solid fuels for heating.

Data from air quality monitoring stations, posted on the website of the Environment and Nature Agency, showed that the quality of air in the entire city was poor on Thursday. The situation was worst in the south-eastern district of Dugave where the concentration of PM10 particles in the air was 112.7 μg/m3 at 11.30 am, while the 24-hour limit value is 50 μg/m3.

More environmental protection news can be found in the Lifestyle section.

ZAGREB, January 14, 2020 - The Croatian Nursing Council (HKMS) on Tuesday condemned a statement made by President Kolinda Grabar Kitarović in which she mentioned nurses in the context of corruption.

Talking about corruption in Croatian society, Grabar-Kitarović said that "friends asked her why she did not take anything to the hospital, because nurses expect that." The President insinuated that nurses "expect gifts" from their patients, HKMS stated.

"Nurses and medical technicians do their jobs in a professional and ethical manner, and they are wholeheartedly committed to their patients' well-being. We find linking this humane profession with corruptive actions unacceptable," they stated.

"Every concerned citizen who knows of or suspects a crime is being committed has the duty to report it, indicating the full name of the suspected person. Labelling nursing as a corrupt profession is unacceptable," said the president of the Croatian Nursing Council (HKMS) Mario Gazić.

The Croatian Nursing Council expects the government to finally start addressing the many burning issues in nursing, such as the shortage of nurses, non-recognition of nursing college degrees, poor organization and unsustainable working conditions in nursing, underpayment, injustices in promotions, irregular distribution of the workload, unclear systematization of work positions, and increasingly frequent cases of verbal and physical violence, HKMS said in a press release.

More health news can be found in the Lifestyle section.

ZAGREB, January 14, 2020 - Croatia will be the first country in the EU to introduce early screening of lung cancer in the whole country, and all people between 50 and 70 years of age who are active smokers, or who have stopped smoking within the last 15 years, and were consuming at least 30 packs of cigarettes per year, will be included in the national lung cancer early detection programme, soon to commence across Croatia.

The goals of the programme include reducing lung cancer mortality by 20% in the next 5 to 10 years thus saving more than 500 lives annually, achieving a 50% response rate to the screening, and raising the five-year survival rate from 10 to 15%.

The national programme, conducted by the Health Ministry in cooperation with the Croatian Thoracic Association, will be officially presented on Tuesday.

Lung cancer is detected in around 3,000 people annually in Croatia, and the leading cause of the disease is smoking. Research shows that 31.1% of Croatia's population are smokers - 35.3% of men, and 27.1% of women. In 2018, 3,021 people were diagnosed with lung cancer (899 women and 2122 men), and 2,789 people died from it. The prevalence of lung cancer is stagnating in men, and rising in women.

Lung cancer is the leading cause of malignant disease deaths in the world and in Croatia. Despite considerable progress in treatment, in most cases it is still an incurable disease, and one of the main reasons for poor treatment results is the fact that two thirds of patients are diagnosed with lung cancer in the advanced stage, when recovery is no longer possible.

Screenings will be performed on low-dose high-resolution CT scanners (LDCT), which can detect even the slightest change in the lungs.

Health facilities across Croatia, in Zagreb, Osijek, Rijeka, Split, Varaždin, Zadar, Dubrovnik, Slavonski Brod, Virovitica, Pula and Krapinske Toplice, are now equipped with 16 LDCT scanners in total.

More health news can be found in the Lifestyle section.

ZAGREB, December 19, 2019 - A uniform calendar for the registration of patients for hospital examination, which is expected to make order and reduce waiting lists for nine medical procedures, has been launched this week, and for the time being it includes 42 of the country's 64 hospitals, it was said at a news conference at the Croatian Health Insurance Institute (HZZO) on Thursday.

The hospitals included in this system have compatible information systems while the others would be integrated by May 2020.

The nine medical procedures are the ones for which currently waiting lists are the longest - MR and CT scans, Holter monitor, heart ultrasound, cardiac stress test, cataract surgery, breast ultrasound, thyroid ultrasound and gastroscopy, and there are plans to expand the list.

Patients will get medical appointments from their GPs while specific dates for procedures such as MR and CT scans, cataract surgery and gastroscopy will be allocated by specialists or hospital administrators.

A patient will be able to cancel their appointment via the eCitizen system or change the date of the examination or the hospital.

The uniform calendar of medical appointments will prevent the multiplication of medical appointments, which currently results in unrealistically long waiting lists, and making an appointment by using the patient's personal identification number will automatically prevent scheduling more than one examination of the same type in a different hospital, HZZO director Lucijan Vukelić said at the news conference.

The uniform calendar consists of red, yellow and green lists into which doctors enter appointments, with the red list designated for priority or urgent appointments, for patients who have to be scheduled for an examination within a period of 14 days.

The yellow list refers to appointments that are not urgent but have to be made so as to prevent causing harm to the patient's health by making them wait longer than prescribed by doctors.

The green list refers to procedures a patient can wait for a longer period of time or to regular check-ups.

More health news can be found in the Lifestyle section.

ZAGREB, December 13, 2019 - The Zagreb University's Faculty of Rehabilitation and Education Sciences on Friday presented results of an extensive study revealing an alarming situation regarding the mental health of young people.

In a group of 30 high school students, two use marijuana once a week or more frequently and one in three drinks alcohol once a week or more frequently - these are some of the basic indicators which show that more frequent alcohol and marijuana consumption is accompanied by poorer indicators of mental health, project head Miranda Novak said.

One in four young people have significant symptoms of anxiety and stress, and in a class of 24, at least one says they have attempted to kill themselves, Novak said, describing the situation as alarming.

On the other hand, the higher the self-awareness, the fewer the symptoms and the less frequent alcohol and marijuana consumption.

Education and Science Minister Blaženka Divjak expressed support to the study and confidence that its results would have an impact on school and other social systems.

We have cooperated with the Faculty of Rehabilitation and Education Sciences on drawing up an action plan for the prevention of school violence and it is expected to be adopted by the government soon, she said, underling the importance of its implementation through the system of intervention, policies and programmes, she said.

She underlined the importance of developing self-awareness and peer solidarity and empathy to enable young people to identify problems on their own and deal with them, she said, recalling the introduction of a number of cross-subject topics in school curricula such as personal and social development, civics and health education.

Analyses of the data show that a more stable family environment contributes to fewer symptoms of depression, anxiety and stress and better emotional competencies and more positive mental health of young people, Novak said, adding that the results of the study showed that investing in the family environment contributed to the empowerment of young people.

As for the school environment, young people who are more emotionally competent are more willing to engage themselves with regard to school tasks and are more committed to school. Young people who are more committed to school show fewer symptoms of anxiety, she concluded.

The study also shows, among other things, that as many as 39% of young people witnessed peer violence once or more frequently over the past month, while 18% experienced it.

More news about young people in Croatia can be found in the Lifestyle section.

ZAGREB, December 11, 2019 - Following a ruling by the Supreme Court that doctors are entitled to higher pay for overtime, Health Minister Milan Kujundžić said on Tuesday he would try together with the HLS physicians' union to find a solution to this issue.

The Supreme Court ruling says that reimbursement to doctors for overtime work should also include compensation for specific work conditions and other benefits, which means that the debt to doctors accrued due to miscalculation of overtime pay is estimated at 1.5 billion kuna (203 million kuna), and so far 4,000 physicians have taken legal action against their employers over this problem.

Several hundred final verdicts have been handed down to date.

The Supreme Court ruling has been applauded by the HLS union and the Croatian Medical Chamber (HLK).

"This is our joint victory in the struggle for doctors' rights," HLK leader Krešimir Luetić said today.

HLS leader Renata Čulinović-Čaić said the ruling confirmed physicians' claims that their overtime pay was miscalculated. Now it is up to the ministry to think and find ways to pay what we have earned, she added.

Kujundžić said that the ministry would try to reach agreement with the HLS on the pace and schedule of payment of that debt. He added that the problem was inherited from the government which was in power in 2013.

More news about the healthcare system can be found in the Lifestyle section.

ZAGREB, Dec 6 (Hina) - Croatia's life expectancy is increasing but is still below the European Union's average by three years, according to findings of the EU report on the State of Health in its member-states.

"Although life expectancy at birth in Croatia increased by 3.4 years between 2000 and 2017, from 74.6 to 78 years, the distance to the EU average remained almost unchanged, amounting to 2.9 years," reads the report's section on Croatia

Croatia's Health Profile, which was presented in Zagreb on Friday by the Andrija Štampar Teaching Institute of Public Health, reads that one the reasons for this gap is "the low effectiveness of public health interventions," and in this context it is underscored that "anti-tobacco policies are underdeveloped, indoor smoking in public places is still widespread, and rates of teenage smoking are the third highest in the EU."

"Obesity rates are rising, particularly among children. Preventable mortality is well above the EU average," reads the report.

"Social inequalities in life expectancy appear to be less pronounced in Croatia than in many other EU countries. For instance, Croatian women with lower education live on average 1.6 years less than those who completed tertiary education, and this gap for women is far below the EU average (4.1 years).

In 2017, Croatians aged 65 could expect to live an additional 17.4 years, 2 years more than in 2000. However, more than 12 years of life of this period is spent with disabilities. The gender gap in life expectancy at age 65 is about 3.5 years in favour of women. However, there is no gender difference in the number of healthy life years because women tend to live a greater proportion of their lives after age 65 with health issues and disabilities, reads the report.

The shorter life expectancy in the Croatian cohort of elderly citizens than in the whole of the EU is the consequence of behavioural risk factors, including dietary factors, tobacco smoking, alcohol consumption and low physical activity, exceeding the EU average in particular for dietary risks and tobacco. Slightly more than half of all deaths in Croatia can be attributed to those behavioural risk factors.

Croatia spent 6.8 % of its GDP on health in 2017, much less than the EU average of 9.8 %. Although it is also among the three lowest spenders in the EU in terms of health spending per capita, Croatia has maintained a relatively high share of public spending, resulting in high levels of financial protection. However, levels of public debt still exert constraints on public spending on health. Furthermore, a large share of health expenditure goes to pharmaceuticals, far exceeding the EU average. Policy initiatives to address this include evolving centralised procurement for hospitals, but there is large scope for further action, such as increasing the share of generics. In contrast, a very small share of health expenditure is spent on long-term care, which is generally underdeveloped. In view of the ageing of the population, it will be important to increase the availability of community-based long-term care.

Croatia is advised to improve the strategic planning of human resources in the healthcare system, although in the country there are fewer unmet needs for medical care than on average in the Union.

In recent years, the number of doctors and nurses has increased in Croatia but they are unevenly distributed across the country, and many are either moving abroad or nearing retirement.

More health news can be found in the Lifestyle section.