Health in Makarska

On Monday, May 25th, all of the students went to the city hall in Makarska to meet with the director of the legal department. She talked to us about the city’s development plan, tourism, and traditions. The government of Makarska is trying to encourage tourism and development of the area, while still maintaining the natural beauty of the city. To help maintain the water quality of the Adriatic Sea, Makarska has recently built a water treatment facility that treats all water before being released into the sea.

After our talk with the director of the legal department, we spoke with Mr. Josip Paunović, who works in the city manager’s office. Mr. Paunović covered a lot of health topics, including smoking, alcohol, substance abuse, and access to health care.

The government implemented the recent smoking ban to help reduce the health care costs related to smoking. The law initially started out as prohibiting smoking in workplaces, but instead of introducing new limitations gradually, the ban was extended to include all indoor public places. To enforce this law, there are inspections in bars and restaurants, and the fines can be at all levels: the individual that is smoking ($200, or a fifth of the average monthly salary), the server allowing the customer to smoke ($2500), or the bar/restaurant owner can all be fined ($20,000).

The smoking ban in Croatia is a very important first step to reducing the number of deaths from smoking and secondhand smoke, but more actions need to be taken. There needs to be a government-funded program to help Croatians stop smoking, whether it be counseling, behavioral therapy, or subsidies to purchase nicotine patches or gum.

About a year ago, DUI laws in Croatia were set to zero tolerance, but the legal limit was changed to a blood alcohol level of 0.05 after complaints from restaurant owners that the law had affected their business. DUIs do not go on a person’s record, but the driver does have to pay a fine. The most commonly abused drug in Croatia is marijuana.

Tourism has many impacts on Makarska. During the year, there are around 15,000 people in the city. In the summer, this number more than doubles to 35,000 due to the large amounts of tourists that come to Makarska. During the summer, there are lifeguards and beach patrol along the busy beaches.

Littering is another problem, especially at the beach. There are people from many different countries visiting the beaches of Makarska, bringing their own customs with them. Some people do not think it is necessary to throw away their trash, while others clean up after themselves. To help with the litter, crews are hired to clean the beaches every morning.

The main problem that comes with tourism is injuries. The ER in Makarska sees about 150 patients daily during the summer, but there is no actual hospital in the city. Any serious cases have to be taken to Split for more advanced care. This can be a problem due to the 2 hour drive from Makarska to Split, and the type of transportation. The ambulances are not actually ambulances, but more like a pick-up van that is not equipped with everything that could possibly needed in an emergency. There are 5 medic teams in the city, and 4 ambulances. The number of tourists in the city during the summer can strain these emergency medical services. Since severe cases from Makarska are sent to Split, this can strain the hospital system in Split. The health center in Makarska was actually designed as a hospital, but because of political reasons, the city has not yet been successful in converting this facility into a full-service hospital.


Following our meeting with Mr. Paunović, the Public Health students went to a local health center and met with the Director of School Health. School health is under the Public Health Department in Croatia. The school system in Makarska has 3,700 students, with less enrolling each year.

A child’s first visit with a school health doctor is usually around May during school enrollment. In the first meeting, the child’s school health record is compiled, consisting of prenatal and maternal health, family history, immunization records, vision, weight, height, etc. A team made up of a psychologist, pediatrician, school health doctor, and the child’s teacher meet to discuss the child’s health record and determine if the child would be best suited for a regular school program or a special education program. The child and his/her family can take the school medical record to their primary care physician and/or keep it with the school health doctor. Comprehensive health exams are conducted in grades 1, 5, 8, and 9. In 3rd grade, vision exams are conducted, and in 6th grade, the student’s motor skills are evaluated.

The school health department provides educational programs on prevention, injuries, hygiene, epidemics, and tourism and prevention programs that encourage early detection through breast self exam or mammograms.

Unlike in the U.S., obesity is not a major health problem in Croatia. The prevalence of overweight and obese students has increased, but only 6% of all children have weight problems, while about 12% of 8th grade students have a problem with their weight.

To help reduce the number of young people that smoke cigarettes, the school health department has anti-smoking programs, lectures, and school classes. As for sexual education in schools, there is no official program. There are two programs that are being debated: a more conservative program teaching abstinence only, and a program that would educate on abstinence and safe sex.

Teen pregnancy is not as big of a problem in Makarska as it is in the U.S. There are only three teen pregnancies per 1,000 population in Makarska. The director of school health informed us that many students that get pregnant during school end up completing their high school education.

Regarding nutrition, the schools serve a snack between the start of the school day and lunch, and then lunch in the afternoon. Some schools have extended programs that also serve breakfast. There are many unhealthy snack and drink machines around the schools. A recent pilot program to introduce healthier snacks was not successful.

- Elizabeth