Noncommunicable Diseases and Former Soviet Union countries

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Non-communicable Diseases and Former Soviet Union
countries

• Eugene Shubnikov, MD,
• Institute of Internal Medicine, Novosibirsk,
  Russia

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PRESIDENT VLADIMIR PUTINState-of-the-Nation
AddressFederal Assembly of the Russian
Federation,The Kremlin, April 25, 2005

• I am deeply convinced that the success of
  our policy in all spheres of life is closely
  linked to the solution of our most acute
  demographic problems. We cannot reconcile
  ourselves to the fact that the life expectancy of
  Russian women is nearly 10 years and of men
  nearly 16 years shorter than in Western Europe.
  Many of the current mortality factors can be
  remedied, and without particular expense. In
  Russia nearly 100 people a day die in road
  accidents. The reasons are well known. And we
  should implement a whole range of measures to
  overcome this dreadful situation.
• I would like to dwell on another subject
  which is difficult for our society the
  consequences of alcoholism and drug addiction.
  Every year in Russia, about 40,000 people die
  from alcohol poisoning alone, caused first of all
  by alcohol substitutes.
• Mainly they are young men, breadwinners.
  However, this problem cannot be
• resolved through prohibition. Our work must
  result in the young generation recognizing the
  need for a healthy lifestyle and physical
  exercise. Each young person must realize that a
  healthy lifestyle means success, his or her
  personal success.

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Health status

• It is useful to begin an account of health status
  developments with a consideration of the Soviet
  period, as the present health crisis of the
  Russian Federation has its roots in events that
  long precede the collapse of the Soviet Union.

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The period until 1991Life expectancy (both
sexes)
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The period until 1991Life expectancy in 1965
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The health care principles upon which the Soviet
health care system was to be based (Nikolai
Semashko)

• Government responsibility for health
• Universal access to free services
• A preventive approach to social diseases
• Quality professional care
• A close relation between science and medical
  practice
• Continuity of care between health promotion,
  treatment and rehabilitation.

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Next steps following the establishment of the
Semashko model in 1918

• Russia made massive strides in arresting the
  spread of infectious diseases.
• Drastic epidemic control measures were
  implemented, particularly in the cases of
  tuberculosis, typhoid fever, typhus, malaria and
  cholera.
• These involved community prevention approaches,
  routine check-ups, improvements in urban
  sanitation and hygiene, quarantines, etc.

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Why?

• The diverging paths of Russia and other
  industrialized nations with respect to health
  status from the 1960s onward has been attributed
  to the failure of the Russian health care system
  to successfully respond to the epidemiological
  transition.

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Why? (cont.)

• The paternalistic Soviet philosophy did not
  encourage the development of responsibility of
  the individual with respect to lifestyle issues
  that have a major bearing on health (alcohol use,
  smoking, diet, etc.), a situation exacerbated by
  the heavy dependence on alcohol sales as a means
  of circulating currency in a country with little
  access to consumer goods. And Soviet medical
  science was effectively isolated from
  developments in the West, not only in terms of
  knowledge of new treatments but also access to
  pharmaceuticals, technology, and the emerging
  evidence based medicine movement.

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A campaign against alcohol

• By the 1980s, the gap between Russia and Western
  countries in life expectancy at birth came to
  about 10 years for men and 6 years for women,
  mostly due to high death rates among those of
  working age (6). In the mid-1980s, the government
  made an attempt to address this problem (9). It
  was by then generally understood that potentially
  avoidable human losses were mostly attributable
  to excess adult age mortality from particular
  causes such as injuries, accidental poisoning,
  suicide, homicide, sudden cardiac death,
  hypertension and other conditions closely related
  to alcohol abuse and its consequences.

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Life expectancy related to Campaign
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But.

• Russia failed to maintain this record, however
  by 1987 the USSR was no longer able to enforce
  the anti-alcohol campaign and death rates rapidly
  resumed their upward trend from 1988 onwards. The
  anti-alcohol campaign was largely prohibitive and
  did not affect the attitude of the majority of
  Russias population towards alcohol.
• Thus towards the end of the Soviet period, the
  Russian population, faced with mortality rates
  much higher and life expectancy lower that than
  those of its western neighbors, was already
  confronting a health crisis which had been
  developing gradually over the previous two to
  three decades.

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The period after 1991

• The health status of the Russian population
  declined precipitously following the collapse of
  the Soviet Union in late 1991. By all accounts,
  in the last decade Russia has been experiencing a
  shock unprecedented in peacetime to its health
  and demographic profiles.

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Russian Federation Population (1980-2000)
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Total mortality, 1990s
Russian Federation
St. Petersburg
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Life expectancy in Russia, male
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Life expectancy in Russia, female
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The leading causes of death in the Russia
Federation

• Cardiovascular diseases with rates that are the
  highest in the European Region (2005 56,4 ( 1,
  3 mln from 2,3 died, or 905 cases per 100,000 ).
• External causes of injury and poisoning (2005 -
  13,7).
• Cancer (2005 - 12,4).

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CVD
Injury
Cancer
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Causes of the mortality crisis

• Major social and economic shock and income
  stratification in a population already vulnerable
  because of
• Poor diet, high levels of smoking, and weak
  systems of social support, in which alcohol and,
  increasingly, intravenous drugs, are easily
  available.
• Health care system is poorly equipped to respond
  to challenges.
• Furthermore new threats are emerging, in the form
  of infectious and parasitic diseases, including
  sexually transmitted diseases, and in particular
  AIDS, whose incidence has been growing
  exponentially since the latter half of the 1990s.

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1997 Concept of health care and medical science
development in the Russian Federation.
Nominally, there are four main prioritiesemerging
from this concept

• Health promotion, prevention and attention to
  lifestyles
• Primary care development based on family
  practice
• De-emphasizing secondary and tertiary care
• Quality of care.

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What ways we may use for improve Health in
Russia?

• Improve prevention
• Reach everybody
• Make it inexpensively

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Role of FSU Internet PreventionNetwork in
improvement Health in Russia

• Networking Russian Public Health specialists via
  Internet
• Improve prevention through the training of
  Russian Public Health specialists through
  Supercourse Library of lectures in Epidemiology,
  Public Health and Internet - www.pitt.edu/super1/
  national/index.htm
• Provide Russian Language Lectures on prevention
  via FSU Internet Prevention web site
  www.pitt.edu/super1/national/index.htm

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All 15 Former Soviet Union Countries are involved
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FSU Supercourse Network, 2008
600 registered members
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More than 250 lectures in Russian language
www.pitt.edu/super1/national/index.htm
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Russian language web site - www.supercourse.pochta
.ru
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5 joint meetings during last 8 years
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FSU Supercourse 2008
Joint publications

• Boyarsky S., Brener I., Vlasov V., Danishevski
  K., Dato V., Zabina H., Ivanov D., LaPorte R.,
  Linkov F., Luchanski V., Troufanov A., Chepurnov
  A., Shubnikov E. Internet Prevention Program for
  Russia. Journal of Diseases Prevention and Health
  Promotion. Number 3, 2001, P.27-31.(in Russian)
• R.Talshinsky et all. (Constructing a NATO
  Supercourse// Scientific Networking and the
  Global Health Network Supercourse. IOS Press,
  2006. P.12-27.
• E.Gursky, D.Zhuravlev, S.Koptilov, R.Laporte,
  A.Rossodivita, V.Chernakov, E.Shubnikov,
  A.Trufanov. Information Sharing Policy in
  Counteracting Chemical,Biological, Radiological
  and Nuclear Threats. Proc. International
  Conference on Emergencies, Moscow, April
  18-20,2007. pp.356-367 (in Russian).

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FSU Supercourse, 2008
All 15 Former Soviet Union Countries are
involved Russian language web site -
www.supercourse.pochta.ru More than 250 lectures
in Russian language About 600 active members of
the network 5 joint meetings during last 8 years
Joint publications
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Health Indicator

• A Variable, susceptible to direct measurement,
  that reflects the state of health of person in a
  community. Examples include infant mortality
  rates, incidence rates based on notified cases of
  disease, disability days, etc. These measures may
  be used as components in the calculation of a
  Health Index.

A Dictionary of Epidemiology / edited for the
International Epidemiological Association by John
M. Last associate editors, Robert A.Spasoffet
al.. -4th ed. P.196.
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Health Index

• A numerical indicator of the health of a given
  population derived from a specified composite
  formula. The components of the formula may be
  INFANT MORTALITY RATES, INCIDENCE RATES,
  INCIDENCE RATE FOR PARTICULAR disease, or other
  Health Indicator.

A Dictionary of Epidemiology / edited for the
International Epidemiological Association by John
M. Last associate editors, Robert A.Spasoffet
al.. -4th ed. P.196.
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Health Education

• The process by which individuals and groups of
  people learn to behave in a manner conductive to
  the promotion, maintenance, or restoration of
  health.

A Dictionary of Epidemiology / edited for the
International Epidemiological Association by John
M. Last associate editors, Robert A.Spasoffet
al.. -4th ed. P.196.
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Health

• A State of complete physical, mental, and social
  well-being and not merely the absence of disease
  or infirmity (WHO,1948).
• The extent to which an individual or a group is
  able to realize aspirations and satisfy needs,
  and to change or cope with the environment.
  Health is a resource for everyday life, not the
  objective of living it is a positive concept,
  emphasizing social and personal resources as well
  as physical capabilities (WHO, 1984).
• A State of equilibrium between humans and the
  physical, biological and social environment,
  compatible with full functional activity (J.Last,
  1997).

A Dictionary of Epidemiology / edited for the
International Epidemiological Association by John
M. Last associate editors, Robert A.Spasoffet
al.. -4th ed. P.196.
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Health Promotion

• The process of enabling people to increase
  control over and improve their health. It
  involves the population as whole in the context
  of their everyday lives, rather than focusing on
  people at risk for specific diseases, and is
  directed toward action on determinants or causes
  of health.

A Dictionary of Epidemiology / edited for the
International Epidemiological Association by John
M. Last associate editors, Robert A.Spasoffet
al.. -4th ed. P.196.
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There are many possibilities to find out the
Country's Health Profilesfrom newspapers,books,TV
,radio and of course Internet.

• WHO data http//www3.who.int/whosis/whsa/whsa_tab
  le1_process.cfm?pathwhosis,whsa,whsa_table1,endp
  ointlanguageenglish
• World Bank Data http//www.worldbank.org/data/wdi2
  001/pdfs/tab2_19.pdf
• Library of Congress Data  http//lcweb2.loc.gov/f
  rd/cs/rutoc.html

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http//www.pitt.edu/super1/lecture/ns0011/006.htm

• Supercourse Team already created Health
• profiles Power Point presentations for all 15
  Former Soviet Union countries based on
  Supercourse methodology of sharing best teaching
  materials between public health  teachers
  worldwide.

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http//www.pitt.edu/super1/lecture/ns0011/006.htm

• The idea is that we would have one person
  (speaking native language!)available in each
  country to collect health indicator information.
  Both WHO and theWorld Bank have this
  information,but is not very user friendly, in
  that it is in tables, ours in Power Point slides.

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We may use YouTube too!
Health indices for FSU
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http//www.pitt.edu/super1/lecture/ns0011/006.htm

• Also, we can update the National Supercourses as
  the data themselves are updated, thus our data
  will be more timely. By having the health indices
  in a user friendly format, e.g. Power Point, we
  can get it into the classrooms of the world very
  quickly. Also, it will be rapidly updated. Our
  system is different than WHO and World Bank, in
  that it is a graphic format,simple and timely.
  We do not complete with them, we compliment them.

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We propose to use following indicators

• Birth statistics
• Life expectancy statistics
• Mortality rates
• Main causes of death
• Infant mortality rates
• Incidence rates based on notified cases of
  disease
• Disability days
• Economics indicators
• Any others according decision of investigator