Stopping the Mortality Crisis in Ukraine
June 8, 2011
Petro Kukuy, 51, has been living in the Western Ukrainian city of Lviv and working as a driver for thirty three years. A year ago, Kukuy had a heart attack. He thinks it was caused by a sedentary life-style.
"Imagine. I've been sitting nearly twelve hours a day. Of course, I should have been walking more to be more active. But my job left me no time. So, I have been collecting my illness step by step," says Kukuy. He started rethinking his lifestyle after his illness got him down.
Ukrainians have a high risk of dying prematurely. Nearly half of the adult population, many of them young, suffers from one or more chronic disease, say the World Bank and the Ukrainian Medical Union (UMU) in a new study "What Underlies Ukraine's Mortality Crisis." Rich and poor alike suffer from these conditions, according to the study. Cardiovascular disease is the leading cause of death and contributes to over half of the disease burden. Why is the Ukrainian population so careless about its health?
As currently organized, Ukraine's health system is unprepared to deal with the mortality crisis. The system needs to move away from a model based on episodic care for acute illnesses to one that is more proactive and meets the needs of patients with chronic conditions.
"Taking care of your health is one of the elements of our people's culture. That is the first factor. The second factor is a trust towards doctors, the trust towards the quality of services provided by the state healthcare system. Both factors are very important. Patients should take care of their health. For example, they should immediately visit doctors to be diagnosed when they have pain in their chest, or they get winded, or have an abnormal heart rate," says Vitaliy Averchuk, a Lviv cardiac surgeon who has saved a lot of people's lives.
The quality of medical care in Ukraine is highly uneven. If you have a heart attack in a village, a small town or a suburb, your chances of survival are low. Emergency medical services could take hours—not minutes—to arrive. Treatment is not always effective.
Doctors sometimes provide patients with the wrong diagnosis or give them wrong advice. Even if they have access to quality care, not every Ukrainian can afford medical care. Most importantly, doctors often do not inform patients about the importance of leading a healthy lifestyle.
"As currently organized, Ukraine's health system is unprepared to deal with the mortality crisis. The system needs to move away from a model based on episodic care for acute illnesses to one that is more proactive and meets the needs of patients with chronic conditions. As chronic disease requires continuous attention, raising awareness of the patient, involving them in the design of their treatment plans will go a long way in ensuring compliance and reducing the risk of premature death," says Rekha Menon, World Bank Senior Economist and one of the main authors of the report.
Recently, local authorities in some urban centers have been trying to improve primary health care. In the capital, Kyiv, the local government is establishing an ambulatory care network and improving the level of knowledge of physicians and pediatricians working there.
"If we talk about decreasing the high mortality rate we must think about improving the socio-economic level of the population. But when we talk about the medical component, which is also an important factor, from the standpoint of the Kyiv city administration we must improve the preventive measures at the level of the primary care system," says Rayisa Moiseyenko, Deputy Head of Kyiv City Council.
Moiseyenko estimates the ambulatory care network will increase primary health care services by 25 percent before the end of this year. The local government plans to open 90 family medicine offices before the end of 2012. But improving the primary care system is not a silver bullet. It is also important to target behavioral risk factors: smoking, alcohol consumption and unsafe driving.
The new World Bank and UMU report shows that many Ukrainians fail to grasp the seriousness of the health risks they face as a result of their lifestyles. Thirty six percent of adults are smokers, 31 percent of them daily smokers. And one fifth of Ukrainian adults indulge in heavy or binge drinking, consuming more than five drinks a day one or more days a month.
Fortunately, public health issues are increasingly gaining attention. Current World Boxing Council world heavyweight champion Vitali Klitschko is a national icon who heads a charitable foundation with his younger brother—also a boxer--to promote healthy lifestyles.
Vitali Klitschko says that there is no cult of healthy living in Ukraine. "In many countries everyone understands that by investing in health they invest in themselves, in something valuable they have. I still remember that in Soviet times there were things associated with a healthy life – competitions and all that, people wearing sports club badges. As a matter of fact, looking after oneself today is by no means cheap. I mean that the number of sports clubs has fallen off and they are not free any more. And not every Ukrainian can afford to visit a multi-gym and go in for sports, as being a member of a sports club or a gym costs hundreds to tens of thousands of hryvnias a month."
The study calls for a concentrated effort by everyone—the government, the private sector—and most importantly—the Ukrainian public. Apart from increasing awareness campaigns among Ukraine's youth, World Bank experts suggest enforcing existing regulations like the ban on selling alcohol and tobacco to minors and the ban on smoking in designated public areas. Taxes, tariffs, legislation and regulations could ensure the effectiveness of existing measures.
The study recommends reorienting the health system so high risk patients are identified and treated, and so chronic conditions are detected early and controlled. It also suggests increasing patient involvement in decisions about treatment, and supporting patients to manage their chronic diseases. The report concludes that without immediate action, Ukraine can lose the next generation to chronic disease. Isn't it time for Ukrainians to stop living on the edge?