Non-communicable Diseases and Former Soviet Union countries Eugene Shubnikov, MD, Institute of Internal Medicine, Novosibirsk, Russia

PRESIDENT VLADIMIR PUTIN State-of-the-Nation Address Federal 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.

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.

The period until 1991 Life expectancy (both sexes)

The period until 1991 Life expectancy in 1965

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.

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.

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.

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.

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.

Life expectancy related to Campaign

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 Russia’s 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.

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

Russian Federation Population ( )

Total mortality, 1990’s Russian Federation St. Petersburg

Life expectancy in Russia, male

Life expectancy in Russia, female

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 ( ,7%). Cancer ( ,4%).

CVD Injury Cancer

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.

1997 “Concept of health care and medical science development in the Russian Federation”. Nominally, there are four main priorities emerging 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.

What ways we may use for improve Health in Russia? Improve prevention Reach everybody Make it inexpensively

Role of FSU Internet Prevention Network 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 Provide Russian Language Lectures on prevention via FSU Internet Prevention web site –

All 15 Former Soviet Union Countries are involved

FSU Supercourse Network, registered members

More than 250 lectures in Russian language

Russian language web site -

5 joint meetings during last 8 years

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 (in Russian) R.Talshinsky et all. (Constructing a NATO Supercourse// Scientific Networking and the Global Health Network Supercourse. IOS Press, P 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 (in Russian).

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

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.Spasoff…[et al.]. -4 th ed. P.196.

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.Spasoff…[et al.]. -4 th ed. P.196.

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.Spasoff…[et al.]. -4 th ed. P.196.

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.Spasoff…[et al.]. -4 th ed. P.196.

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.Spasoff…[et al.]. -4 th ed. P.196.

There are many possibilities to find out the Country's Health Profiles from newspapers,books,TV,radio and of course Internet. WHO data: cfm?path= whosis,whsa,whsa_table1,endpoint&language=english cfm?path= whosis,whsa,whsa_table1,endpoint&language=english World Bank Data Library of Congress Data

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.

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 the World Bank have this information, but is not very user friendly, in that it is in tables, ours in Power Point slides.

Health indices for FSU We may use YouTube too!

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.

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