Why is Public Health Important to Countries of Eastern Europe and Russia? TH Tulchinsky MD MPH Braun School of Public Health Oct 2003

"All mankind is of one author, and is one volume; when one man dies, one chapter is not torn out of the book, but translated into a better language; ….. As therefore the bell that rings to a sermon, calls not upon the preacher only, but upon the congregation to come: so this bell calls us all: … “No man is an island, entire of itself...any man's death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee."

Learning from Others Learning from Others Science and technology – “the state of the art” Disease patterns Infectious Non-infectious Toxic Trauma Nutritional Interventions for prevention Interventions for case management Managing health systems

GDP Per Capita CEE, Russia, Israel

Crude Fertility Rates, CEE, Russia, Israel

Crude Mortality Rates

Life Expectancy, CEE, Russia, Israel

Maternal Mortality, CEE, Russia, Israel

Stroke Mortality, CEE, Russia, Israel

CHD Mortality, CEE, Russia, Israel

Ca Cx Mortality, CEE, Russia, Israel

MVA Mortality, CEE, Russia, Israel

Trauma Mortality, CEE, Russia, Israel

Cirrhosis Mortality, CEE, Russia, Israel

Diabetes Mortality, CEE, Russia, Israel

Public Health Burden of CEE, Russia High mortality from preventable disease Nutrition e.g. MNDs, obesity-unfitness, diabetes Chronic disease e.g. congestive heart failure, diabetes, cancer, osteoporosis, dementias Infectious diseases (new and old)e.g. TB, HIV, STDs Inequalities e.g. geographic disparities Mental health, substance abuse, depression Costs (rising), resources (limited), priorities (needed)

Health Status: International Data Source Health for All Data Base, WHO European Region Accessible at Country programs –Copy Diskette 1 and diskette 2 to hard disc –Open –Includes all countries in WHO Euro region –Superb: Use it

Why Health Targets? US and WHO experience Objectives with funding support Measurable set of objectives, targets, goals –National, regional comparisons –International comparisons –Funding allocation Relevant to Israel –Ethnic and deprived group health –Diabetes –Hypertension –Nutrition status monitoring etc

Urgent Issues International standards Down size hospital sector, transfer to home care Training in NPH National health priorities, policies, targets Immunization Vitamin K for newborns Hypertension control at primary care level Clinical guidelines TB, STD, HIV control Monitoring and continuing adaptation

What Should You Be Reading? MMWR HFA Data Base WER Am Journal of Pub Health European Journal of Pub Health NEJM Lancet/BMJ Pubmed Internet Promed