Washington, 2 June 1997 (RFE/RL) - Much has been said about the health crisis in Central and Eastern Europe and the former Soviet Union, which is traced to diseases linked to smoking, drinking, improper diets and lack of exercise. But less well-known are efforts by groups within and outside the region to help stop this trend that threatens to overwhelm the public health systems.
With a budget of $1.8 million and a full-time staff of four, the Center for Communications, Health and the Environment hardly seems equipped to meet the health challenges that have festered for years in a region of 400 million, but the non-profit group that works out of a small suite in Washington uses innovative approaches and a large network of partners to advance the cause of health promotion in the former communist countries.
"We focus on prevention of non-communicable diseases," says the Center's chairman, Dr. Sushma Palmer. Non-communicable diseases, she told RFE/RL in an interview, are the major killers of adults throughout the region. In many cases, Palmer added, these diseases can be prevented.
Non-communicable diseases are ailments not caused by germs or parasites and that cannot be passed from person to person. Heart disease, high blood pressure, diabetes and lung cancer are examples of non-communicable diseases. They are all conditions that medical experts say may be linked to personal behaviors -- or bad habits -- such as smoking, excessive drinking, overeating and eating too much fat, and not getting enough physical activity.
Medical scientists are a cautious lot, and the use of words such as "link" or "suggest" is about the strongest connection most will make between a non-communicable disease and a personal behavior. Not every person who smokes, for example, will develop lung cancer, and not every person who eats too much and exercises too little will develop the type of diabetes that strikes adults.
However, doctors and other health experts are firmly convinced that the way a person lives will increase the possibility of developing a non-communicable disease over a span of years. This possibilty is called a risk, and smoking, alcohol abuse, a bad diet and inactivity are what are called modifiable risk factors, which means that they are behaviors that can be changed.
Palmer and her colleagues are trying to encourage people to change their behaviors. She says the Center uses a variety of approaches, some of them adapted from successful health promotion programs in the United States.
The Center was founded in 1990 by Palmer, a former academician at the U.S. National Academy of Sciences, and her husband, Mark Palmer, a former U.S. Ambassador to Hungary.
The not-for-profit group relies on grants to finance its work. It has received funds from charitable institutions and public service organizations such as the Soros Foundation. It also receives about 20 percent of its operating budget from grants administered through the U.S. Agency for International Development.
The Center has started programs using community interventions, development of non-governmental organizations in the countries of the region, and public education through the mass media. The Center also works with government health ministries as well as hospitals and clinics.
In the Czech Republic, for example, where heart disease is the leading cause of death, the Center has established a partnership program with doctors in Prague, the district of Litomerice, and the village of Dubec. The program was aimed at identifying people at risk of developing heart disease and educating them about what they could do to protect their health.
After about five years, the Center says the program has succeeded in convincing a sizable number of people to quit smoking and to make healthy changes in their diets.
In Russia, the Center has helped give birth to two local health promotion organizations, the Health and Environment Foundation in Moscow, and the Association of Physicians of the Don in Azov. These two groups, in turn, have led to the establishment of a network of more than 50 non-governmental organizations devoted to health care throughout Russia.
The Center has also produced a television program called "A Family Year." The five-part series depicts the struggles of four real-life families in the Czech Republic, Hungary, Poland and Russia in coping with health and environmental challenges in a post-communist world.
Palmer says the program has been broadcast on state television in Russia and on private cable television systems in a total of 17 countries in the region. Each segment of the program features the ways in which the families handle the health issues of smoking and drinking, diet, disease prevention, maternal health and living with environmental pollution.
Currently, the Center is also using television as part of a major anti-smoking campaign in Russia. The World Health Organization (WHO) reported this month that smoking causes 280,000 deaths a year in Russia. The WHO says two-thirds of Russian men and one-third the women in Russia smoke, and that the smoking rates for adolescents, particularly girls, are rising.
However, instead of grim warnings about the dangers of smoking, which surveys say most young people tend to ignore, the Center has produced vignettes for television, called public service announcements, that portray the more immediate hazards of smoking. In one such production, a young man has been feverishly smoking cigarettes while awaiting the arrival of his girl friend. When she arrives, she enjoys the fragrance of the rose he gives her, but then turns away from him in disgust when she smells the tobacco smoke on his breath and clothing.
Palmer says the mass media, especially television, is an important tool for communicating health messages. She points out that 90 percent of the population in the region owns a television set, giving television a special role in health promotion campaigns.
Palmer concedes that health promotion still faces big obstacles in the region, not the least of which is the economic dislocation that followed in the wake of communism's fall. The daily struggle to make ends meet, she says, has pushed concerns about personal health down on the list of individual priorities.
However, she says health promotion programs such as those developed by the Center are having a positive impact among the better-educated segments of the societies.
No one can change the ingrained habits of millions of people overnight, she says, but that doesn't mean that people shouldn't try.