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Former U.S.S.R.: Health Crisis Looms In The East, Says Report

Washington, 20 September 1996 (RFE/RL) -- Diseases caused by smoking, excessive drinking and unhealthy eating habits threaten to overwhelm the health systems of the former communist countries in Central and Eastern Europe and the former Soviet Union, says a new international report.

The report says smoking will lead to the greatest increase in diseases that are not caused by infection, what medical experts call non-communicable diseases.

"The world as a whole and Eastern Europe probably as much as any other region and more than many other regions, faces a great epidemic of disease related to tobacco over the next 50 years, and that's primarily of two kinds -- heart disease and lung cancer," says Dr. Richard Feachem of the World Bank.

Feachem was one of the principal authors of the study convened by the United Nations' World Health Organization. It took five years to complete. Major participants in the study include the World Bank, the Harvard University School of Public Health in the U.S. state of Massachusetts, the governments of Australia, Canada, Norway, Sweden, Switzerland and the United Kingdom and several private foundations.

The report forecast global health trends through the year 2020. The researchers divided the world into eight regions. All of the countries of Central Europe, Eastern Europe, the Baltic States, the former Yugoslavia and most of the former Soviet republics were grouped under the heading of "Former Socialist Economies." Armenia, Azerbaijan, Georgia, Kazakstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan were included in a group called the "Middle Eastern Crescent."

There were no individual reports for specific countries.

The major goals of the study were to identify trends in public health to enable national health systems to make plans for the next 25 years, to encourage research into finding treatments and preventions for diseases that can be averted by changes in personal behavior, and to make recommendations for government health planners.

One recommendation that Dr. Feachem says requires urgent attention in the former communist countries is encouraging men and women to quit smoking, or to never start.

"The evidence on the relationship between tobacco abuse and heart disease and tobacco abuse and lung cancer is very strong," Feachem said in an interview with RFE/RL. "We know what the risks are. We know very precisely what smoking behavior does."

He says the "epidemic of disease" linked to smoking will hit in "20, 30, 40 years after the epidemic of smoking." Feachem says more men then women smoke, but more women are smoking now than ever before. In contrast to Western Europe, Scandinavia, the United States and Canada, the number of men and women who smoke in the former communist countries is not dropping.

In that region, says Feachem, countries have not yet adopted "the kind of measures that many Western European countries and North American companies have adopted to limit, or to make smoking less attractive in various ways."

These methods include restrictions on the types of cigarette advertising that may be used. In the United States, for example, tobacco companies may not advertise on television. Other regulations in force in the United States and many Western countries are prohibitions on smoking in public buildings and restaurants, national laws that prohibit the sale of tobacco products to children under 18, and higher taxes on tobacco products.

Feachem says that, in general, the former communist countries are "way behind the Western European countries and North America in their concern with and their efforts on unhealthy behavior."

While the World Bank official conceded that there are big differences in the health of people and in the approach to health care among the countries of the entire region, Feachem asserted that, taken as a whole, "the health status of adult men in Eastern Europe is extraordinarily bad."

"The whole story there is quite extraordinary," Feachem said of Eastern Europe and the former Soviet Union. "The health status is very low, compared to Western Europe."

He said the health status of men has been in decline since the mid- 1960s and that life expectancy -- the age to which a person is expected to live -- has gone down. Feachem said this is a "historically unparalleled event."

This contention is supported by statistics from other sources.

For example, a report on "Russia's Demographic Crisis," prepared last year by the U.S.-based research organization called the RAND Corporation, says that life expectancy for Russian men has plummeted from a peak of almost 65 years in 1987 to 59 years in 1993. Women still live much longer on the average in Russia, but even expectancy rates for women are dropping, from a high of 74 years in 1987 to 72 years in 1993.

Other research shows that heart disease is the main reason that people die young, not only in Russia, but throughout the former communist countries.

The American Heart Association reports that from the Czech Republic to Russia, heart disease is the leading killer of adult men and women.

Figures for 1993, the most recent year surveyed, show that the death rate in Hungary for heart disease in men is the highest in central Europe. The rate is 1,015 per every 100,000 persons.

In Bulgaria the rate is 979 per 100,000.

In Romania it is 885 per 100,000.

In Poland, the rate is 862 per 100,000.

In the Czech Republic the rate is 813 per 100,000.

Among women, heart disease is the leading killer in Romania, with 526 deaths per 100,000 attributed to that cause.

Bulgaria is next highest with 497 deaths per 100,000.

Hungary's rate is 468 per 100,000.

Poland's is 381 per 100,000.

The figure in the Czech Republic is 373 per 100,000.

The heart disease death rates for men and women are by far the highest in Europe.

In Russia, much of the news in recent weeks has been about President Boris Yeltsin's impending surgery to relieve his heart disease. The American Heart Association statistics show that Yeltsin is hardly alone. Russia has the highest death rate for cardiovascular disease -- among both men and women -- in the developed world. The figures say that 1,318 of every 100,000 Russian men die from cardiovascular disease every year; for women, the rate is 607 per 100,000 thousand.

By comparison, the death rate for heart disease in the United States is 460 per 100,000 for men and 222 per 100,000 for women. Heart disease is still the leading cause of death in the United States.

American Hearth Association statistics on other countries in Eastern Europe and the former Soviet Union were not available.

According to the World Health Organization study, heart disease, strokes and roadway and workplace accidents will be the leading causes of deaths and disabilities in the former communist countries by the year 2020.

Heart disease and strokes are linked to what health experts call "lifestyle choices." That means these conditions are often the result of bad habits. Smoking, overeating or eating an unbalanced diet, and excessive drinking all can lead to cardiovascular disease, experts say. There is also a definite link between smoking and lung cancer and some other forms of cancer.

Dr. Feachem said that experts don't know precisely why the general health in the region has deteriorated since the collapse of communism, but he says experts have some good ideas.

"Firstly tobacco was playing a major role," he said. "Secondly, obesity. Men in the region are more obese then men in Western Europe."

Then, he blames diet, which he said is "exceptionally bad." He says diets throughout the region are characterized by high amounts of animal fat and high amounts of salt. Too much fat can elevate a person's blood cholesterol levels and that can lead to clogged arteries. Too much salt is believed by some researchers to contribute to high blood pressure, which can also damage arteries.

Feachem also blames excessive alcohol consumption. Chronic drinking can lead to heart and liver damage and many other disorders that can shorten a person's life. He added that accidents, both on the highways and at the workplace, are increasing.

"People in the region like to think that environmental pollution is the cause of all the health problems," Feachem said. "That's not true."

Feachem said the new report will help the World Bank and other international institutions as they work with governments in the region to bring about health sector reforms. He said it is a priority for governments to make investments in disease prevention now, rather than having to spend enormous sums of money in 20 or 30 years on treatment.

But Feachem also notes that there has to be what he calls a culture change among people "before we can expect major improvement."

"There is a mindset inherited from the past that thinks someone else is responsible, that it is someone else's fault," he says. "Changing that mindset is important."