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Central Asia: Health Report -- Study Says Medical Service Reaches The Poor

This week's RFE/RL Health Report features a World Bank study containing some interesting findings on health care in Central Asia. RFE/RL correspondent K.P. Foley also looks at some successful strategies to reduce smoking -- and the diseases it causes; and, a multilateral effort to bring the latest medical and scientific research to the Caucasus and Central Asia via the Internet.

Washington, 12 December 2000 (RFE/RL) -- The World Bank says that in some of the poorest countries it is, not surprisingly, the poorest people who fail to receive adequate health care. However, the Bank also says this is not necessarily true in at least three Central Asian republics.

A recent World Bank study (Socio-economic Differences in Health, Nutrition and Population) looked at disparities in health status in 44 countries -- including Kazakhstan, Kyrgyzstan, and Uzbekistan. The reports, according to the Bank, focused particularly on the link between health and poverty.

Davidson Gwatkin, a health and poverty specialist at the Bank, said the reports, "clearly show that basic health programs are not serving the poor well enough to close the inequality gap with the rich." In an RFE/RL interview, he added that in the three Central Asian nations, however, the gap between rich and poor is not as vast.

"The three together are really quite different from the African, Asian and Latin American countries that make up the great majority of the 44 that we covered in that poor-rich inequalities are considerably less. They're remarkably equal with respect to services."

In its study, the Bank analyzed data that had been collected previously by the U.S. Agency for International Development and by an international data collection effort called the Demographic and Health Survey program. The data included statistics, such as the number of deaths for every 1,000 live births -- known as the infant mortality rate -- the percent of underweight and under-developed children; the rate of immunization against common diseases, and the number of cases in a population of ailments such as diarrhea and acute respiratory infections.

The reports do not comment on the quality of health care in any of the 44 countries. The purpose of the reports, said Gwatkin, is to provide a statistical basis to help the countries plan their health care programs. He said most data used for health policy planning are often based on averages for an entire nation or region. The World Bank reports, however, account for differences among rich, poor and middle classes.

"We thought we needed much better information about conditions that prevailed among poor segments of the population in order to help countries and us plan and implement programs. That was the motivation."

Gwatkin said he hesitates to attempt to explain why the three Central Asian countries fare so much better in the analyses than the other 41 countries studied.

"I think for these three particular countries, it is a confirmation and a tribute to what these countries have done in the past with respect to the provision of health services. In other words, they have gotten out to reach the poor in a way that is really quite unusual for countries in that stage of development."

********** Task Force Recommends Anti-Smoking Strategies

Washington, 12 December 2000 (RFE/RL) -- An independent panel of U.S. experts has concluded that there is enough evidence available to recommend the use of nine specific strategies to curb smoking.

Doctors say smoking can lead to heart disease, lung cancer and other cancers, and respiratory ailments such as emphysema. Governments, international organizations such as the United Nations, and non-profit public health advocates are waging an all-out campaign on several fronts to curb tobacco use -- especially among youths.

Now, the U.S. government's Centers for Disease Control (CDC) reports that there is a variety of proven methods for use in tobacco control. The Task Force on Community Preventive Services, a group of 15 experts, analyzed 166 published scientific studies on selected tobacco control interventions. In a report published last month, the task force concluded that it could recommend nine methods for use in anti-tobacco campaigns.

In an RFE/RL interview, the associate director for science at the CDC, Terry Pechacek, said the task force investigated such things as studies that examined how increased taxes on cigarettes affected tobacco consumption, studies that compared mass media anti-smoking campaigns, and the effectiveness of local or state public health initiatives.

"The one big message that we want to put out about lung cancer and these other things is that we have a high degree of confidence that we now have an effective technology that not only can reduce smoking rates but also smoking-related disease such as lung cancer."

Among other things, the task force said it "strongly recommended," adoption of smoking bans or restrictions by local governments to reduce exposure to smoke. Governments should also increase the cost of cigarettes through taxes to discourage potential new smokers -- particularly children -- and to encourage smokers to quit. The task force also found that mass media education campaigns are effective in keeping young people away from cigarettes, particularly when they are combined with other strategies such as tax increases.

Another successful strategy, the task force said, is the use of telephone counseling for people trying to quit. Pechacek said experts have confidence in all of the strategies that have been recommended.

"All of the recommendations that we make are science-based and when we make a recommendation it means that they have evidence that they work."

The CDC estimates that 47 million American adults smoke. Pechacek says there is now an ever-expanding arsenal of resources to help them quit.

********** Pilot Program Offers Web Access To Research

Geneva, 12 December 2000 (RFE/RL) -- The United Nations and several public and private partners have begun a pilot program that promises to provide Internet access to medical and scientific information to research centers in Armenia and Uzbekistan.

The UN 's World Health Organization said last week that the program will enable researchers in these two countries to "read the same journals, search the same databases, join in the discussion groups, (and) compete for the same grants as their colleagues from wealthier countries."

The pilot project is part of a larger UN program called "Health InterNetwork," that aims to improve global public health by providing access to health information. The World Health Organization and the Soros Foundation, a non-profit organization, have joined with commercial Internet service providers SilverPlatter and ISI to organize and pay for the program.

WHO Director-General Gro Harlem Bruntland noted that, the project will not only enable scientists in emerging countries to be able to access research from Europe and North America. She says the rest of the world will be able to learn about important work being done in the developing world.

Bruntland said, "valuable research is carried out in developing countries and emerging economies, but the researchers are hampered by not being able to share," this information.

In addition to Armenia and Uzbekistan, Ghana, Mali, Mozambique, Mongolia, Uganda, and Tanzania will also be included in the pilot project. The WHO says that it hopes to eventually enroll as many as 40 nations in the information-sharing program.