[Show abstract][Hide abstract] ABSTRACT: Alcohol consumption is a leading cause of mortality and morbidity in countries of the former Soviet Union, but little is known about its social determinants. Recent research has suggested that workplace contexts may play a role. Using qualitative methods, we investigate the relationship between workplace social contexts and drinking in Ukraine. We conducted 24 individual semi-structured interviews and two focus group discussions in Lviv and Kharkiv, Ukraine, with male railway employees aged 18+ years. Data were analysed using a thematic analysis approach. Men in our sample expressed strong feelings of interdependence and trust towards their co-workers which we defined as 'social solidarity'. Drinking with co-workers was often seen as obligatory and an integral part of co-worker social occasions. Engagement in sport or family obligations seemed to act as a deterrent to drinking among some workers. A strong sense of solidarity exists between railway co-workers in Ukraine, perhaps a remnant of the Soviet era when individuals relied on informal networks for support. Alcohol may be used as a means of expressing this solidarity. Our findings point to factors, namely engagement in sports and family, which may offer opportunities for interventions to reduce alcohol consumption among workers in Ukraine.
Global Public Health 11/2014; · 0.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Progressive realisation of Universal Health Coverage is a widely accepted goal for the post-2015 Millennium Development Goals. Yet the means to pay for it is a subject of intense debate.
Method: Using cross-national fixed effects models,investigated how alternative tax systems affect health coverage and associated child and maternal health outcomes in 89 low- and middle-income countries from 1995-2011.
Findings: We identified tax revenue as a major statistical determinant of progress towards Universal Health Coverage. Each $100 per capita per year of additional tax revenues corresponded to $9.86 yearly increase in government health spending (95% CI $3.92 to $15.8). This association was particularly strong for taxes on capital gains, profits and income ($16.7, 95% CI: $9.16 to $24.3). In countries with low tax revenues (<$1000 per capita per year), an additional $100 tax revenue per year substantially increased the extent of health coverage by 11.4 percentage points (95% CI 5.51 to 17.2). However, in contrast, $100 per capita increase in regressive forms of taxation, such as taxes on goods and services, which may reduce the ability of the poor to afford essential goods, was associated with higher rates of under five mortality rate by 0.43 per 100,000 population (95% CI: 0.14 to 0.72).
Interpretation: Increasing domestic tax revenues is a key element of a strategy to achieving Universal Health Coverage. Pro-poor taxes on profits and capital gains appear to support expansion of health coverage without the adverse effects on health outcomes of higher taxes on goods and services.
142nd APHA Annual Meeting and Exposition 2014; 11/2014
[Show abstract][Hide abstract] ABSTRACT: In the previous two decades, countries of the former Soviet Union underwent a number of economic and social transformations. While there has been some limited evidence on the relationship between socioeconomic well-being and mental health in the developing and transitional economies, the evidence on economic inequalities in mental health has so far been scarce. In this paper, we analyze two unique datasets collected in 2001 (N=18,428) and in 2010 (N=17,998) containing data on 9 countries of the former Soviet Union, exploring how mental health inequalities have changed there between 2001 and 2010. Using regression analysis, as well as indirect standardization approach with concentration indices, we found that mental health appears to have substantially improved in most studied countries during the 2000 decade. Specifically, both the proportion of people with poor mental health, as well as wealth-related inequalities in poor mental health, decreased in almost all countries, except Georgia. The two indicators thus appear to go hand in hand in both survey years: countries which had the smallest proportion of people with poor mental health tended to have the least inequality. Our findings give ground for optimism that at least on these measure, the most difficult times associated with the transition to a market economy in this region may be coming to an end.
Social Science [?] Medicine 11/2014; · 2.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Between now and 2030, every country will experience population ageing—a trend that is both pronounced and historically unprecedented. Over the past six decades, countries of the world had experienced only a slight increase in the share of people aged 60 years and older, from 8% to 10%. But in the next four decades, this group is expected to rise to 22% of the total population—a jump from 800 million to 2 billion people. Evidence suggests that cohorts entering older age now are healthier than previous ones. However, progress has been very uneven, as indicated by the wide gaps in population health (measured by life expectancy) between the worst (Sierra Leone) and best (Japan) performing countries, now standing at a difference of 36 years for life expectancy at birth and 15 years for life expectancy at age 60 years. Population ageing poses challenges for countries’ economies, and the health of older populations is of concern. Older people have greater health and long-term care needs than younger people, leading to increased expenditure. They are also less likely to work if they are unhealthy, and could impose an economic burden on families and society. Like everyone else, older people need both physical and economic security, but the burden of providing these securities will be falling on a smaller portion of the population. Pension systems will be stressed and will need reassessment along with retirement policies. Health systems, which have not in the past been oriented toward the myriad health problems and long-term care needs of older people and have not sufficiently emphasized disease prevention, can respond in different ways to the new demographic reality and the associated changes in population health. Along with behavioural adaptations by individuals and businesses, the nature of such policy responses will establish whether population ageing will lead to major macroeconomic difficulties.
[Show abstract][Hide abstract] ABSTRACT: After the break-up of the Soviet Union in 1991, the countries that emerged from it faced myriad challenges, including the need to reorganize the organization, financing and provision of health services. Over two decades later, this book analyses the progress that twelve of these countries (Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, the Russian Federation, Tajikistan, Turkmenistan, Ukraine and Uzbekistan) have made in reforming their health systems. Building on the health system reviews of the European Observatory on Health Systems and Policies (the HiT series), it illustrates the benefits of international comparisons of health systems, describing the often markedly different paths taken and evaluating the consequences of these choices. This book will be an important resource for those with an interest in health systems and policies in the post-Soviet countries, but also for those interested in health systems in general. It will be of particular use to governments in central and eastern Europe and the former Soviet countries (and those advising them), to international and non-governmental organizations active in the region, and to researchers of health systems and policies.
11/2014; World Health Organization., ISBN: 978 92 890 5028 9
[Show abstract][Hide abstract] ABSTRACT: Unhealthy persons are more likely to lose their jobs than those who are healthy but whether this is affected by recession is unclear. We asked how healthy and unhealthy persons fared in labour markets during Europe's 2008–2010 recessions and whether national differences in employment protection helped mitigate any relative disadvantage experienced by those in poor health. Two retrospective cohorts of persons employed at baseline were constructed from the European Statistics of Income and Living Conditions in 26 EU countries. The first comprised individuals followed between 2006 and 2008, n = 46,085 (pre-recession) and the second between 2008 and 2010, n = 85,786 (during recession). We used multi-level (individual- and country-fixed effects) logistic regression models to assess the relationship (overall and disaggregated by gender) between recessions, unemployment, and health status, as well as any modifying effect of OECD employment protection indices measuring the strength of policies against dismissal and redundancy. Those with chronic illnesses and health limitations were disproportionately affected by the recession, respectively with a 1.5- and 2.5-fold greater risk of unemployment than healthy people during 2008–2010. During severe recessions (>7% fall in GDP), employment protections did not mitigate the risk of job loss (OR = 1.06, 95% CI: 0.94–1.21). However, in countries experiencing milder recessions (<7% fall in GDP), each additional unit of employment protection reduced job loss risk (OR = 0.72, 95% CI: 0.58–0.90). Before the recession, women with severe health limitations especially benefited, with additional reductions of 22% for each unit of employment protection (AORfemale = 0.78, 95% CI: 0.62–0.97), such that at high levels the difference in the risk of job loss between healthy and unhealthy women disappeared. Employment protection policies may counteract labour market inequalities between healthy and unhealthy people, but additional programmes are likely needed to protect vulnerable groups during severe recessions.
[Show abstract][Hide abstract] ABSTRACT: Background
The ¿25x25¿ strategy to tackle the global challenge of non-communicable diseases takes a traditional approach, concentrating on a few diseases and their immediate risk factors. Discussion: We propose elements of a comprehensive strategy to address NCDs that takes account of the evolving social, economic, environmental and health care contexts, while developing mechanisms to respond effectively to local patterns of disease. Principles that underpin the comprehensive strategy include: (a) a balance between measures that address health at the individual and population level; (b) the need to identify evidence-based feasible and effective approaches tailored to low and middle income countries rather than exporting questionable strategies developed in high income countries; (c) developing primary health care as a universal framework to support prevention and treatment; (d) ensuring the ability to respond in real time to the complex adaptive behaviours of the global food, tobacco, alcohol and transport industries; (e) integrating evidence-based, cost-effective, and affordable approaches within the post-2015 sustainable development agenda; (f) determination of a set of priorities based on the NCD burden within each country, taking account of what it can afford, including the level of available development assistance; and (g) change from a universal ¿one-size fits all¿ approach of relatively simple prevention oriented approaches to more comprehensive multi-sectoral and development-oriented approaches which address both health systems and the determinants of NCD risk factors.SummaryThe 25x25 is approach is absolutely necessary but insufficient to tackle the the NCD disease burden of mortality and morbidity. A more comprehensive approach is recommended.
Globalization and Health 10/2014; 10(1):74. · 1.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
WHO stresses the need to act on the social determinants of tuberculosis. We tested whether alternative social protection programmes have affected tuberculosis case notifications, prevalence, and mortality, and case detection and treatment success rates in 21 European countries from 1995 to 2012.
We obtained tuberculosis case notification data from the European Centre for Disease Prevention and Control's 2014 European Surveillance System database. We also obtained data for case detection, treatment success, prevalence, and mortality rates from WHO's 2014 tuberculosis database. We extracted data for 21 countries between Jan 1, 1995, and Dec 31, 2012. Social protection data were from EuroStat, 2014 edition. We used multivariate cross-national statistical models to quantify the association of differing types of social protection programmes with tuberculosis outcomes. All analyses were prespecified.
After we controlled for economic output, public health spending, and country fixed effects, each US$100 increase in social protection spending was associated with a decrease per 100 000 population in the number of tuberculosis case notifications of −1·53% (95% CI −0·28 to −2·79; p=0·0191), estimated incidence rates of −1·70% (−0·30 to −3·11; p=0·0201), non-HIV-related tuberculosis mortality rate of −2·74% (−0·66 to −4·82; p=0·0125), and all-cause tuberculosis mortality rate of −3·08% (−0·73 to −5·43; p=0·0127). We noted no relation between increased social spending and tuberculosis prevalence (−1·50% [–3·10 to 0·10] per increase of $100; p=0·0639) or smear-positive treatment success rates (−0·079% [–0·18 to 0·34] per increase of $100; p=0·5235) or case detection (−0·59% [–1·31 to 0·14] per increase of $100; p=0·1066). Old age pension expenditure seemed to have the strongest association with reductions in tuberculosis case notification rates for those aged 65 years or older (−3·87% [–0·95 to −6·78]; p=0·0137).
Investment in social protection programmes are likely to provide an effective complement to tuberculosis prevention and treatment programmes, especially for vulnerable groups.
European Centre for Disease Prevention and Control.
[Show abstract][Hide abstract] ABSTRACT: During the 2007-11 recessions in Europe, suicide increases were concentrated in men. Substantial differences across countries and over time remain unexplained. We investigated whether increases in unaffordable housing, household indebtedness or job loss can account for these population differences, as well as potential mitigating effects of alternative forms of social protection.
[Show abstract][Hide abstract] ABSTRACT: There remains limited evidence on comorbidity of mental disorders among conflict-affected civilians, particularly internally displaced persons (IDPs) and former IDPs who have returned to their home areas (returnees). The study aim was to compare patterns of mental disorders and their influence on disability between IDPs and returnees in the Republic of Georgia. A cross-sectional household survey was conducted with adult IDPs from the conflicts in the 1990s, the 2008 conflict, and returnees. Posttraumatic stress disorder (PTSD), depression, anxiety, and disability were measured using cut scores on Trauma Screening Questionnaire, Patient Health Questionnaire 9, Generalised Anxiety Disorder 7, and the WHO Disability Assessment Schedule 2.0. Among the 3,025 respondents, the probable prevalence of PTSD, depression, anxiety, and comorbidity (>1 condition) was 23.3%, 14.0%, 10.4%, 12.4%, respectively. Pearson correlation coefficients (p < .001) were .40 (PTSD with depression), .38 (PTSD with anxiety), and .52 (depression with anxiety). Characteristics associated with mental disorders in regression analyses included displacement (particularly longer-term), cumulative trauma exposure, female gender, older age, poor community conditions, and bad household economic situation; coefficients ranged from 1.50 to 3.79. PTSD, depression, anxiety, and comorbidity were associated with increases in disability of 6.4%, 9.7%, 6.3%, and 15.9%, respectively. A high burden of psychiatric symptoms and disability persist among conflict-affected persons in Georgia.ResumenContinúa existiendo limitada evidencia sobre la comorbilidad de los trastornos mentales entre civiles afectados por conflictos, particularmente personas desplazadas internamente y personas previamente desplazadas internamente que han regresado a sus áreas de origen (repatriados). El objetivo del estudio fue comparar patrones de trastornos mentales y su influencia en la discapacidad entre personas desplazadas internamente y repatriados en la República de Georgia. Se realizó un estudio transversal de encuestas domiciliarias con personas adultas internamente desplazadas en los conflictos de los años 90, el conflicto del 2008, y repatriados. Se evaluó Trastorno por Estrés Postraumático (TEPT), depresión, ansiedad, y discapacidad usando el Trauma Screening Questionnaire, Patient Health Questionnaire 9, Generalised Anxiety Disorder 7, y el WHO Disability Assessment Schedule 2.0. Entre los 3,025 encuestados, la prevalencia de TEPT, depresión, ansiedad y comorbilidad (>1 afección) fue 23.3%, 14.0%, 10.4%, 12.4% respectivamente. Los coeficientes de correlación de Pearson (p<.001) fueron .40 (TEPT con depresión), .38 (TEPT con ansiedad), .52 (depresión con ansiedad). Las características asociadas con trastornos mentales en los análisis de regresión incluyeron el desplazamiento (particularmente a más largo plazo), la exposición acumulativa a trauma, el género femenino, la edad avanzada, las pobres condiciones comunitarias y la mala situación económica del hogar. Los coeficientes oscilaron entre 1,50 y 3,79. TEPT, depresión, ansiedad y comorbilidad se asociaron a mayor discapacidad de 6%, 10%, 6% y 16%, respectivamente. Una alta carga de trastornos mentales y discapacidad persisten entre las personas afectadas por conflictos en Georgia.Traditional and Simplified Chinese Abstracts by AsianSTSS標題：格魯吉亞的內部流放人士和回流人士的精神病及其傷殘狀況撮要：我們只有少量研究關於受衝突影響的平民中精神病的共病性，尤其是那些內部流放人士或曾內部流放而重返家園的人士(即回流者)。本研究旨在對照格魯吉亞共和國內部流放人士和回流者的精神病模式，及其影響傷殘的狀況。研究是橫斷面設計，而樣本是在1990年代和2008年衝突中內部流放及回流的成人。我們使用創傷篩選問卷，病者健康問卷第九版，廣泛焦慮症第七版和WHO傷殘評估日程2.0來評斷創傷後壓力症(PTSD) 、抑鬱、焦慮和傷殘情況。在3,025名受訪者中，PTSD、抑鬱、焦慮和共病性(>一種病症)的流行率分別是23.3%，14.0%，10.4%和12.4%。Pearson相關系數(p <.001)是.40 (PTSD和抑鬱)，.38(PTSD和焦慮), 及 .52 (抑鬱和焦慮)。回歸分析中與精神病相關特性包括：流放(特別是長期)，累積創傷經歷、女性、年老、社區狀況不理想、和家庭經濟景況系數不良(從1.50至3.79)。PTSD、抑鬱、焦慮和共病狀況與傷殘加劇(分別是6%, 10%, 6%和16%) 相連。格魯吉亞受衝突影響人士中普遍存在精神病困擾和嚴重傷殘。标题：格鲁吉亚的内部流放人士和回流人士的精神病及其伤残状况撮要：我们只有少量研究关于受冲突影响的平民中精神病的共病性，尤其是那些内部流放人士或曾内部流放而重返家园的人士(即回流者)。本研究旨在对照格鲁吉亚共和国内部流放人士和回流者的精神病模式，及其影响伤残的状况。研究是横断面设计，而样本是在1990年代和2008年冲突中内部流放及回流的成人。我们使用创伤筛选问卷，病者健康问卷第九版，广泛焦虑症第七版和WHO伤残评估日程2.0来评断创伤后压力症(PTSD) 、抑郁、焦虑和伤残情况。在3,025名受访者中，PTSD、抑郁、焦虑和共病性(>一种病症)的流行率分别是23.3%，14.0%，10.4%和12.4%。Pearson相关系数(p <.001)是.40 (PTSD和抑郁)，.38(PTSD和焦虑), 及 .52 (抑郁和焦虑)。回归分析中与精神病相关特性包括：流放(特别是长期)，累积创伤经历、女性、年老、小区状况不理想、和家庭经济景况系数不良(从1.50至3.79)。PTSD、抑郁、焦虑和共病状况与伤残加剧(分别是6%, 10%, 6%和16%) 相连。格鲁吉亚受冲突影响人士中普遍存在精神病困扰和严重伤残。
Journal of Traumatic Stress 10/2014; 27(5). · 2.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pharmaceutical costs dominate out-of-pocket payments in former Soviet countries, posing a severe threat to financial equity and access to health services. Nationally representative household survey data collected in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine were analysed to compare the level of population having to forego medicines in 2001 and 2010. Subgroup analysis was conducted to assess differences between populations of different economic status, and rural and urban populations. A substantial proportion of the population did forego medicines in 2010, from 29.2% in Belarus to 72.9% in Georgia. There was a decline in people foregoing medicines between 2001 and 2010; the greatest decline was seen in Moldova [rate ratio(RR) = 0.67(0.63;0.71)] and Kyrgyzstan [RR = 0.63(0.60;0.67)], while very little improvement took place in countries with a higher Gross National Income (GNI) per capita and greater GNI growth over the decade such as Armenia [RR = 0.92(0.87;0.96)] and Georgia [RR = 0.95(0.92;0.98)]. Wealthier, urban populations have benefitted more than poorer, rural households in some countries. Countries experiencing the greatest improvement over the study period were those that have implemented policies such as price controls, expanded benefits packages, and encouragement of rational prescribing. Greater commitment to pharmaceutical reform is needed to ensure that people are not forced to forego medicines.
[Show abstract][Hide abstract] ABSTRACT: This qualitative study with 23 EU doctors working in the UK highlights that contrary to media reports, doctors from other member states working in the UK were well prepared and their main motivation to migrate was to learn new skills and experience a new health care system. Interviewees’ highlighted some aspects of their employment that work well and others that need improving. Some interviewees reported initially having language problems, but most agreed that after a few months this was resolved. EU doctors overwhelmingly reported having very positive experiences with patients; enjoying the less hierarchical structure of the NHS than their home systems; and appreciating the emphasis on evidence-based medicine. Interviewees mostly complained about the lack of cleanliness of hospitals and some examples of risk to patient safety. Interviewees did not experience discrimination against them other than some instances of patronising and snobbish behaviour. Although, a few reported that their nationality would not allow them to reach senior positions. Overall, interviewees reported having enjoyable experiences with patients and appreciating what the NHS had to offer.
[Show abstract][Hide abstract] ABSTRACT: Rationale
This paper aims to identify factors that support or impede the introduction and expansion of teleradiology across borders in the European Union (EU), focusing on both those factors acting within countries and those that are specifically cross-border as well as discussing how the current EU legislation impacts on the provision of this type of services.
A qualitative study was developed to explore the issues that arise when implementing teleradiology services across European borders. A total of 12 semi-structured interviews with key actors were conducted, recorded and fully transcribed. These were analysed using thematic analysis.
The factors supporting provision of new services in teleradiology were: increasing demand for reading images in countries with few radiologists; long waiting lists for MRI reading; and new demand for second and sub-specialized reading of images. The obstacles to the introduction and expansion of teleradiology services included uncertainty about liability in case of malpractice, registration of health care professionals, data security, non-standard contracts and quality reporting systems; and health care system and cultural differences. Radiologists identified as positive experiences the chance to learn and improve their skills in a shorter period of time, having flexibility, and sharing knowledge in a network environment. The most frequently reported negative aspect was the inability to interact with referring clinicians. Language barriers were not identified as a constraint. When asked about policy implications and potential recommendations, participants proposed the introduction of EU wide policies on radiologists’ credentials; greater clarity within the EU on data access and sharing; and minimum quality requirements for teleradiology providers.
Teleradiology services face several challenges; most can be overcome if those engaging in this type of collaborations are eager to make it a success. However, it would be beneficial to have a transparent European legal framework that clarifies issues related to the registration and licensing of healthcare professionals; clarifies arrangements for data sharing and protection; and specifies liability and means of access to redress. Once this legal framework is in place it should be communicated to regulators, health care professionals and patients in a clear way so that it cannot be undermined or ignored and it truly promotes services of good quality which are beneficial to European citizens.