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KYIV June 2009. Highest Population Decline In Europe with Working-age Cohorts Shrinking Fastest.

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Presentation on theme: "KYIV June 2009. Highest Population Decline In Europe with Working-age Cohorts Shrinking Fastest."— Presentation transcript:

1 KYIV June 2009

2 Highest Population Decline In Europe with Working-age Cohorts Shrinking Fastest

3 Ukraine vs Europe: Since 1980s, Sharp Decline in Life Expectancy

4 Ukraine vs Europe: Second Worst Life Expectancy and Fewer Number of Years Lived in Full Health Life expectancy and Healthy life expectancy in Ukraine and selected European countries, in years, 2002

5 Ukraine vs Europe: Second Highest Mortality Among Working-age Population. Males are Most at Risk! Probability of dying between 15 to 60 years per 1000 population: Adult Mortality in Ukraine and Selected Countries CountriesBothFemalesMales Czech Republic10867148 Hungary177104249 Poland14579209 Russia300158432 Slovenia10456148 Ukraine264142384

6 Mortality Rates as High as in Low Income Countries…

7 Non-Communicable Diseases (NCD) are Major Killers in Ukraine Deaths by cause in Ukraine, 2002

8 … Together With External Causes They are Responsible for Most of Premature Deaths Main causes of mortality by age group in Ukraine in comparison with EU (EU=100) MalesFemales

9 …and disabilities Ten leading conditions that reduce years of life in Ukraine Top Ten Causes of DALYs % share in total DALYs 1Ischemic heart disease12.65 2Cerebrovascular disease6.02 3Unipolar depressive disorders5.18 4Other unintentional injuries4.81 5HIV/AIDS3.62 6Self-inflicted injuries3.28 7Poisonings3.02 8Congenital anomalies2.94 9Nutritional deficiencies2.82 10Violence2.48 Disability- Adjusted Life- Years (DALY) is a health-gap measure summarising the number of years lost due to death and disease.

10 Why These Health Patterns? Top Ten Risk Factors Responsible For 84% of Total Disease Burden Risk factors Ukraine Czech Republic HungaryPolandRussiaSlovenia 1 High blood pressure16.612.812.210.49.88.2 2 High cholesterol14.49.88.96.96.46.3 3 Tobacco12.815.520.916.611.013.7 4 Alcohol12.36.215.59.24.711.4 5 High BMI9.08.47.87.16.8 6 Low fruit and vegetable intake8.03.05.73.32.22.1 7 Physical inactivity5.64.13.93.12.92.8 8 Illicit drug use3.00.91.20.41.1 9 Unsafe sex1.61.21.01.31.00.8 10 Indoor smoke from solid fuel use 1.1 Combined84.461.975.9 59.1 45.253.2

11 Major causes of death: Cardiovascular diseases, cancer, liver diseases etc. Injuries, poisoning HIV/AIDS Reasons – unhealthy lifestyles (alcohol, smoking, drug abuse, poor diet, lack of exercise) – these five risk factors account for half of diseases burden Consequences – aging, shrinking labor pool, high gender gap in life expectancy (widows and single women). Most of these deaths are either preventable or treatable Preventable – public health, target risk factors, burden in all countries, cross-sectoral linkages important Treatable – early detection and treament, quality of services Focus on quality of care From Challenges To Opportunities :

12 Premature Deaths are Avoidable - but will require significant behavioral change !

13 Premature Deaths are Avoidable ! Prevention: Large Gains at a Small Cost Interventions Tobacco control Counter-advertising Increased tobacco taxes Legislative interventions (mandatory warning labels, banning sales to minors, advertising bans, etc.) School-based health education Border control of illegal tobacco imports Alcohol control Counter-advertising Increased alcohol taxes Legislative interventions (mandatory warning labels, banning sales to minors, advertising bans, etc.) School-based health education Strict drunk-driving laws Road SafetyMandatory seat belts Strict drunk driving laws Speed limits Safe driving lessons Preventing Deaths Through 3 Leading Risk Factors

14 Health Crisis Response is Not Only MoH Business Ukraine needs an integrated, multi-sectoral approach to NCD prevention and control, including : educational efforts environmental regulatory efforts revenue regulatory efforts (e.g., taxes on harmful inputs) treatment efforts

15 Premature Deaths are Avoidable ! Treatment: Focus on Primary Care Death rates from treatable mortality for 25-64 year olds in Ukraine

16 Premature Deaths are Avoidable ! Evidence from Europe: Hungary Programming: early 1990s, five successive national health documents on health promotion, public health challenges, health policy investments, and the direction of long-term health policy; Implementation: led by the National Institute for Health Promotion within a comprehensive reform framework; Results: increase in LE by 3 years within a ten year period.

17 Premature Deaths are Avoidable ! Evidence from Europe: Finland Programming: early 1970s, the North Karelia (NK) Project designed to reduce high mortality of heart disease, later rolled out for the whole country; Implementation: intervention through community organizations, involvement of key policy-makers, media and communication campaign to prevent risky lifestyles, and good M&E framework; Results over 25 years: mortality rate of heart disease fell by 73% in NK and by 65% in the whole country, lung cancer mortality reduced by 70% in NK and by 60% in Finland.

18 Focus on Ukraine: Health Care Delivery has Changed Little since Independence … Highly inefficient spending with lions share of Ukraines budget allocation going to hospitals and specialized facilities (86 %). Preventive and primary health care remains largely neglected. Rigid norms drive budgeting and allocation of resources at the local level High share of out-of-pocket payments (OOP) creates financial barriers in accessing health care Considerable overcapacity in the hospital sector Lack of an established and accountable physician gate- keeping mechanism. Utilization rates remain high, but quality of services received has declined dramatically.

19 Health System Unable to Cope with New Challenges Unless Reforms are Initiated… Key Reform Areas: Policy and regulations : comprehensive reform plan, clear definition of roles and responsibilities of players… Financing : removing structural constraints in resource allocation and provider payment, introduction of performance-based provider payment mechanism … Service Delivery : focus on primary care, introduction of referral, reduction of overcapacity, administrative decentralization …

20 It is not too late …


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