Why is Public Health Why is Public Health Important to Countries of Important to Countries of

Eastern Europe and Russia?Eastern Europe and Russia?

TH Tulchinsky MD MPHTH Tulchinsky MD MPH

Braun School of Public HealthBraun School of Public Health

Oct 2003Oct 2003

"All mankind is of one author, and is one volume; when one man dies, one chapter is not torn out of the book, but translated into a better language; …..

As therefore the bell that rings to a sermon, calls not upon the preacher only, but upon the congregation to come: so this bell calls us all: …

““No man is an island, entire of itself...any man's No man is an island, entire of itself...any man's death diminishes me, because I am involved in death diminishes me, because I am involved in mankind; and therefore never send to know for mankind; and therefore never send to know for whom the bell tolls; it tolls for thee."whom the bell tolls; it tolls for thee."

Learning from OthersLearning from Others Science and technology – “the state of the art”Disease patterns• Infectious•Non-infectious• Toxic• Trauma•Nutritional

Interventions for preventionInterventions for case managementManaging health systems

GDP Per Capita CEE, Russia, IsraelGDP Per Capita CEE, Russia, Israel

0

5000

10000

15000

20000

1970 1975 1980 1985 1990 1995 2000 2005

Israel

Moldova

Russia

FYR Macedonia

CEE average

990001 Gross domestic product, US$ per capita

Crude Fertility Rates, CEE, Russia, Crude Fertility Rates, CEE, Russia, IsraelIsrael

5

10

15

20

25

30

1970 1975 1980 1985 1990 1995 2000 2005

Israel

Moldova

Russia

FYR Macedonia

CEE average

998004 + Live births per 1000 population

Crude Mortality RatesCrude Mortality Rates

6

7

8

9

10

11

12

13

14

15

16

1970 1975 1980 1985 1990 1995 2000 2005

Israel

Moldova

Russia

FYR Macedonia

CEE average

998005 +Crude death rate per 1000 population

Life Expectancy, CEE, Russia, IsraelLife Expectancy, CEE, Russia, Israel

64

66

68

70

72

74

76

78

80

1970 1975 1980 1985 1990 1995 2000 2005

Israel

Moldova

Russia

FYR Macedonia

CEE average

060101 +Life expectancy at birth, in years

Maternal Mortality, CEE, Russia, IsraelMaternal Mortality, CEE, Russia, Israel

0

10

20

30

40

50

60

70

80

1970 1975 1980 1985 1990 1995 2000 2005

Israel

Moldova

Russia

FYR Macedonia

CEE average

080100 +Maternal deaths per 100000 live births

Stroke Mortality, CEE, Russia, IsraelStroke Mortality, CEE, Russia, Israel

0

50

100

150

200

250

300

350

1970 1975 1980 1985 1990 1995 2000 2005

Israel

Moldova

Russia

FYR Macedonia

CEE average

090302 +SDR,cerebrovascular disease,all ages/100000

CHD Mortality, CEE, Russia, IsraelCHD Mortality, CEE, Russia, Israel

50

100

150

200

250

300

350

400

450

500

550

600

1970 1975 1980 1985 1990 1995 2000 2005

Israel

Moldova

Russia

FYR Macedonia

CEE average

090202 +SDR,ischaemic heart disease,all ages/100000

Ca Cx Mortality, CEE, Russia, IsraelCa Cx Mortality, CEE, Russia, Israel

1

2

3

4

5

6

7

8

9

10

11

1970 1975 1980 1985 1990 1995 2000 2005

Israel

Moldova

Russia

FYR Macedonia

CEE average

100302 +SDR,cancer of cervix,all age,per 100000

MVA Mortality, CEE, Russia, IsraelMVA Mortality, CEE, Russia, Israel

5

10

15

20

25

30

35

1970 1975 1980 1985 1990 1995 2000 2005

Israel

Moldova

Russia

FYR Macedonia

CEE average

110212 +SDR, transport accidents, per 100000

Trauma Mortality, CEE, Russia, IsraelTrauma Mortality, CEE, Russia, Israel

0

50

100

150

200

250

300

1970 1975 1980 1985 1990 1995 2000 2005

Israel

Moldova

Russia

FYR Macedonia

CEE average

110102 +SDR,ext.cause injury&poison.all age/100000

Cirrhosis Mortality, CEE, Russia, IsraelCirrhosis Mortality, CEE, Russia, Israel

0

20

40

60

80

100

120

1970 1975 1980 1985 1990 1995 2000 2005

Israel

Moldova

Russia

FYR Macedonia

CEE average

991705 +SDR chron.liver dis&cirrhosis,all/100000

Diabetes Mortality, CEE, Russia, IsraelDiabetes Mortality, CEE, Russia, Israel

0

5

10

15

20

25

30

35

40

45

1970 1975 1980 1985 1990 1995 2000 2005

Israel

Moldova

Russia

FYR Macedonia

CEE average

993504 +SDR diabetes, all ages, per 100000

Public Health Burden of CEE, RussiaPublic Health Burden of CEE, Russia• High mortality from preventable disease• Nutrition e.g. MNDs, obesity-unfitness,

diabetes• Chronic disease e.g. congestive heart

failure, diabetes, cancer, osteoporosis, dementias

• Infectious diseases (new and old)e.g. TB, HIV, STDs

• Inequalities e.g. geographic disparities• Mental health, substance abuse, depression• Costs (rising), resources (limited), priorities

(needed)

Health Status: International Health Status: International Data SourceData Source

• Health for All Data Base, WHO European Region

• Accessible at www.who.dk/• Country programs

–Copy Diskette 1 and diskette 2 to hard disc

–Open

– Includes all countries in WHO Euro region

–Superb: Use it

Why Health Targets?Why Health Targets?• US and WHO experience• Objectives with funding support• Measurable set of objectives, targets, goals–National, regional comparisons– International comparisons–Funding allocation

• Relevant to Israel –Ethnic and deprived group health–Diabetes–Hypertension–Nutrition status monitoring etc

Urgent IssuesUrgent Issues• International standards• Down size hospital sector, transfer to home care• Training in NPH• National health priorities, policies, targets• Immunization• Vitamin K for newborns• Hypertension control at primary care level• Clinical guidelines• TB, STD, HIV control• Monitoring and continuing adaptation

What Should You Be Reading?What Should You Be Reading?• MMWR www.cdc.gov/mmwr• HFA Data Base www.who.dk• WER www.who.int/• Am Journal of Pub Health• European Journal of Pub Health• NEJM• Lancet/BMJ• Pubmed• Internet• Promed