Dismal quality of life and low life expectancy have plagued Ukraine since the collapse of the Soviet Union.
Despite recent reforms, national health care remains geared toward treating illness – all too often inefficiently and unsuccessfully – rather than preventing them, a much more cost-effective solution.
A death rate of 15.7 per 1,000 and a life expectancy of 68.7 years, compared to Poland’s 10.24 per 1,000 and 76.2 years, according to the CIA World Factbook, reveals the poor state of the nation’s health.
More visibly, early morning metro travelers are sure to meet scads of young and not so young men who meet up near stations for a quick cigarette and a beer or two before heading off to work, testament to a society where the need for health is trumped by that of the daily grind.
This, however, does not mean Ukrainians aren’t spending money on health care.
Expenditures are estimated at close to 7 percent of gross domestic product, a level comparable to most European countries.
Spending is split more or less equally between public and private sources, though the latter is overwhelmingly made up of ad hoc out-of-pocket spending rather than prepaid plans.
Moreover, the funds are largely misguided, experts say, with public institutions treating symptoms not causes while the population retains its unhealthy lifestyle and tries to compensate with self-medication.
Preventive medicine, the idea that diseases should be tackled preemptively, took off in the 19th century, when doctors began worrying about microorganisms and started taking the idea of washing hands between deliveries of children seriously.
It later moved to much broader social programs which addressed such issues as urban sanitary conditions, early screening programs and educating the population on how to lead a healthy lifestyle.
Together with breakthroughs in techniques and drugs, the development of preventive health care is a major driver behind the improvement in global health.
In Ukraine, however, the idea is only just taking off.
Despite recent reforms, national health care remains geared toward treating illness – all too often inefficiently and unsuccessfully – rather than preventing them, a much more cost-effective solution.
A pilot program launched by President Viktor Yanukovych in Donetsk, Vinnytsia and Dnipropetrovsk Oblasts, as well as the capital of Kyiv, aims to change the way the system is operating.
Rather than going to see specialists directly, patients would first consult family doctors who know their history better and would direct them where necessary.
This program, which should be implemented nationwide in 2014 if successful, has been lauded by former Health Minister Mykola Polishchuk, who claimed that owing to better knowledge of the patients, family doctors would be more attune to their needs.
Polischuk said this has led to a 6 percent decrease in morbidity in Great Britain. “More family doctors means higher life expectancy,” he said.
This also breaks ground in terms of prophylactic screening, explained Maxim Boroda, who heads the economic policy program and quality of life issues at the Ukrainian Institute of Public Policy, a think tank.
Family doctors would be able to screen patients for potential illnesses during check-ups, monitoring their health on a yearly basis.
“This is part of the idea why family doctors were introduced,” Boroda asserted, claiming that much of the criticism leveled at the program was simply due to people having to change their habits.
Maxim Boroda of the Ukrainian Institute of Public Policy.
According to the expert, the government has also moved to run mandatory examinations for so-called social diseases, such as HIV or tuberculosis, whenever patients pass through the health care system.
This is a solution notably used by developing states that lack the resources for universal screenings. So far the program has noted some success in Donetsk Oblast, where it found financial support from Ukraine’s richest man Rinat Akhmetov.
Others, however, are less upbeat about the situation.
“The program is a complete disaster,” said Dr. Sergei Potashev, a Texas-trained cardiologist working in Ukraine.
The main motivation for the program, he said, was a lack of well-trained specialists. Rather than improving the situation, it would simply drag the process out, making people travel further to get the help they need, and thus increasing the mortality rate.
While such a program might work in Western countries with much greater resources, Ukraine’s infrastructure is simply too shoddy to pull it off.
Such family doctors, Potashev said, would thus tend to an elderly patient with an infectious disease and then follow up with an infant.
Dr. Sergei Potashev
Moreover, Potashev declared, the overall system was broken. Health care workers do not promote life saving drugs, either because they simply don’t know them or are financed on a “what’s left” basis.
The burden of excessive regulation, new directives and no money is also weighing down on the functioning of the system.
“What we have been experiencing is slow and inevitable decay of the health care,” he said.
Yet some progress has been made on tackling the nation’s vices, a leading factor behind the staggering mortality rates.
On March 13 President Viktor Yanukovych signed a law banning advertisement and sponsorship by the tobacco industry.
The law, which will take effect in six months, will put an end to ads at kiosks and other point of sale places, sponsoring events at night clubs, and distributing free promotional cigarettes. Experts have described the event as a major victory.
On the same day Ukraine’s parliament passed in the first reading a measure to ban smoking in restaurants and stadiums.
Progress on reducing alcohol consumption has also been made.
According to Boroda, the ban on selling alcoholic beverages to minors is finally being enforced.
“When I was at school there was no problem getting alcohol. It is only now, at the age of 27, that I am being asked if I am old enough,” he joked.
Yet Potashev claimed the road ahead is still long in changing people’s mentality, whereby beer drinking, for example, isn’t really counted as alcohol consumption.
Moreover, experts say, raising taxes on harmful products, as has been done in Western countries, is the key to reducing consumption.
The problem with introducing such “sin taxes” is that their effectiveness would likely be limited. In both Russia and Ukraine, studies have shown that increases in the price of vodka have simply switched consumption to more dangerous counterfeit and home-made products.
”[Making alcohol more expensive] does not mean people will drink less,” Boroda said.
Moreover, there is a lack of support from the ministry of health, which focuses on the narrowly defined health programs.
“The ministry of health is like the ministry of medicine,” Boroda said. He explained that while it is working with doctors and hospitals, the ministry is doing little about the lifestyle aspect.
This matters, Boroda argued, noting that the quality of people’s health is 10 percent health care, 20 percent environment, 20 percent genetics, and 50 percent healthy living habits.
The problem, though, is how resilient bad habits have shown themselves to be. You can ban smoking indoors, but you can’t make people quit.
Kyiv Post staff writer Jakub Parusinski can be reached at [email protected].
