HIGHLIGHTS ON HEALTH IN UKRAINE
Country Highlights give an overview of the health and health-related situation in a given country and compare, where possible, its position in relation with other countries in the region. The Highlights have been developed in collaboration with Member States for operational purposes and do not constitute a formal statistical publication. They are based on information provided by Member States and other sources as listed.
CONTENTS OVERVIEW...... 1 THE COUNTRY AND ITS PEOPLE ...... 2 HEALTH STATUS...... 5 LIFESTYLES...... 18 ENVIRONMENT AND HEALTH...... 20 HEALTH CARE SYSTEM...... 22 REFERENCES...... 25
HIGHLIGHTS ON HEALTH IN UKRAINE ORIGINAL RUSSIAN E 72372 OCTOBER 2000 TECHNICAL NOTES
Highlights on Health provide an overview of the health of a country’s population and the main factors related to it. When possible, comparisons are made with other countries in WHO’s European Region, as one means of assessing the country’s comparative strength and weaknesses. As a rule, data have been taken for this purpose from one common international source; nevertheless, even under these circumstances the comparability of data may be limited owing to differences in national definitions, registration systems, etc. Unless otherwise mentioned, the main source of all data is the “Health for All” (HFA) database of the WHO Regional Office for Europe (issue January 2000). Where necessary, specific data from national sources are cited in the Highlights. Two main types of graphical presentation are used in the Highlights to illustrate comparisons between countries: S line charts, showing the trend in a particular indicator in the country in question (thicker line) compared with reference countries (thin lines); S bar charts, showing a particular country’s ranking compared with reference countries. The latest available data are used (i.e. the last year for which data are available may differ from one country to another). This type of chart is sensitive to small differences in the value of an indicator and should accordingly be interpreted with a certain amount of caution. For instance, a given country’s position relative to other countries may change sharply one way or another when more recent data are included.
There are 51 Member States in WHO’s European Region. It is not always appropriate to include all these countries in comparisons. For that reason, the charts mentioned above show a limited number of (usually geographically neighbouring) countries, which have certain similarities caused by their historical developments. In this case, comparisons are made with the other 14 countries that were formerly republics of the Soviet Union, with the average for all 15 newly independent states (NIS) formed following the break-up of the USSR, with the average for the five central Asian republics (CAR), and with the average for the 15 countries that are members of the European Union (EU). Mortality data are the most complete and comparable, and they therefore constitute the main component of international comparisons. However, even in this case there is often some doubt about the completeness of the recording of deaths, especially at very young and old ages, and regarding the accuracy of coding of causes of death. Unless otherwise stated, the charts are based on mortality rates standardized for the European standard population structure (for further details, see any issue of the World Health Statistics Annual). In most cases, so-called “premature mortality” in the age group 0–64 years is used. In order to ensure comparability, the majority of indicators have been calculated at the WHO Regional Office for Europe (WHO/EURO), using a uniform methodology and software. For that reason, the values of some indicators in the HFA database may differ somewhat from national assessments based on other methods. This is true in particular for indicators such as life expectancy and maternal mortality. Only a relatively small amount of the data contained in the HFA database is used in the Highlights. If further data are needed, readers are recommended to make use of the database itself, which can be downloaded from WHO/EURO’s web site (www.who.dk.Country Information). A list of references and a glossary are given at the end of this Highlight. OVERVIEW
OVERVIEW
In Ukraine, like in the other newly neoplasms among people over 65 years is independent states (NIS) of the former Soviet relatively low. As in most NIS, a fall in lung Union, the birth rate has fallen steadily since cancer mortality was seen in the 1990s. In the mid-1980s. Together with an increase in Ukraine, like in Belarus, the number of cases mortality, this led initially to a substantial fall of thyroid cancer in children rose sharply after in the natural rate of population increase and the disaster at the Chernobyl nuclear power then, from 1991, to a natural loss of plant. population. In 1999, Ukraine was one of the The level and trends in mortality due to worst placed countries in WHO’s European external causes of injuries and poisoning in Region in terms of overall mortality and a Ukraine are similar to the pattern seen in negative trend in natural population growth. neighbouring NIS. Mortality due to road In general, the trend in life expectancy in traffic accidents fell substantially in Ukraine in Ukraine is similar to that in most other NIS. the 1990s and is now virtually equal to the EU The substantial improvement in this indicator average. in 1985–1986, thanks to an anti-alcohol The incidence of tuberculosis increased campaign, was then replaced by a downward steadily throughout the 1990s but remains trend, and by 1992 it had returned to the level lower than the average for the NIS. seen before the campaign. Average life expectancy then continued to fall until 1995, The incidence of syphilis took on epidemic like in a number of other NIS. It increased proportions in the period 1993–1996; although between 1996 and 1998, but then fell again the rate has been falling since 1997, it remains slightly in 1999. one of the highest in the Region. Infant mortality increased between 1991 and There has been a sharp increase in the number 1993 but fell to 13 per 1000 live births in of cases of clinically diagnosed AIDS since 1999. Maternal mortality has shown a marked 1995. In 1998, the incidence of AIDS in downward trend. The infant and maternal Ukraine was the highest of all the NIS. The mortality rates in Ukraine are lower than the increase in the number of new cases of HIV averages for the NIS. infection shows an even worse trend. Trends in mortality from diseases of the The prevalence of smoking and the death rate circulatory system in general, and from the from smoking-related causes are among the main causes found within this group, show the highest in the European Region. same features as trends in overall mortality. Ukraine’s health care expenditure (as a Together with other NIS, the rate of premature percentage of gross domestic product) (0–64 years) mortality due to diseases of the remained almost unchanged in the 1990s and, circulatory system in Ukraine is among the like that of other NIS, is among the lowest in highest in WHO’s European Region. the European Region. The premature mortality rate due to cancer in In the past decade, the hospital bed rate in Ukraine is one of the highest in Europe, Ukraine has shown a downward trend, and it is despite a downward trend observed since currently slightly lower than the NIS average. 1995. However, the mortality rate due to
HIGHLIGHTS ON HEALTH IN UKRAINE 1 THE COUNTRY AND ITS PEOPLE
THE COUNTRY AND ITS PEOPLE
Ukraine regained its independence in 1991, Basic data on Ukraine and the following the break-up of the USSR. The State WHO European Region structure is that of a presidential republic. The Ukraine Europe President is Leonid Kuchma. The presidential (1999) (1997) term of office is five years. The unicameral Population (millions) 49.7 parliament consists of 450 deputies, elected for Population aged 18.2 a period of four years. S 0–14 years, % 20.1 Ukraine is divided into 26 administrative areas S 15–64 years, % 68.0 66.3 (the cities of Kyiv and Sevastopol’, and 24 S 65 years, % 13.8 13.6 provinces or oblasty), and the autonomous 2 republic of Crimea. Kyiv, the capital of Area, km 603 700 Population density per 82.2 31 Ukraine, has a population of 2.6 million. The km2 cities of Kharkiv, Dnepropetrivsk, Odessa and Urban population (%) 72b 72.7 Donetsk each have a population of more than Births per 1000 7.8 11.11 one million. population Deaths per 1000 The official language is Ukrainian. 14.9 10.94 population Natural growth rate per -7.1 0.17 1000 population Gross domestic product (GDP) per person in 2190a 12 500 US$, PPP* a 1997; b1998 * PPP - purchasing power parity
Age pyramid, 1981 and 1999
85+ 1981 80–84 1999 75–79 Males Females 70–74
65–69
60–64
55–59
50–54
45–49
40–44
35–39 Age group (years)Age group 30–34
25–29
20–24
15–19
10–14
5–9
0–4
2500000 1500000 500000 500000 1500000 2500000 Population
HIGHLIGHTS ON HEALTH IN UKRAINE 2 THE COUNTRY AND ITS PEOPLE
Demography residence in Ukraine (80% of whom emigrated In the past decade, Ukraine has been from the Russian Federation, Belarus and the experiencing an adverse demographic Republic of Moldova). situation. Since 1991, the death rate has Ukrainians make up 73% of the population of exceeded the birth rate. In 1999, the natural Ukraine, and Russians account for 22%. The population loss reached a level of -7.1 per remaining 5% are from minority nationalities 1000. This figure means that Ukraine has one (Romanians, Poles, Belarussians and others). of the highest rates of natural population loss Approximately 7 million Ukrainians live in in the European Region. other NIS (5 million in the Russian In 1999, the mid-year population of Ukraine Federation). In addition, more than 5 million was 49.7 million. Over the past seven years people of Ukrainian nationality live in other (1993–1999), the population of the country has European countries, north or south America, or fallen by 2 271 000 people or 4.4%. Australia (UNDP, 1999). The main factor responsible for this situation is the falling birth rate, against the background Education and religion of an increase in mortality. The downward The literacy rate of the adult population in trend in the birth rate became pronounced in 1997 was 99%. Approximately 53% of the 1987. By 1999 it had fallen almost two-fold, to population over the age of 25 years have 7.8 per 1000 population. Similar processes are completed at least secondary education. seen in neighbouring NIS such as the Russian Federation and Belarus. The mortality rate, Orthodox Christianity is the dominant religion. which had begun to fall in 1997–1998, rose The Orthodox church in Ukraine is represented again in 1999 to 14.9 per 1000 population, one by various confessions. Some people in the of the highest figures in the Region. western part of Ukraine profess Catholicism (as uniates). (UNDP, 1999).
Migrant population and ethnic profile In 1999, approximately 37 500 citizens of Economy Ukraine emigrated to Israel, the United States, In the Soviet era, Ukraine’s economy was Germany and other countries. In the same deeply integrated with that of the USSR. Inter- year, some 36 000 people took up permanent republic trade accounted for more than 80% of all exports and imports. The destruction of these economic links after independence was Natural population growth rate regained had a significant adverse effect on Ukraine’s economy. 40
35 Overall, gross domestic product (GDP) fell by about 50% in the period 1991–1994. In 1994 30 alone, it fell by 25%. The slump in 25 manufacturing has halted in recent years. In 20 1997, per capita GDP was lower than average 15 for the NIS. 10 Inflation climbed from 390% in 1991 to 5 10 255% in 1993. As a result of measures
Net change per 1000 population 0 taken by the government (including the -5 introduction of a national currency, the
-10 hryvna), inflation fell to 10% in 1997. 80 82 84 86 88 90 92 94 96 98 However, the economic crisis in 1998 caused Year the annual inflation rate in the country to rise Ukraine ȿɋ average to 20% (WHO Liaison Office in Ukraine, CAR average NIS average 1999).
HIGHLIGHTS ON HEALTH IN UKRAINE 3 THE COUNTRY AND ITS PEOPLE
GDP per person in US $ (purchasing power parity PPP), latest available data
ȿU (1997) Belarus (1997) Russian Federation (1997) Lithuania (1997) Estonia (1995) Latvia (1997) Kazakhstan (1997) NIS (1997) CAR (1997) Uzbekistan (1997) Armenia (1997) Kyrgyzstan (1998) Ukraine (1997) Turkmenistan (1997) Republic of Moldova (1998) Azerbaijan (1997) Tajikistan (1997) Georgia (1997)
0 2000 4000 6000 8000 10000 12000 14000 16000 18000 20000 22000
PPP in US $ per peson
HIGHLIGHTS ON HEALTH IN UKRAINE 4 HEALTH STATUS
HEALTH STATUS
Trends in the main health indicators in Rates of morbidity due to tuberculosis and Ukraine have been similar to the general sexually transmitted infections are pattern seen in most NIS. An improvement of substantially higher than the European the indicators in 1985–1986 was followed by a averages. sharp deterioration up to 1995. There has since been a trend towards better health status. But in 1999 life expectancy fell again and Life expectancy mortality increased. Evidently, this is linked to Like in most other NIS, life expectancy in a deterioration in the socio-economic situation Ukraine rose slightly during the anti-alcohol as a result of the economic crisis at the end of campaign in 1985-1986 but then showed a 1998. According to preliminary data, a similar considerable (3.2-fold) fall between 1987 and process is also being seen in the Russian 1995. In 1996–1998, life expectancy in Federation. Ukraine rose slightly and was higher than the average for the NIS. In 1999, a decline to 68.2 Like in a number of NIS, the situation in years was registered, and it is substantially Ukraine is characterized by high mortality lower than in the EU countries. from cardiovascular diseases and from external causes of injuries and poisoning. An In the period 1986–1999, the difference in life increase in mortality due to infectious diseases expectancy between men and women was seen in 1999. increased from 8.1 to 10.9 years. On the basis of this figure, Ukraine (together with a number of other NIS) is in the leading group of countries in WHO’s European Region.
Selected health indicators in Ukraine and the European Region
Ukraine Europe (1999) (1997) Life expectancy 68.2 73.3 S Men 62.8 69.2 S Women 73.7 77.4 Infant mortality per 1000 live birth 13.0 12.0 Maternal mortality per 1000 live birth 25.2 19.4 Standardized death rate (SDR) for all causes of death per 100 000 population 1318.3 980.1 SDR for cardiovascular diseases per 100 000 population 768.2 482.7 SDR for malignant neoplasms per 100 000 population 174.4 184.6 SDR for injuries and poisoning per 100 000 population 141 86.4 SDR for diseases of the respiratory organs per 100 000 population 65.8 63.5 SDR for diseases of the digestive system per 100 000 population 39.1 39.1 SDR for infectious and parasitic diseases per 100 000 population 23.8 13.8 ɚ New cases of tuberculosis per 100 000 population 54.2 39.8ɚ New cases of syphilis per 100 000 population 114 74.0ɚ ɚ New cases of AIDS per 100 000 population 0.59 1.94ɚ a 1998
HIGHLIGHTS ON HEALTH IN UKRAINE 5 HEALTH STATUS
Life expectancy at birth in years, latest available data
Sweden (1996)
France (1997)
Iceland (1994)
Switzerland (1994)
Italy (1996)
Israel (1996)
Greece (1997)
Spain (1996)
Austria (1998)
Netherlands (1997)
Norway (1995)
EU (1996)
Germany (1997)
Malta (1997)
Luxembourg (1996)
United Kingdom (1997)
Finland (1996)
Belgium (1994)
Denmark (1996)
Ireland (1995)
Portugal (1998)
Slovenia (1998)
Armenia (1998)
Czech Republic (1998)
Albania (1993)
Slovakia (1998)
FYM (1997)
Croatia (1998)
Poland (1996)
Georgia (1994)
Lithuania (1998)
CCEE (1998)
Azerbaijan (1998)
Bulgaria (1998)
Hungary (1998)
Estonia (1998)
Romania (1998)
Latvia (1998)
Turkey (1997)
Uzbekistan (1998)
Belarus (1998)
Tajikistan (1995)
Ukraine (1999)
Republic of Moldova (1998)
NIS (1998)
CAR (1998) FYM: the former Yugoslav Republic of Macedonia
Russian Federation (1998) CCEE: the countries of central and eastern Europe
Kyrgyzstan (1998) NIS: the newly independent states of the former USSR
Turkmenistan (1998) CAR: the central Asian republics
Kazakhstan (1998)
60 65 70 75 80 Life expectancy (years)
HIGHLIGHTS ON HEALTH IN UKRAINE 6 HEALTH STATUS
Life expectancy at birth, males Life expectancy at birth, females 85 85
80 80
75 75
70 70
65 65 Life expectancy (years) Life expectancy (years)
60 60
55 55 80 82 84 86 88 90 92 94 96 98 80 82 84 86 88 90 92 94 96 98 Year Year
Ukraine EU average Ukraine EU average CAR average NIS average CAR average NIS average
Main causes of death and disease Hospital admission rates in Ukraine differ In Ukraine, as in most other countries, from the average figures for Europe in a cardiovascular diseases are the most frequent number of respects. cause of death. This is particularly true of A substantially higher percentage of hospital people over 65 years old. admissions in the country are due to diseases In Ukraine, like the Russian Federation, of the respiratory organs. On the other hand, external causes of injuries and poisoning are there are only half as many hospital the second most frequent category of causes of admissions due to cancer as the European death in the structure of premature mortality. average.
Structure of mortality (in %) by main cause of death and age group in Ukraine (1999), compared with the average for the European Region (1997)
0–64 years 65 years and above Cause of death Ukraine Europe Ukraine Europe Cardiovascular diseases 34.8 30.7 74.3 59.9
Malignant neoplasms 18.5 22.8 9.7 16.5
Accidents, injury and poisoning 23.0 19.5 2.3 2.6
Diseases of the respiratory system 5.0 5.6 5.0 7.0
Infectious and parasitic diseases 4.0 3.0 0.3 0.5
Diseases of the digestive system 5.3 5.7 1.4 3.0
Ill-defined conditions 1.1 2.7 6.0 4.3
Other diseases 8.4 10.0 1.1 6.1
HIGHLIGHTS ON HEALTH IN UKRAINE 7 HEALTH STATUS
Inpatients by disease category (% of all patients hospitalized) Trends in mortality from cardiovascular diseases, 0–64 years Ukraine Europe Disease category (1998) (1997) 300 Infectious and parasitic 4.4 3.5 250 diseases
Malignant neoplasms 3.2 6.3 200
150 Cardiovascular diseases 12.8 11.7
Diseases of the respiratory 100 15.2 10.1 system
Standardized death raper per 100 000 Standardized 50 Diseases of the digestive 11.1 9.7 system 0 80 82 84 86 88 90 92 94 96 98 Injury and poisoning 8.2 8.3 Year
Ukraine EU average Other diseases 45.1 50.4 CAR average NIS average
Mortality from cardiovascular Cardiovascular diseases diseases, 0–64 years, Three main periods can be distinguished as latest available data regards trends in premature mortality due to Turkmenistan (1998) cardiovascular diseases (CVD) over the past Kazakhstan (1998) 15 years: first, from 1985 to 1989, a reduction CAR (1998) and stabilization during the period of the anti- Belarus (1998) Russian Federation (1998) alcohol campaign; second, a sharp increase up Ukraine (1999) to 1995; and third, a fall in mortality right up Kyrgyzstan (1998) to 1998. A slight increase in CVD mortality NIS (1998) Uzbekistan (1998) was seen again in 1999. In terms of this Georgia (1994) indicator, Ukraine has one of the highest Latvia (1998) figures in Europe. Azerbaijan (1998) Tajikistan (1995) A similar situation is seen for ischaemic heart Republic of Moldova (1998) disease (IHD) which, according to the latest Estonia (1998) Lithuania (1998) available data, shows one of the highest rates Armenia (1998) in the European Region. ȿU (1996) The trend in mortality due to cerebrovascular 50 100 150 200 250 300 diseases is similar to the general pattern for Standardized death rape per 100 000 CVD.
HIGHLIGHTS ON HEALTH IN UKRAINE 8 HEALTH STATUS
Trends in mortality from Trends in mortality from ischaemic cerebrovascular diseses, 0–64 years heart disease, 0–64 years 125 200
100
150
75
100 50
50 25 Standardized death rate per 100 000 Standardized Standardized death rape per 100 000 Standardized
0 0 80 82 84 86 88 90 92 94 96 98 80 82 84 86 88 90 92 94 96 98 Year Year
Ukraine EU average Ukraine EU average CAR average NIS average CAR average NIS average
Mortality from ischaemic heart Mortality from cerebrovascular disease, 0–64 years, diseases, 0–64 years, latest available data latest available data
Kazakhstan(1998) Kyrgyzstan (1998) Belarus (1998) Kazakhstan (1998) Ukraine (1999) Republic of Moldova (1998) Azerbaijan (1998) Russian Federation (1998) Georgia (1994) Belarus (1998) Turkmenistan (1998) NIS (1998) Russian Federation (1998) CAR (1998) NIS (1998) Georgia (1994) CAR (1998) Ukraine (1999) Latvia (1998) Uzbekistan (1998) Uzbekistan (1998) Latvia (1998) Estonia (1998) Azerbaijan (1998) Kyrgyzstan (1998) Estonia (1998) Tajikistan (1995) Tajikistan (1995) Republic of Moldova (1998) Armenia (1998) Armenia (1998) Lithuania (1998) Lithuania (1998) Turkmenistan (1998) ȿU (1996) ȿU (1996)
0 30 60 90 120 150 0 25 50 75 100 125 150 Standardized death rate per 100 000 Standardized death rate per 100 000
HIGHLIGHTS ON HEALTH IN UKRAINE 9 HEALTH STATUS
Malignant neoplasms The rate of premature mortality due to Morbidity due to malignant neoplasms has malignant neoplasms in Ukraine is one of the continued to increase slowly since 1990. There highest in Europe, despite a slight downward has been a significant increase in morbidity trend since 1995. due to breast cancer. The mortality rate due to lung cancer shows a In Ukraine, like in Belarus, the number of clear downward trend since 1992, like in other cases of thyroid cancer in children rose sharply NIS. Nonetheless, it remains higher than the after the disaster at the Chernobyl nuclear average for the NIS and is one of the highest in power plant (WHO Liaison Office in Ukraine, the European Region. 1999).
Trends in mortality from cancer, Trends in mortality from 0–64 years trachea/bronchus/lung cancer, 150 0–64 years 35
125 30
100 25
20 75
15 50
10 Standardized death rate per 100 000 per rate death Standardized 25 5 Standardized death rate per 100 000 per rate death Standardized
0 0 80 82 84 86 88 90 92 94 96 98 80 82 84 86 88 90 92 94 96 98 Year Year Ukraine EU average Ukraine ȿU average CAR average NIS average CAR average NIS average
Mortality from cancer, 0–64 years, Mortality from trachea/bronchus/lung latest available data cancer, 0–64 years, latest available data Kazakhstan (1998) Kazakhstan (1998) Ukraine (1999) Russian Federation (1998) Russian Federation (1998) Estonia (1998) Belarus (1998) Latvia (1998) Estonia (1998) Belarus (1998) Lavia(1998) Ukraine (1999) Republic of Moldova (1998) NIS (1998) Lithuania (1998) Lithuania (1998) NIS (1998) Republic of Moldova (1998) ȿU (1996) EU (1996) Armenia (1998) Armenia (1998) CAR (1998) CAR (1998) Kyrgyzstan (1998) Kyrgyzstan (1998) Azerbaijan (1998) Georgia (1994) Turkmenistan (1998) Azerbaijan (1998) Georgia (1994) Uzbekistan (1998) Uzbekistan (1998) Turkmenistan (1998) Tajikistan (1995) Tajikistan (1995)
0 25 50 75 100 125 150 0 5 10 15 20 25
Standardized death rate per 100 000 Standardized death rate per 100 000
HIGHLIGHTS ON HEALTH IN UKRAINE 10 HEALTH STATUS
Injury and poisoning Like in a number of other NIS, mortality due Throughout the whole period under review, to external causes of injury and poisoning rose this indicator has remained lower in Ukraine substantially in Ukraine between 1987 and than the average for the NIS. 1995. The main causes are evidently a The rate of mortality as a result of homicide is deterioration of the economic situation and a lower than the NIS average but substantially return to the drinking pattern seen before the higher than the European average. Mortality 1985–1986 anti-alcohol campaign. The due to road traffic accidents has fallen almost downward trend in mortality that occurred two-fold since 1991 and is now somewhat between 1996 and 1998 was replaced by an lower than the European average. increase in 1999.
Trends in mortality Trends in mortality from homicide from external causes
300 100 Armenia (1988) = 538
250 80
200 60
150
40 100
20 50 death rate per 100 000 Standardized Standardized death rate per 100 000 Standardized
0 0 80 82 84 86 88 90 92 94 96 98 80 82 84 86 88 90 92 94 96 98 Year Year Ukraine EU average Ukraine EU average CAR average NIS average CAR average NIS average
Mortality from external causes, Mortality from homicide, latest available data latest available data
Russian Federation (1998) Russian Federation (1998) Belarus (1998) Kazakhstan(1998) Estonia (1998) Estonia (1998) Latvia (1998) NIS (1998) Kazakhstan (1998) Latvia (1998) NIS (1998) Ukraine (1999) Lithuania (1998) Republic of Moldova (1998) Ukraine (1999) Belarus (1998) Republic of Moldova (1998) CAR(1998) Kyrgyzstan (1998) Kyrgyzstan (1998) CAR (1998) Turkmenistan (1998) Turkmenistan (1998) Tajikistan (1995) Tajikistan (1995) Lithuania (1998) Uzbekistan (1998) Azerbaijan (1998) Georgia (1994) Uzbekistan (1998) ȿU (1996) Armenia (1998) Armenia (1998) Azerbaijan (1998) ȿU (1996) Georgia (1994) 0 50 100 150 200 0 5 10 15 20 25 Standardized death rate per 100 000 Standardized death rate per 100 000
HIGHLIGHTS ON HEALTH IN UKRAINE 11 HEALTH STATUS
Mental health Infectious diseases After a sharp rise between 1992 and 1996, Mortality due to infectious and parasitic mortality due to suicides and self-inflicted diseases is somewhat lower than in the injuries has fallen slightly and is neighbouring countries of the Russian approximately equal to the average for the Federation and Belarus. Of the countries in the NIS. European Region, only the central Asian The incidence of mental disorders increased republics and Azerbaijan have higher mortality somewhat between 1991 and 1998 and has rates for these causes than the figures found in mirrored the trend in the average for the NIS. Ukraine. However, the rate of increase in the incidence After a long period of downward movement of alcoholic psychosis is lower than average (between 1980 and 1990), the incidence of for the NIS. tuberculosis has risen substantially but remains lower than the average for the NIS. In 1998, a slight reduction in tuberculosis incidence was Trends in mortality from suicide recorded. and self-inflicted injury 50 As from 1993, the increase in syphilis incidence assumed threatening proportions in
40 Ukraine, like in a number of other NIS. However, syphilis incidence fell somewhat between 1996 and 1998. 30 A sharp increase in the incidence of diphtheria
20 was registered in Ukraine, like in a number of other NIS, at the start of the 1990s. Diphtheria incidence increased ten-fold in Ukraine 10 between 1990 and 1991 (from 0.2 to 2.1 per Standardized death rate per 100 000 per rate death Standardized 100 000 population). The most serious 0 80 82 84 86 88 90 92 94 96 98 situation occurred in 1995, when the rate Year reached 10.3 per 100 000 population. In Ukraine EU average subsequent years, it has fallen substantially (to CAR average NIS average 1.4 per 100 000 in 1998).
Mortality from suicide and Trends in mortality from infectious self-inflicted injure, and parasitic diseases latest available data
Lithuania (1998) Tajikistan (1995) Kazakhstan (1998) Belarus (1998) Turkmenistan (1998) Russian Federation (1998) Kyrgyzstan (1998) Latvia (1998) CAR (1998) Kazakhstan (1998) Uzbekistan (1998) Estonia (1998) Azerbaijan (1998) NIS (1998) Ukraine (1999) Ukraine (1999) NIS (1998) Republic of Moldova (1998) Russian Federation (1998) CAR (1998) Latvia (1998) Kyrgyzstan (1998) Republic of Moldova (1998) EU (1996) Lithuania (1998) Turkmenistan (1998) Estonia (1998) Uzbekistan (1998) Georgia (1994) Tajikistan (1995) Armenia (1998) Georgia (1994) Belarus(1998) Armenia (1998) EU (1996) Azerbaijan (1998) 0 10203040506070 0 1020304050 Standardized death rates per 100 000 Standardized death rate per 100 000
HIGHLIGHTS ON HEALTH IN UKRAINE 12 HEALTH STATUS
Until 1994, Ukraine was a country with a low The increase in the number of new cases of prevalence of HIV infection. As from 1995, HIV infection is causing considerable concern. the number of clinically diagnosed cases of According to the latest available data, the AIDS began to rise sharply, and the situation number of new cases of HIV seropositivity is began to resemble an epidemic. In 1998, the one of the highest in the European Region. incidence of AIDS in Ukraine was the highest The AIDS situation is worst in the Crimea and of all the NIS, but it was still lower than in EU in Donetsk province, as well as in cities such countries. as Odessa and Dnepropetrivsk (WHO Liaison Office in Ukraine, 1999).
Incidence of tuberculosis Incidence of syphilis per 100 000 population per 100 000 population
160 300
140 250 120
200 100
80 150
60 100 New cases per 100 000 New New cases per 100 000 New 40 50 20
0 0 80 82 84 86 88 90 92 94 96 98 80 82 84 86 88 90 92 94 96 98 Year Year Ukraine EU average Ukraine EU average CAR average NIS average CAR average NIS average
Incidence of diphtheria Incidence of AIDS per 100 000 population per 100 000 population 100 20
90
80 15 70
60
50 10
40
New cases per 100 000 New 30 New cases per 100 000 New 5 20
10
0 0 80 82 84 86 88 90 92 94 96 98 90 92 94 96 98 Year Year Ukraine EU average Ukraine CAR average NIS average
HIGHLIGHTS ON HEALTH IN UKRAINE 13 HEALTH STATUS
Other diseases Compared with the average for the NIS, The mortality rate for diseases of the digestive Ukraine does not have a high mortality rate for organs is lower than the average for the NIS diseases of the respiratory organs. However, and close to the European figure. the mortality rate due to chronic diseases of the lower respiratory tract (bronchitis, emphysema and bronchial asthma) is one of the highest in the European Region (46.7 per 100 000 in 1999).
Trends in mortality from diseases Trends in mortality from diseases of the respiratory system of the digestive system 300
150 250
125
200 100
150 75
100 50 Standardized death rate per 100 000 Standardized Standardized death rate per 100 000 per rate death Standardized 50 25
0 0 80 82 84 86 88 90 92 94 96 98 80 82 84 86 88 90 92 94 96 98 Year Year Ukraine EU average Ukraine EU average CAR average NIS average CAR average NIS average
Mortality from diseases Mortality from diseases of the respiratory system, of the digestive system, latest available data latest available data
Tajikistan (1995) Republic of Moldova (1998) Kyrgyzstan (1998) Kyrgyzstan (1998) CAR (1998) Turkmenistan (1998) Turkmenistan (1998) Uzbekistan (1998) Uzbekistan (1998) CAR (1998) Kazakhstan (1998) Azerbaijan (1998) Republic of Moldova (1998) Kazakhstan (1998) Azerbaijan (1998) Tajikistan (1995) NIS (1998) NIS (1998) Ukraine (1999) Estonia (1998) Belarus (1998) Ukraine (1999) Russian Federation (1998) Latvia (1998) EU (1996) Russian Federation (1998) Armenia (1998) Georgia (1994) Lithuania (1998) Lithuania (1998) Estonia (1998) EU (1996) Latvia (1998) Armenia (1998) Georgia (1994) Belarus (1998)
0 40 80 120 160 200 0 20406080100120 Standardized death rate per 100 000 Standardized death rate per 100 000
HIGHLIGHTS ON HEALTH IN UKRAINE 14 HEALTH STATUS
Disability being used in Ukraine, infant mortality is in In 1998, approximately 240 000 people were practice being recorded using the old criteria. registered as disabled for the first time. This According to rough estimates, the infant rate (479 per 100 000 population) is somewhat mortality rate would increase by lower than the average for the NIS. approximately 20% if the international criterion of a live birth was used. This is in line with the experience of other countries that Health of children and adolescents have made the transition to the international Infant mortality in Ukraine is one of the lowest definition. among the NIS. In 1999 it was 13.0 per 1000 live births, which is lower than most NIS. In the structure of morbidity (first-ever Although the WHO definition of live birth is diagnosis) among children, the categories most frequently found are diseases of the respiratory system, diseases of the nervous system and Infant mortality rate sense organs, and diseases of the skin and per 1000 live births subcutaneous tissue. 60 In the period from 1991 to 1997, the
50 prevalence of neoplasms among children increased by 46%, that of congenital
40 anomalies by 37%, and that of diseases of the blood and blood-forming organs by 97%
30 (WHO Liaison Office in Ukraine, 1999). In 1998, immunization coverage of children 20 under one year of age against diphtheria, Deaths per 1000 live births per 1000 live Deaths poliomyelitis and tetanus was 98.7%, against 10 measles and tuberculosis was 97.4% and against pertussis was 97.3%. 0 80 82 84 86 88 90 92 94 96 98 Year Women’s health Ukraine EU average CAR average NIS average In Ukraine women outlive men by almost 11 years and have lower mortality due to the main causes of death.
Infant mortality rate Number of abortions per 1000 live births per 1000 live births
Turkmenistan (1998) 2200 Tajikistan (1995) 2000 Kyrgyzstan (1998) CAR (1998) 1800 Uzbekistan (1998) 1600 Kazakhstan (1998) NIS (1998) 1400
Republic of Moldova (1998) 1200 Georgia (1994) 1000 Azerbaijan (1998) Russian Federation (1998) 800 Latvia (1998) 600 Armenia (1998) births per 1000 live Abortions Ukraine (1999) 400
Belarus (1998) 200 Estonia (1998) 0 Lithuania (1998) 80 82 84 86 88 90 92 94 96 98 EU (1996) Year 0 10203040 Ukraine EU average Deaths per 1000 llive births CAR average NIS average
HIGHLIGHTS ON HEALTH IN UKRAINE 15 HEALTH STATUS
Maternal mortality shows a clear downward Premature mortality due to breast cancer fell trend (from 41.3 per 100 000 live births in until 1989 but has since shown an upward 1981 to 25.2 per 100 000 in 1998), but it trend and, according to the latest data, is remains substantially higher than the European higher than the average for the NIS. average. The rate of premature mortality due to breast Despite a quite substantial reduction in the cancer increased steadily in the period between number of abortions between 1996 and 1998, 1981 and 1998 and is one of the highest both the rate per 1000 live births continues to be in the NIS and in the European Region as a one of the highest in the European Region. whole.
Trends in maternal mortality Trends in mortality from cancer of the breast among females 100 aged 0–64 years
90 30
80 25 70
60 20
50 15 40
30 10 Deaths per 100 000 live births per 100 000 live Deaths
20 Standardized dath rate per 100 000 Standardized 5 10
0 0 80 82 84 86 88 90 92 94 96 98 80 82 84 86 88 90 92 94 96 98 Year Year Ukraine EU average Ukraine EU average CAR average NIS average CAR average NIS average
Maternal mortality rate per 100 000 Mortality from cancer of the breast live births, latest available data among females aged 0–64, latest available data Tajikistan (1995) Kazakhstan (1998) Armenia (1998) Latvia (1998) Ukraine (1999) Russian Federation (1998) Estonia (1998) EU (1996) Turkmenistan (1996) Lithuania (1998) Azerbaijan (1998) Russian Federation (1998) Republic of Moldova (1998) Georgia (1994) Kyrgyzstan (1998) Latvia (1998) NIS (1998) NIS (1998) CAR (1996) Kazakhstan (1998) Belarus (1998) Belarus (1998) Armenia (1998) Republic of Moldova (1998) Ukraine (1999) Azerbaijan (1998) Estonia (1998) CAR (1998) Kyrgyzstan (1998) Lithuania (1998) Uzbekistan (1998) Uzbekistan (1998) Turkmenistan (1998) EU (1996) Tajikistan (1995) Georgia (1994) 0 5 10 15 20 25 0 10203040506070 Standardized death rate per 100 000 Deaths per 100 000 live births
HIGHLIGHTS ON HEALTH IN UKRAINE 16 HEALTH STATUS
Trends in mortality from cancer Mortality from cancer of the cervix of the cervix among females among females aged 0–64, aged 0–64 years latest available data
10 Republic of Moldova (1998) Lithuania (1998) Estonia (1998) 8 Kazakhstan (1998) Ukraine (1998) Kyrgyzstan (1998) 6 Armenia (1998) Latvia (1998) NIS (1998) 4 Russian Federation (1998) CAR (1998) Uzbekistan (1998) 2 Georgia (1994) Standardized death rate per 100 000 Standardized Belarus (1998) Tajikistan (1995) 0 Turkmenistan (1998) 80 82 84 86 88 90 92 94 96 98 Azerbaijan (1998) Year EU (1996)
Ukraine EU average 0246810 CAR average NIS average Standardized death rate per 100 000
HIGHLIGHTS ON HEALTH IN UKRAINE 17 LIFESTYLES
LIFESTYLES
Tobacco consumption Per capita annual cigarette consumption in According to available data, it is equal to 3.7 Ukraine is higher than the averages for the NIS litres of pure alcohol (5.9 litres for men and and EU countries. In 1999, mortality due to 1.6 litres for women). Some 4% of the lung cancer in Ukraine was higher than in population of Ukraine have a daily most countries in the European Region. consumption of more than 50 grams of pure Survey data obtained as part of the EUROHIS alcohol. In this connection, 38.9% of those project show smoking prevalence in Ukraine surveyed never drink alcohol (EUROHIS, to be 53.2% (72.9% among men and 42.1% 2000). among women). This is one of the highest The frequency of alcoholic psychoses (per 100 figures in WHO's European Region. 14.8% of 000 population) rose steadily in the period men and 0.8% of women smoke more than 20 1991-1995, but fell after 1995 and, according cigarettes a day (EUROHIS, 2000). As noted to the most recent data, is approximately one above, Ukraine has high rates of mortality third lower than the NIS average. from chronic diseases of the lower respiratory tract and a number of other, smoking-related causes of death. Illicit drug use According to available data, most registered drug users in Ukraine are multi-drug users. Alcohol consumption More specifically, some 20% of these people According to data on recorded alcohol regularly use marijuana (and 95% do so consumption, Ukraine is one of the countries occasionally). In addition, there is widespread with a low level of consumption use of home-produced morphine derivates. (approximately 2 litres of pure alcohol per Cocaine is used by fewer than 1% of registered person per year) (WHO Regional Office for drug addicts. Europe, 1997). However, there are grounds for Ukraine was the first NIS to begin submitting believing that the real level of alcohol data on the prevalence of HIV infection among consumption is substantially higher. drug abusers, who are known to be one of the main risk groups for development of AIDS. In December 1995, 6 of 57 registered cases of Number of cigarettes consumed AIDS (10.5%) were in this risk group. In the per person per year 3200 first nine months of 1995, 263 cases of HIV 3000 infection were found among registered drug 2800 abusers (WHO Regional Office for Europe, 2600 1997). 2400 2200 2000 Nutrition 1800 According to FAO data, average daily calorie 1600 1400 consumption per head (2797 kCal in 1997) is Number of cigarettes Number 1200 somewhat lower than the average for the NIS. 1000 The consumption of meat, fish, eggs, fresh 800 600 vegetables and fruit fell in Ukraine, like in 400 other NIS, in the period 1994–1997, which led 90 92 94 96 98 to shortfalls in the intake of trace elements, Year Ukraine EU average protein and energy that were significant in CAR average NIS average terms of public health (WHO Liaison Office in Ukraine, 1999).
HIGHLIGHTS ON HEALTH IN UKRAINE 18 LIFESTYLES
Overweight Excess weight is one of the main risk factors Ukraine show that the prevalence of obesity for cardiovascular diseases. Data from surveys (BMI > 30) is 17.5% (14.1% among men and of the population aged over 15 years in 19.4% among women) (EUROHIS, 2000).
HIGHLIGHTS ON HEALTH IN UKRAINE 19 ENVIRONMENT AND HEALTH
ENVIRONMENT AND HEALTH
Air quality Waste and soil As a result of the downturn in industrial Very large amounts of waste have production in Ukraine, like in most other NIS, accumulated, owing to the fact that for many there has been a fall in the amount of years Ukraine has specialized in producing pollutants discharged into the atmosphere in raw materials and energy. recent years. Since 1990, there has been a two- Each year, more than 1.5 million tonnes of fold reduction in emissions from stationary solid waste accumulate in surface waste sources, and a four-fold drop in those from dumps. In total, more than 20 000 million mobile sources. Nonetheless, approximately tonnes of waste have accumulated, 2% of one third of the population of Ukraine live in which is toxic waste. conditions of intensive air pollution. There are 2754 waste storage sites in Ukraine, Stationary sources (industrial plants) produce with a total capacity of 2500 million m3. most of the air pollution (76% of all Approximately 60% of these sites do not emissions). Of this total, metalworking comply with health and hygiene requirements. enterprises account for 32.4%, plants operated The amount of industrial waste is increasing by the Ministry of Energy for 23.2%, and the each year, but not more than 20% is recycled mining industry for 16.6%. for use as a secondary raw material. Mobile sources are the main air pollutants in Forty million tonnes of solid domestic waste major city (Kyiv, Lutsk, Zhytomyr, Ivano- are generated each year. Up to 80% of the sites Frankivsk, Kirovohrad, Poltava, Fastiv, etc.), for storage of solid domestic waste do not where they account for 60–90% of total meet health and hygiene standards. emissions (NEHAP, 1999). The situation with regard to storage of pesticides is causing concern. A total of Water management and sanitation 22 000 tonnes of pesticides, classified as The quality of water from surface sources in hazardous waste and subject to destruction, Ukraine is deteriorating as a result of have now accumulated. A substantial discharges of insufficiently treated and proportion of this waste consists of banned untreated sewage from populated localities and substances (such as DDT). individual plants. More than 4.6 million hectares of land in 11 In the Dnieper river basin, which serves as a regions of Ukraine are polluted with source of drinking water for 30 million people, radionuclides. As a result, 119 000 hectares of only 25% of the sewage is treated to a level land, including 65 000 hectares of arable land, that meets current hygiene standards. have been taken out of use. Each year, up to 25% of the samples of water taken from piped and private water supplies do Radioactive pollution not meet hygiene standards in terms of Ukraine is one of the countries with a high bacteriological indicators. The existing system level of natural radiation due to radon 222. of disinfecting water by means of chlorine The mean individual dose of natural radiation leads to the risk of the formation of amounts to 3.8 mSv/year (1 mSv is one organochlorine compounds. thousandth of a Sievert, the unit used to The state of the water supply network does not measure the biologically effective dose). meet current requirements, either. Each year As a result of the damage at the Chernobyl 10% of the samples of drinking water analysed nuclear power plant, significant areas in do not meet the standards for taste and level of Ukraine were polluted with radionuclides, the mineralization and contain chemical impurities most important of which are caesium 137 and in concentrations exceeding maximum strontium 90. permissible levels (NEHAP, 1999).
HIGHLIGHTS ON HEALTH IN UKRAINE 20 ENVIRONMENT AND HEALTH
The total collective dose of radioactive Individual doses of radiation experienced by radiation received by the population of the personnel of Ukrainian nuclear power Ukraine in the 10 years since the Chernobyl plants vary from 1 to 5 mSv per year, and are disaster is estimated at 50 000 Sv. More than comparable with figures for the staff of plants 69% of this dose was received by the rural in EU countries (NEHAP, 1999). population. The largest lifetime dose is received by children who were under 1 year of age in 1986. Occupational health and safety In 1998, the incidence of occupational diseases Ukraine’s national register contains data on in Ukraine was 1.85 per 10 000 workers. Most 900 000 clean-up workers or “liquidators” (i.e. cases (76.8%) were recorded in mines. people who have worked in the Chernobyl zone). The average individual exposure for The largest category is diseases of the this category of people is estimated to be respiratory system, and especially pneumoconiosis (30.6%) and chronic 120–180 mSv. bronchitis (19.1%). Significant amounts of radioactive waste (63 million m3) have built up in Kirovograd and The level of occupational morbidity is Dnepropetrivsk regions, where uranium is substantially lower in Ukraine than in mined. developed countries. Apparently, this is explained by insufficient identification of Five nuclear power stations are in operation in cases of occupational diseases. There are Ukraine. A nuclear reactor with a capacity of instances of significant delay in diagnosing 1 million kilowatts produces 26 tonnes of chronic heavy metal poisoning, occupational nuclear waster per year. Waste from the dermatoses and lung diseases (asbestosis, Chernobyl nuclear power plant is stored in fibrosis) (NEHAP, 1999). “wet” repositories, which have a maximum service life of 30 years. After this time, a chain reaction may occur.
HIGHLIGHTS ON HEALTH IN UKRAINE 21 HEALTH CARE SYSTEM
HEALTH CARE SYSYTEM
Health system reform There have been changes in Ukraine’s health In line with the Presidential Decree of 8 sector as a result of the economic, social and August 2000, a national policy in the area of political reforms in the period following the public health (the “Health of the Nation” country’s declaration of independence, but programme) and an outline health care reform they are inconsistent and fragmentary. plan were to be finalized by the end of 2000 The Ministry of Health is currently (WHO Liaison Office in Ukraine, 1999). endeavouring to coordinate the restructuring of the health sector. However, the process is Health care expenditure and health being hindered by the lack of a national system funding strategy in this area. Health care expenditure in Ukraine in 1998 amounted to 3.5% of GDP, which is higher Health care resources and their utilization than the NIS average but lower than that for in Ukraine, compared with EU countries. European averages Inpatient care accounted for 67.9% of total Ukraine Europe health care expenditure. (1998) (1997) Hospital beds 903.2 812.0 per 100 000 population Outpatient services Physicians The average number of visits per person 299 343.4 per 100 000 population (including visits to doctors at first-aid points Hospital admissions and in casualty departments) has fallen 18.8 18.7 per 100 population recently; in 1998 it was 8.5, which is lower than the figures in the neighbouring countries Average hospital stay, 15.7 12.7 days of the Russian Federation and Belarus. However, the figure for Ukraine is higher than Health care expenditure 3.5 6.0 as a percentage of GDP the averages for the NIS and WHO’s European Region as a whole.
Total health care expenditure as a percentage of GDP, Trends in the average number of latest available data contacts with primary health care
EU (1997) establishments Republic of Moldova (1997) 14 Estonia (1998) Lithuania (1998) 12 Belarus (1998) Armenia (1993) 10 Latvia (1998) Turkmenistan (1996) 8 Ukraine (1998) Uzbekistan (1998) 6 NIS (1998) Kyrgyzstan (1998) 4 CAR (1998)
Russian Federation (1995) contacts per year person Outpatient 2 Kazakhstan (1998) Azerbaijan (1997) 0 Tajikistan (1998) 80 82 84 86 88 90 92 94 96 98 Georgia (1998) Year
0246810 Ukraine EU average Percentage of GDP CAR average NIS average
HIGHLIGHTS ON HEALTH IN UKRAINE 22 HEALTH CARE SYSTEM
Inpatient services The hospital bed rate in Ukraine has fallen Hospital admissions also fell in the same substantially since 1991 (to 903.2 per 100 000 period, to 18.8 per 100 population, which is population in 1998) and is somewhat lower roughly equal to the NIS average. than the NIS average. The average length of hospital stay has fallen slightly, to 15.7 days in 1998.
Number of hospital beds Average length of stay in hospital per 100 000 population in days 1600 20
1400 18
1200
16 1000
14 800 Length of stay in days Beds per 100 000 population Beds 600 12
400 80 82 84 86 88 90 92 94 96 98 10 80 82 84 86 88 90 92 94 96 98 Year Year Ukraine EU average Ukraine EU average CAR average NIS average CAR average NIS average
Hospital bed rates, Hospital admissions latest available data per 100 population
30 Belarus (1998) Russian Federation (1998)
Republic of Moldova (1998) 25 NIS (1998) Lithuania (1998) Latvia (1998) 20 Ukraine (1998) Azerbaijan (1998) 15 Kazakhstan (1998) Kyrgyzstan(1998)
Estonia (1998) 10 Turkmenistan (1997) EU (1997) Hospital admissions per 100 population admissions Hospital CAR (1998) 5 Tajikistan (1998) Armenia (1998) 0 Uzbekistan (1998) 80 82 84 86 88 90 92 94 96 98 Georgia (1998) Year 400 600 800 1000 1200 Ukraine EU average
Beds per 100 000 population CAR average NIS average
HIGHLIGHTS ON HEALTH IN UKRAINE 23 HEALTH CARE SYSTEM
Medical personnel According to recent data, the Trends in physician/population ratio physician/population ratio (299 per 100 000 in 600
1998) is lower than the average for the NIS. 550
To a significant extent, this is explained by 500 differences in the definition of a “physician”. 450 It should be noted that, since 1996, data on the 400 number of physicians in Ukraine include only those in practice (i.e. not counting those 350 working in research institutes, the civil service, 300 etc.). 250 Number of physicians per 100 000 of physicians Number 200
150
100 80 82 84 86 88 90 92 94 96 98 Year Ukraine EU average CAR average NIS average
HIGHLIGHTS ON HEALTH IN UKRAINE 24 REFERENCES
REFERENCES
EUROHIS, 2000. Experience of health interview surveys in Ukraine. Kyiv, Ukrainian Institute of Public Health. NEHAP, 1999. Ukraine National Environmental Health Ⱥction Ɋlan. Kyiv, Ministry of Health. UNDP, 1999. Ukraine National Human Development Report. WHO LIAISON OFFICE IN UKRAINE, 1999. Ukraine Country Health Report. WHO REGIONAL OFFICE FOR EUROPE, 1997. Smoking, drinking and drug-taking in the European Region (Alcohol, Drugs and Tobacco programme).
HIGHLIGHTS ON HEALTH IN UKRAINE 25 GLOSSARY
Incidence rate: the number of new cases of a disease occurring in a population per 100 000 people during a specified period (usually 1 year). Infant mortality rate: the yearly number of deaths of children aged less than 1 year per 1000 live births. Life expectancy at birth: an estimate of the average number of years a newborn child can expect to live provided that the prevailing age-specific patterns of mortality at the time of birth were to stay the same throughout the child’s life. Prevalence rate: the total number of people in a population who have a disease or any other attribute at a given time or during a specified period per 100 000 of that population. Purchasing power parity (PPP): a standardized measure of the purchasing power of a country’s currency, based on a comparison of the number of units of that currency required to purchase the same representative basket of goods and services in a reference country and its currency (usually US dollars) The EU uses the purchasing power standard to measure this. Standardized death rate (SDR): a death rate (usually per 100 000 population) adjusted to the age structure of a standard European population. Total fertility rate: the average number of children that would be born alive per woman during her lifetime if she were to bear children at each age in accordance with prevailing age-specific birth rates.
© World Health Organization 2000
The designations employed and the presentation of the material in this document do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The map on the cover (©1999 Lonely Planet Publications) has been adapted from that on the Lonely Planet Web site (http://www.lonelyplanet.com) with their permission. The copyright remains with Lonely Planet Publications. This document has been produced by the Health Information unit at the WHO Regional Office for Europe, in close collaboration with the Medical Statistics Centre of the Ministry of Health of Ukraine.
KEYWORDS: HEALTH STATUS, LIFESTYLE, ENVIRONMENTAL HEALTH, DELIVERY OF HEALTH CARE, COMPARATIVE STUDY, UKRAINE. The views expressed in this document are those of WHO. Comments or additional information should be forwarded to:
Health Information Unit Telephone: +45 39 17 12 00 WHO Regional Office for Europe Telex: 12000 who dk 8 Scherfigsvej Telefax: +45 39 17 18 95 DK-2100 Copenhagen Ø E-mail: [email protected] Denmark Web: http://www.who.dk