HIGHLIGHTS ON HEALTH IN AZERBAIJAN
Country Highlights give an overview of the health and health-related situation in a particular country and compare, where possible, its position in relation with other countries in WHO’s European 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 the country itself and obtained from other sources.
CONTENTS OVERVIEW ...... 1 THE COUNTRY AND ITS PEOPLE ...... 2 HEALTH STATUS ...... 5 LIFESTYLES...... 18 ENVIRONMENT AND HEALTH ...... 19 HEALTH CARE SYSTEM...... 20 REFERENCES ...... 23
HIGHLIGHTS ON HEALTH IN AZERBAIJAN MARCH 2001 E72376 ORIGINAL: RUSSIAN 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 (June 2000 version). 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 of indicators such as average life expectancy and maternal mortality. Only a relatively small amount of the information 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 document.
HIGHLIGHTS ON HEALTH IN AZERBAIJAN OVERVIEW
OVERVIEW
Azerbaijan continues to have a relatively high The figure for premature mortality due to natural growth rate for its population, despite a cancer is one of the lowest in the European fall in the birth rate in the 1990s. In terms of Region. age structure, the population is still one of the According to the latest available data, youngest in the European Region. The mortality due to external causes of injury and displacement of hundreds of thousands of poisoning is among the lowest in WHO refugees as a result of the conflict with European Region. The sharp upsurge in Armenia has had a significant effect on the mortality due to these causes between 1992 demographic situation in Azerbaijan. and 1994 was due to the armed conflict. Life expectancy in Azerbaijan, like in the other Azerbaijan has one of the highest rates of trans-Caucasian countries, is higher than in diabetes mortality in the European Region. In other newly independent states (NIS). The terms of diabetes prevalence, however, it is in pronounced fall in the life expectancy between a middle-ranking position. This contradiction 1992 and 1994 was caused by an increase in may reflect both a genuinely high level of the number of violent deaths during the armed mortality among people with diabetes and conflict in Nagorno-Karabakh. errors in coding the principal cause of death. Registered infant mortality in Azerbaijan is The incidence of malaria (which, like in slightly lower than the NIS average. However, Tajikistan, continues to be one of the highest this figure is most probably reduced by in the Region) is a serious problem in incomplete registration of deaths and the use Azerbaijan. of a definition of a live birth that is different from the internationally accepted one. The fact Since the early 1990s, the number of hospital that Azerbaijan has the lowest ratio of neonatal beds per 100 000 population has fallen slowler to postneonatal deaths in the European Region than in most other NIS. The trends and levels most probably reflects substantial under- in the numbers of physicians, dentists and registration of deaths in the early period after nurses are close to the NIS averages. the birth. Per capita, levels of hospital admissions and Azerbaijan continues to have a high rate of outpatient consultations have fallen maternal mortality. The number of abortions substantially since the end of the 1980s and, per 1000 live births in Azerbaijan is like in neighbouring trans-Caucasian significantly lower than the NIS average and is countries, are among the lowest in the now close to the average for European Union European Region. (EU) countries. According to the latest available data, Premature (0–64 years) mortality due to Azerbaijan (again, like other trans-Caucasian cardiovascular diseases is similar to the NIS countries) has one of the lowest figures in the average but significantly higher than the Region for health care expenditure as a average for western European countries. percentage of gross domestic product (GDP). Specific features in national practice with regard to coding causes of death may account for the high proportion of people aged over 65 years who die from these causes.
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 1 THE COUNTRY AND ITS PEOPLE
THE COUNTRY AND ITS PEOPLE
Azerbaijan became independent in 1991. The State structure is that of a presidential Basic data on Azerbaijan and the WHO European Region republic. The President is Heydar Aliyev. The parliament (Milli Mejlis) consists of 125 Azerbaijan Europe members. (1999) (1998) Baku, the capital, has a population of Population (millions) 7.98 1.7 million people. The national language is Population aged Azerbaijani. S 0–14 years. % 32.8 19.8 S 15–64 years. % 61.6 66.5 S 65 years. % 13.7 Demography 2 Azerbaijan continues to have quite a high Area. km 86 600 Population density per natural population growth rate, despite a 2 92 31 km pronounced downward trend in the birth rate. Total mortality is not high, relatively Urban population (%) 57 72.6 Births per 1000 speaking, and fell in the period 1995–1998. 14.7 10.95 Owing to the high proportion of children, the population Deaths per 1000 population can be regarded as “young” in 5.8 10.85 population demographic terms. The mid-year population Natural growth rate per 8.9 0.1 of Azerbaijan in 1999, according to 1000 population preliminary estimates, was 7 982 800 people. Gross domestic product (GDP) per person in 2175 ɚ 13 585 US$. PPP* a1998 * PPP - purchasing power parity
Age pyramid, 1981 and 1999
85+ 1981 80–84 1999 75–79
70–74 Males Females
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
500000 300000 100000 100000 300000 500000 Population
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 2 THE COUNTRY AND ITS PEOPLE
Family structure Migrant population and ethnic profile In recent years, the number of registered In 1999, 4 300 more people left Azerbaijan marriages per 1000 population has fallen than migrated to the country. The main flow of sharply (from 10.5 in 1990 to 4.8 in 1999). At emigrants in recent years has been to the the same time, the number of divorces per Russian Federation, the United States and 1000 population has also fallen (from 2.0 in Israel (Council of Europe, 1999). As a result of 1990 to 0.6 in 1999) (State Committee on the armed conflict with Armenia, some Statistics, 2000). 250 000 ethnic Azerbaijanis moved to Azerbaijan in the period 1988–1991. At present, there are 576 000 temporarily Natural population growth rate displaced persons (UNDP Azerbaijan, 2000).
40 Education and religion 35 The literacy rate among the adult population in 30 Azerbaijan in 1997 was 96.3%. Approximately 25 72% of the population over the age of 15 years 20 has completed secondary education. 15 Most of the population are Muslims. Other 10 religious faiths include Christianity (Orthodox,
5 Catholic and Protestant) and Judaism (UNDP Net change per 1000 population per change Net Azerbaijan, 2000). 0
-5
-10 Economy 81 83 85 87 89 91 93 95 97 99 Azerbaijan’s economy experienced a deep Year Azerbaijan EU average recession in the period 1991–1995, as CAR average NIS average evidenced by hyperinflation, a slump in output and a reduction in real income levels. By 1993, GDP had fallen by 60% compared with the 1989 figure.
GDP per person in US $ (purchasing power parity PPP), latest available data
EU (1999) Estonia (1998) Russian Federation (1998) Lithuania (1998) Belarus (1998) Latvia (1998) NIS (1998) Kazakstan (1998) Georgia (1998) Ukraine (1998) CAR (1998) Turkmenistan (1998) Kyrgyzstan (1998) Azerbaijan (1998) Armenia (1998) Uzbekistan (1998) Republic of Moldova (1998) Tajikistan (1998)
0 2000 4000 6000 8000 10000 12000 14000 16000 18000 20000 22000 PPP in US $ per person
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 3 THE COUNTRY AND ITS PEOPLE
Owing to tight monetary and tax policy, the Russian Federation at the end of 1998 had a economic situation began to improve in 1996. substantial negative effect on the further Inflation, which had reached 1600% in 1994, development of Azerbaijan’s economy, like fell to 2% by 1998. In the same year, there was that of most other NIS. In 2000, GDP growth a 6.1% increase in GDP. People’s income was 11.3% - largely owing to rising oil prices levels rose by 59% in the period 1995–1998. on the global market (Economist Intelligence However, they remain one of the lowest in the Unit, 2001). NIS. The financial crisis that broke out in the
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 4 HEALTH STATUS
HEALTH STATUS
Overall, people’s health status (as measured by the transition period. Life expectancy began to the main indicators) has been improving in rise as from 1995. Together with its Azerbaijan since the mid-1990s. For some neighbouring trans-Caucasian countries, indicators, trends and levels are similar to Azerbaijan has one of the highest figures for those seen in neighbouring trans-Caucasian or life expectancy among the NIS. In 1999, it was central Asian countries. 71.4 years. The difference in life expectancy between men Life expectancy and women in Azerbaijan is lower than the The trend in life expectancy is characterized average for the European Region. In 1999, it by a sharp decline in 1992–1994. To a was 7.1 years, against a background of an significant extent, this was caused by the increase in male life expectancy and a slight armed conflict with Armenia, accompanied by decrease in female life expectancy compared the socio-economic difficulties experienced in with 1998.
Selected heath indicators in Azerbaijan and the European Region
Azerbaijan Europe (1999) (1998) Life expectancy 71.7 73.6 S Men 68.1 69.6 S Women 75.1 77.6 Infant mortality per 1000 live birth 16.5 11.1 Maternal mortality per 100 000 live birth 43.4 19.0 Standardized death rate (SDR) for all causes of death per 100 000 population 1009 961 SDR for cardiovascular diseases per 100 000 population 615 476 SDR for malignant neoplasms per 100 000 population 113 183 SDR for injuries and poisoning per 100 000 population 31.6 84.7 SDR for diseases of the respiratory organs per 100 000 population 71.7 60.6 SDR for diseases of the digestive system per 100 000 population 58.2 38.0 SDR for infectious and parasitic diseases per 100 000 population 27.6 13.2 New cases of tuberculosis per 100 000 population 58.0 40.4ɚ New cases of syphilis per 100 000 population 8.1 57.5ɚ New cases of AIDS per 100 000 population 0.1 1.4ɚ a1999
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 5 HEALTH STATUS
Life expectancy at birth in years, latest available data
Switzerland (1997)
Sweden (1996)
France (1997)
Italy (1997)
Iceland (1996)
Spain (1997)
Norway (1997)
Austria (1999)
Israel (1997)
Greece (1998)
EU (1997)
Netherlands (1997)
Germany (1998)
Luxembourg (1997)
United Kingdom (1998)
Malta (1999)
Belgium (1995)
Finland (1996)
Denmark (1996)
Ireland (1996)
Slovenia (1999)
Portugal (1998)
Albania (1998)
Czech Republic (1999)
Armenia (1999)
Croatia (1999)
FYM (1997)
Bosnia and Herzegovina (1991)
Lithuania (1999)
Poland (1996)
CCEE (1999)
Georgia (1994)
Slovakia (1999)
Azerbaijan (1999)
Bulgaria (1999)
Estonia (1999)
Hungary (1999)
Romania (1999)
Latvia (1999)
Turkey (1998)
Uzbekistan (1998)
Tajikistan (1995)
Kyrgyzstan (1999)
Ukraine (1999) Belarus (1999) CAR: the central Asian republics
Republic of Moldova (1999) CCEE: the countries of central and eastern Europe NIS (1999) EU: the countries of the European Union CAR (1998) FYM: the former Yugoslav Republic of Macedonia Turkmenistan (1998) NIS: the newly independent states of the former USSR Russian Federation (1999)
Kazakhstan (1999)
60 65 70 75 80 Life expectancy (years)
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 6 HEALTH STATUS
Life expectancy at birth, Life expectancy at birth, males females 85 85
80 80
75 75
70 70
65 65 Life expectancy (years) Life expectancy (years) Life
60 60
55 55 81 83 85 87 89 91 93 95 97 99 81 83 85 87 89 91 93 95 97 99 Year Year Azerbaijan EU average Azerbaijan EU average CAR average NIS average CAR average NIS average
Main causes of death and disease The standardized death rate in Azerbaijan is This may point to certain specific features of slightly higher than the average for WHO national practice with regard to coding the European Region. Premature mortality fell main cause of death. steadily in the period 1995–1999. Hospital admission rates differ somewhat from Cardiovascular diseases are the leading cause the average figures for Europe. In particular, a of death. Malignant neoplasms are the second substantially higher percentage of hospital most frequent category of causes of death in admissions in the country is due to diseases of the structure of premature mortality. the respiratory organs and to infectious and Among the elderly (65 years and above), the parasitic diseases. vast majority of recorded deaths are due to cardiovascular diseases.
Structure of mortality (in %) by main cause of death and age group in Azerbaijan (1999) compared with the average for the European Region (1998)
0–64 years 65 years and above Cause of death Azerbaijan Europe Azerbaijan Europe Cardiovascular diseases 42.9 30.8 71.8 60.0
Malignant neoplasms 16.1 23.0 8.3 16.6
Accidents, injury and poisoning 7.1 19.7 0.8 2.6
Diseases of the respiratory system 9.3 5.4 5.8 6.9
Infectious and parasitic diseases 6.0 2.9 0.8 0.6
Diseases of the digestive system 6.5 5.6 5.3 3.0
Ill-defined conditions 1.7 2.6 2.9 4.0
Other diseases 10.4 10.0 5.9 6.3
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 7 HEALTH STATUS
Cardiovascular diseases Two periods can be distinguished as regards The death rate from cerebrovascular disease is trends in premature mortality due to relatively low compared with other NIS, but cardiovascular diseases (CVD) in Azerbaijan: substantially above the EU average. first, from 1987 to 1994, a prolonged rise in mortality, and second, a downward shift as from 1995. According to the latest available Trends in mortality from data, premature mortality due to CVD in cardiovascular diseases, 0–64 years Azerbaijan in 1999 was lower than the NIS 300 average but remained substantially higher than the average for EU countries. 250
The rate of premature mortality due to 200 ischaemic heart disease has long been one of the highest in Europe, despite a downward 150 trend since 1994. The sharp fall in registered ischaemic heart disease mortality in 1988 and 100 the corresponding “surge” in mortality from 50 other (non- ischaemic heart disease and non- death rate per 100 000 Standardized cerebrovascular) CVD are most probably the consequence of changes in practice regarding 0 selection of the main cause of death and point 81 83 85 87 89 91 93 95 97 99 Year to the possibility of poor quality coding. Azerbaijan EU average CAR average NIS average
Mortality from cardiovascular Inpatients by disease category diseases, 0–64 years, (% of all patients hospitalized) latest available data Azerbaijan Europe Turkmenistan (1998) Disease category (1999) (1998) Kazakhstan (1999) Russian Federation (1999) Infectious and parasitic 6.1 3.4 CAR (1998) diseases Belarus (1999) NIS (1999) Malignant neoplasms 2.3 6.7 Ukraine (1999) Uzbekistan (1998) Cardiovascular Kyrgyzstan (1999) 9.5 12.5 diseases Georgia (1994) Republic of Moldova (1999) Diseases of the 15.3 10.1 Tajikistan (1995) respiratory system Azerbaijan (1999) Diseases of the Latvia (1999) 11.1 10.0 digestive system Estonia (1999) Lithuania (1999) Armenia (1999) Injury and poisoning 4.9 8.4 EU (1997)
0 50 100 150 200 250 300 Other diseases 50.8 48.7 Standardized death rate per 100 000
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 8 HEALTH STATUS
Trends in mortality from ischaemic Trends in mortality from heart disease, 0–64 years cerebrovascular diseases, 0–64 years 125 200
100
150
75
100 50
50 25 Starardized death rate per 100 000 Starardized Standardized death rate per 100 000 Standardized
0 0 81 83 85 87 89 91 93 95 97 99 81 83 85 87 89 91 93 95 97 99 Year Year
Azerbaijan EU average Azerbaijan EU average CAR average NIS average CAR average NIS average
Mortality from ischaemic heart Mortality from cerebrovascular diseases, 0–64 years, diseases, 0–64 years, latest available data latest available data
Belarus (1999) Kyrgyzstan (1999) Ukraine (1999) Kazakhstan (1999) Russian Federation (1999) Russian Federation (1999) Kazakhstan (1999) Republic of Moldova (1999) Georgia (1994) Belarus (1999) NIS (1999) Turkmenistan (1998) CAR (1998) Azerbaijan (1999) Georgia (1994) NIS (1999) Ukraine (1999) CAR (1998) Uzbekistan (1998) Republic of Moldova (1999) Latvia (1999) Latvia (1999) Estonia (1999) Tajikistan (1995) Azerbaijan (1999) Kyrgyzstan (1999) Tajikistan (1995) Estonia (1999) Armenia (1999) Armenia (1999) Turkmenistan (1998) Lithuania (1999) Lithuania (1999) EU (1997) EU (1997)
0 20 40 60 80 100 120 140 020406080100
Standardized death rate per 100 000 Standardized death rate per 100 000
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 9 HEALTH STATUS
Malignant neoplasms The trend in premature mortality due to An increase in cancer mortality was registered malignant neoplasms in Azerbaijan is different in 1999, primarily owing to a rise in the rate at from that in most NIS. A slight increase in older ages (+65 years). mortality in the mid-1980s was followed by a In Azerbaijan, like in the neighbouring country continuing fall. The mortality rate in of Georgia and most CAR, the rate of Azerbaijan is thus significantly lower than the premature mortality due to cancer of the NIS average and close to that of the CAR. trachea/bronchus/lung is one of the lowest in WHO European Region.
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 Standardized 25 Standardized death rate per 100 000 per rate death Standardized 5
0 0 81 83 85 87 89 91 93 95 97 99 81 83 85 87 89 91 93 95 97 99 Year Year Azerbaijan EU average Azerbaijan EU average CAR average NIS average CAR average NIS average
Mortality from trachea/bronchus/lung Mortality from cancer, 0–64 years, cancer, 0–64 years, latest available data latest available data
Russian Federation (1999) Russian Federation (1999) Ukraine (1999) Kazakhstan (1999) Belarus (1999) Latvia (1999) Kazakhstan (1999) Belarus (1999) Latvia (1999) Ukraine (1999) Lithuania (1999) Lithuania (1999) NIS (1999) NIS (1999) Republic of Moldova (1999) Estonia (1999) Estonia (1999) EU (1997) Armenia (1999) Armenia (1999) EU (1997) Republic of Moldova (1999) CAR (1998) CAR (1998) Kyrgyzstan (1999) Kyrgyzstan (1999) Azerbaijan (1999) Azerbaijan (1999) Turkmenistan (1998) Georgia (1994) 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 AZERBAIJAN 10 HEALTH STATUS
Injury and poisoning The trend in mortality due to external causes characteristic of most NIS (a reduction in of injury and poisoning is substantially mortality as a result of the anti-alcohol different in Azerbaijan than in most other NIS, campaign in 1986/1987) is practically not seen above all owing to the peak in deaths from in the case of Azerbaijan. these causes in 1992–1994 caused by the According to the latest available data, armed conflict in Nagorno-Karabakh. This is mortality due to external causes of injury and clearly apparent from the trend in the number poisoning is among the lowest in the European of deaths coded as homicide during this Region. period. At the same time, the picture
Trends in mortality Trends in mortality from homicide from external causes 100 300 Armenia (1988) = 538
250 80
200 60
150
40
100
20 Standardized death rate per 100 000 Standardized Standardized death rate per 100 000 Standardized 50
0 0 81 83 85 87 89 91 93 95 97 99 81 83 85 87 89 91 93 95 97 99 Year Year Azerbaijan EU average Azerbaijan 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 (1999) Russian Federation (1999) Kazakhstan (1999) Belarus (1999) NIS (1999) Latvia (1999) Estonia (1999) NIS (1999) Latvia (1999) Estonia (1999) Ukraine (1999) Lithuania (1999) Republic of Moldova (1999) Ukraine (1999) Belarus (1999) Kazakhstan (1999) CAR (1998) Republic of Moldova (1999) Kyrgyzstan (1999) Kyrgyzstan (1999) Turkmenistan (1998) CAR (1998) Tajikistan (1995) Turkmenistan (1998) Lithuania (1999) Tajikistan (1995) Azerbaijan (1999) Uzbekistan (1998) Uzbekistan (1998) Georgia (1994) Armenia (1999) EU (1997) EU (1997) Armenia (1999) Georgia (1994) Azerbaijan (1999) 0 5 10 15 20 25 30 0 50 100 150 200 250 Standardized death rate per 100 000 Standardized death rate per 100 000
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 11 HEALTH STATUS
Mortality due to road traffic accidents fell Infectious diseases substantially in 1993/1994. According to the In Azerbaijan, like in the CAR, the mortality latest available data, it is one of the lowest in rate due to infectious and parasitic diseases has WHO European Region. for a long time been higher than the NIS average. Mental health A rise in the incidence of tuberculosis was In Azerbaijan, like in Armenia, the mortality seen in 1991–1995, and it has since stabilized rate due to suicide and self-inflicted injury is at one of the highest levels in the Region. among the lowest in WHO’s European The incidence of malaria (which, despite a Region. substantial fall in 1997–1999, continues to be Similarly, the registered incidence of mental one of the highest in the Region) is a serious disorders generally, and of alcohol psychoses problem in Azerbaijan. in particular, is one of the lowest in the Region.
Trends in mortality from suicide Trends in mortality from infectious and self-inflicted injury 50 and parasitic diseases 150
40 125
100 30
75
20 50
10 Standardized death rate per 100 000 Standardized
Standardized death rate per 100 000 Standardized 25
0 0 81 83 85 87 89 91 93 95 97 99 81 83 85 87 89 91 93 95 97 99 Year Year Azerbaijan EU average Azerbaijan EU average CAR average NIS average CAR average NIS average
Mortality from suicide and self-inflicted Mortality from infectious and parasitic injury, latest available data diseases, latest available data
Lithuania (1999) Tajikistan (1995) Russian Federation (1999) Turkmenistan (1998) Belarus (1999) Kazakhstan (1999) Estonia (1999) CAR (1998) Kazakhstan (1999) Kyrgyzstan (1999) Latvia (1999) Uzbekistan (1998) NIS (1999) Azerbaijan (1999) Ukraine (1999) NIS (1999) Republic of Moldova (1999) Russian Federation (1999) CAR (1998) Ukraine (1999) Kyrgyzstan (1999) Republic of Moldova (1999) EU (1997) Latvia (1999) Turkmenistan (1998) Lithuania (1999) Uzbekistan (1998) Estonia (1999) Tajikistan (1995) Belarus (1999) Georgia (1994) Georgia (1994) Armenia (1999) Armenia (1999) Azerbaijan (1999) EU (1997)
0 1020304050 0 10203040506070 Standardized death rate per 100 000 Standardized death rate per 100 000
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 12 HEALTH STATUS
Incidence of tuberculosis An increase in the incidence of diphtheria was per 100 000 population registered in the country, like in most other 160 NIS, in 1994–1995. The spread of this disease
140 was halted and incidence fell thanks to the joint efforts of the Ministry of Health, 120 UNICEF and WHO. 100 Azerbaijan is one of the countries with a low 80 prevalence of HIV infection. Very recently, 60 however, the number of new cases of infection New cases per 100 000 cases New 40 has begun to rise sharply. Only two new cases of HIV infection were registered in 1996, 20 whereas there were 64 in the first half of 1999. 0 81 83 85 87 89 91 93 95 97 99 The main routes of infection are injection drug Year use (41% of all cases, and 65% of cases in Azerbaijan EU average men) and heterosexual contacts (30% of all CAR average NIS average registered cases) (UNDP Azerbaijan, 2000).
Other diseases Incidence of malaria per 100 000 population Thanks to a marked downturn as from 1995, the incidence of diseases of the respiratory 500
450 organs in 1999 was close to the NIS average.
400 Mortality due to diseases of the digestive 350 system has increased since 1987, and for a 300 number of years it has been close to the CAR 250 average, remaining one of the highest among 200 the NIS and in WHO European Region as a
New cases per 100 000 cases New 150 whole. 100 Azerbaijan has one of the highest rates of 50 diabetes mortality in the Region. In terms of 0 81 83 85 87 89 91 93 95 97 99 diabetes prevalence, however, it is in a middle- Year ranking position. This contradiction may Azerbaijan EU average reflect both a genuinely high level of mortality CAR average NIS average among people with diabetes and errors in coding the principal cause of death. It should Incidence of dyphtheria be noted that similar trends in diabetes per 100 000 population mortality are also seen in the neighbouring 100 country of Armenia and in most CAR. 90
80
70
60
50
40
30 New cases per 100 000 New
20
10
0 81 83 85 87 89 91 93 95 97 99 Year Azerbaijan EU average CAR average NIS average
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 13 HEALTH STATUS
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 50 death rate per 100 000 Standardized 25
0 0 81 83 85 87 89 91 93 95 97 99 81 83 85 87 89 91 93 95 97 99 Year Year
Azerbaijan EU average Azerbaijan 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 (1999) Kyrgyzstan (1999) Kyrgyzstan (1999) CAR (1998) Turkmenistan (1998) Turkmenistan (1998) Uzbekistan (1998) Uzbekistan (1998) CAR (1998) Kazakhstan (1999) Azerbaijan (1999) Republic of Moldova (1999) Kazakhstan (1999) NIS (1999) Tajikistan (1995) Azerbaijan (1999) NIS (1999) Belarus (1999) Russian Federation (1999) Ukraine (1999) Ukraine (1999) Russian Federation (1999) Estonia (1999) EU (1997) Georgia (1994) Armenia (1999) Latvia (1999) Lithuania (1999) Lithuania (1999) Estonia (1999) EU (1997) Latvia (1999) Belarus (1999) Georgia (1994) Armenia (1999)
0 40 80 120 160 200 0 20 40 60 80 100 120
Standardized death rate per 100 000 Standardized death rate per 100 000
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 14 HEALTH STATUS
Disability The incidence of new cases of disability in Azerbaijan in 1999 was 234 per 100 000 Infant mortality rate population, substantially lower than the per 1000 live births average for the NIS. 60
The main causes of disability are CVD, 50 tuberculosis, nervous system disorders and diseases of the sensory organs (State 40 Committee on Statistics, 2000).
30 Health of children and adolescents 20
Infant mortality in Azerbaijan rose slightly at births 1000 live per Deaths the beginning of the 1990s but has since fallen 10 steadily. In 1999, it was 16.5 per 1000 live births, which is lower than the NIS average. It 0 should be noted that the definition of “live 81 83 85 87 89 91 93 95 97 99 birth” used in Azerbaijan excludes many Year Azerbaijan EU average children who die within seven days after birth. CAR average NIS average According to rough estimates, the infant mortality rate would increase by approximately 20% if the international Infant mortality rate criterion of a live birth was used. This is in per 1000 live births line with the experience of other countries that Turkmenistan (1998) have made the transition to the international CAR (1998) definition. Kyrgyzstan (1999) Uzbekistan (1998) In addition, many neonatal deaths that occur Kazakhstan (1999) after births at home remain unregistered. At Tajikistan (1999) present, there is a very large number of such Republic of Moldova (1999) births (UNDP Azerbaijan, 2000). This is NIS (1999) indirectly confirmed by analysis of the ratio Russian Federation (1999) Georgia (1994) between neonatal (0–27 days) and Azerbaijan (1999) postneonatal (28–365 days) mortality. For Armenia (1999) Azerbaijan, this ratio is the lowest in the Ukraine (1999) Region and approximately four times lower Belarus (1999) Latvia (1999) than the NIS average. Estonia (1999) Mortality due to diarrhoeal diseases among Lithuania (1999) children up to five years of age is also EU (1997) relatively high, although it has been falling 0 10203040 since 1995. Deaths per 1000 live births In 1998, the immunization coverage rate in children under one year of age against diphtheria, tuberculosis and tetanus was 95.7%; against measles it was 96.9%, against tuberculosis 94.5% and against poliomyelitis 96.4%.
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 15 HEALTH STATUS
Women’s health The maternal mortality rate in Azerbaijan Trends in maternal mortality (43.4 per 100 000 live births in 1999) remains 100 one of the highest among the NIS. 90
Haemorrhage during birth is the main cause of 80 maternal mortality. 70
The abortion rate in Azerbaijan in 1999 was 60 178 per 1000 live births. This figure is 50 significantly lower than the NIS average and close to the average for EU countries. 40 30
Premature mortality due to breast cancer rose 100 000 live per Deaths births slightly in the 1990s but remains substantially 20 below the NIS average; Azerbaijan has one of 10 the lowest figures in the Region for this 0 indicator. 81 83 85 87 89 91 93 95 97 99 Year
The premature mortality rate due to cancer of Azerbaijan EU average the uterus is also one of the lowest in the CAR average NIS average Region, although it began to increase in 1993.
Maternal mortality rate per 100 000 live births, latest available data
Number of abortions Tajikistan (1995) per 1000 live births Georgia (1999) 2200 Kazakhstan (1999)
2000 Kyrgyzstan (1999) Russian Federation (1999) 1800 Turkmenistan (1996) 1600 Azerbaijan (1999) Latvia (1999) 1400 NIS (1999) 1200 CAR (1996) 1000 Armenia (1999) Republic of Moldova (1999) 800 Ukraine (1999) 600 Abortions per 1000 live births per 1000 live Abortions Belarus (1999) 400 Estonia (1999) Lithuania (1999) 200 Uzbekistan (1998) 0 EU (1997) 81 83 85 87 89 91 93 95 97 99 0 10203040506070 Year Azerbaijan EU average Deaths per 100 000 live births CAR average NIS average
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 16 HEALTH STATUS
Trends in mortality from cancer Trends in mortality from cancer of the breast among females of the cervix among females aged 0–64 years aged 0–64 years 25 10
20 8
15 6
10 4
5 2 Standardized death rate per 100 000 Standardized Standardized death rate per 100 000 Standardized
0 0 81 83 85 87 89 91 93 95 97 99 81 83 85 87 89 91 93 95 97 99 Year Year Azerbaijan EU average Azerbaijan EU average CAR average NIS average CAR average NIS average
Mortality from cancer of the breast Mortality from cancer of the cervix among females aged 0–64, among females aged 0–64, latest available data latest available data
Armenia (1999) Lithuania (1999) Republic of Moldova (1999) Republic of Moldova (1999) Ukraine (1999) Kyrgyzstan (1999) EU (1997) Kazakhstan (1999) Russian Federation (1999) Estonia (1999) Estonia (1999) Ukraine (1999) Georgia (1994) NIS (1999) Belarus (1999) Russian Federation (1999) Latvia (1999) Armenia (1999) Lithuania (1999) Latvia (1999) NIS (1999) CAR (1998) Kazakhstan (1999) Belarus (1999) Azerbaijan (1999) Uzbekistan (1998) Kyrgyzstan (1999) Georgia (1994) CAR (1998) Tajikistan (1995) Uzbekistan (1998) Turkmenistan (1998) Turkmenistan (1998) Azerbaijan (1999) Tajikistan (1995) EU (1997)
0 5 10 15 20 25 0246810
Standardized death rate per 100 000 Standardized death rate per 100 000
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 17 LIFESTYLES
LIFESTYLES
Tobacco consumption Illicit drug use According to available data, smoking Marijuana and opium derivatives are the drugs prevalence in Azerbaijan in 1997 was most frequently used in Azerbaijan (WHO approximately 26.5% of the population over Regional Office for Europe, 1997). The 15 years of age; however, this figure was incidence of drug abuse increased from 5.5 somewhat lower than in the majority of other per 100 000 population in 1990 to 21.2 per NIS. 100 000 in 1999 (State Committee on Annual cigarette consumption per capita in Statistics, 2000). Azerbaijan is stable and lower than the NIS average. Lung cancer mortality, as a proxy Nutrition indicator of smoking levels, was also lower Average per capita calorie intake fell than the NIS average in 1998. substantially in Azerbaijan, like in neighbouring trans-Caucasian countries, in the Alcohol consumption early 1990s. In 1999, it was 2191 kcal per Azerbaijan is one of the group of countries person per day, which is one of the lowest with low per capita alcohol consumption levels in the European Region. A significant figures (0.9 litres of pure alcohol equivalent in fall in the consumption of fat and protein has 1997). The low figures for alcohol psychosis also been seen. According to data from the and cases of alcohol dependency are related to State Committee on Statistics, the actual local traditions of alcohol consumption (WHO consumption of wheat is higher than the Regional Office for Europe, 1997). physiological requirement, while that of meat, fish and milk is substantially lower. This is responsible for the development of anaemia in Number of cigarettes consumed many children and women and reflects the per person per year socioeconomic difficulties being experienced 3200 by a significant proportion of the population. 3000 The problems of anaemia and an inadequate 2800 diet are particularly acute for temporarily 2600 displaced persons. Anaemia affected 79% of 2400 2200 non-pregnant women in this group, while 30% 2000 of the children surveyed had a poor diet 1800 (UNDP Azerbaijan, 2000). 1600 1400 Number of cigarettes Number 1200 1000 800 600 400 90 91 92 93 94 95 96 97 98 99 Year Azerbaijan EU average CAR average NIS average
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 18 ENVIRONMENT AND HEALTH
ENVIRONMENT AND HEALTH
Air quality As a result of the downturn in industrial recycling water in industry is almost non- production in Azerbaijan, like in many other existent. On the Apsheron Peninsula, roughly NIS, there has been a fall in the amount of half the drinking water is lost from the water pollutants discharged into the atmosphere in supply system owing to its poor technical recent years. Since 1990, there has been a condition. reduction in overall atmospheric pollution More than 80% of the population live in from stationary sources and an increase in the districts where there are no modern water proportion of total pollutants attributable to supply or sewage systems. The rivers Kura and motor vehicle traffic. Araks are significantly polluted by industrial The highest levels of atmospheric pollution in and agricultural waste (UNDP Azerbaijan, Azerbaijan have been registered in five cities: 2000). Baku, Sumgait, Gjanzha, Ali-Bajramly and Mingechaur. Waste and soil Levels of up to five times the maximum Soil erosion due to the effects of wind and permissible concentrations of the pollutants water, salinization and pollution with monitored have been recorded in these cities industrial waste are serious threats in (UNDP Azerbaijan, 2000). Azerbaijan. Approximately half of the country’s flat land is subject to erosion, and Water management and sanitation 14% suffers from salinization and a high level The shortage of water resources in Azerbaijan of subsurface water. More than 60 000 is compounded by their inefficient use. hectares of land are polluted with industrial Broken-down irrigation systems lead to water waste, especially oil (UNDP Azerbaijan, losses of up to 50%, while the practice of 2000).
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 19 HEALTH CARE SYSTEM
HEALTH CARE SYSTEM
Health system reform In accordance with the “Overall plan for Health care expenditure in Azerbaijan in 1999 reorientation of the health system and reform amounted to 1.6% of GDP, which is one of the in the organization and delivery of medical lowest levels in the European Region. In 1998, care to the population”, the main lines of health care accounted for 5.8% of government reform are: spending, equivalent to some US$ 9.9 per
S Creation of the legislative and legal foundation for the new health system Health care resources and their utilization and for protecting people’s health; in Azerbaijan compared with S Definition of forms of centralized and European averages decentralized management for the health Azerbaijan Europe (1999) (1999) system; Hospital beds S Giving priority to primary health care; 890 778 per 100 000 population S Rationalization of the network and bed Physicians stock of health care establishments; 357 362 per 100 000 population S Reform of the public health and Hospital admissions 4,8 18,1 ɚ epidemiological surveillance service; per 100 population S Transition to principles of insurance- Average hospital stay. 17 12,2 ɚ based medicine; days S Development of fee-for-service Health care expenditure 1,6 6,1 ɚ arrangements; as a percentage of GDP S Reform of the pharmacy sector; a S Privatization of health care; 1998 S Accreditation, certification and licensing of health care establishments, personnel, drugs and food products; Total health care expenditure S Reform of medical education as a percentage of GDP, latest available data (Ministry of Health, 1999). EU (1998) Estonia (1999) Lithuania (1998) Health care expenditure and health Belarus (1999) system funding Latvia (1999) One cause of the crisis in the country’s health Armenia (1993) Turkmenistan (1996) system was the imbalance between the existing Ukraine (1998) structures, on the one hand, and the increasing Republic of Moldova (1999) reduction in government funding for the Uzbekistan (1999) sector, on the other. Thanks to the measures NIS (1999) CAR (1998) taken in recent years, as well as the Russian Federation (1995) development of fee-for-service arrangements Kazakhstan (1999) and assistance from international humanitarian Kyrgyzstan (1999) organizations, the problem has become less Azerbaijan (1999) Tajikistan (1998) acute in several important areas of health care Georgia (1998) work. 0246810 Percentage of GDP
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 20 HEALTH CARE SYSTEM person. In reality, just over 50% of the The hospital bed rate fell in Azerbaijan in the requested resources are allocated to the health 1990s, but not as significantly as in most other sector (State Committee on Statistics, 2000). NIS. In 1999, it was 890 per 100 000 It should be noted that most patients in population. This figure is close to the NIS Azerbaijan (78% in 1999) have to make average. At the same time, the bed occupancy “informal” payments both in money and in rate fell by almost 50% compared with 1990 food, especially in rural areas (World Bank, (WHO Liaison Office in Azerbaijan, 1999). 2000). This is not surprising, since the salary One of the main thrusts of the reform is to of a health care worker is 31% of the average work on reducing the number of hospital beds. pay in the country (State Committee on The urgency of this problem is due to the fact Statistics, 2000). that some 65% of all health care resources are
Outpatient services Number of hospital beds In 1997, primary medical care in Azerbaijan per 100 000 population was delivered in 1817 outpatient/polyclinic 1600 establishments (WHO Liaison Office in Azerbaijan, 1999). 1400
The average number of visits per person 1200 (including to doctors at first-aid points and calls for ambulance) in 1999 was 5.1, which is 1000 lower than the NIS average. According to available data, the general practitioner ratio in 800
1999 was 18.3 per 100 000 population. In 100 000 population Beds per total, 20-25% of physicians deliver primary 600 health care. 400 81 83 85 87 89 91 93 95 97 99 Inpatient services Year In 1998, inpatient care in Azerbaijan was Azerbaijan EU average CAR average NIS average delivered in 862 hospitals (WHO Liaison Office in Azerbaijan, 1999). Hospital bed rates, latest available data Trends in the average number of contacts with primary health care Belarus (1999) Russian Federation (1999) establishments NIS (1999)
14 Lithuania (1999) Ukraine (1998) 12 Azerbaijan (1999) Latvia (1999) 10 Republic of Moldova (1999) Kyrgyzstan (1999) 8 Kazakhstan (1999) Estonia (1999) 6 Turkmenistan(1997) EU (1998) 4 Tajikistan (1999) CAR (1999) Outpatient contacts per year person Outpatient 2 Armenia (1999) Uzbekistan (1999) 0 81 83 85 87 89 91 93 95 97 99 Georgia(1999)
Year 400 600 800 1000 1200 Beds per 100 000 population Azerbaijan EU average CAR average NIS average
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 21 HEALTH CARE SYSTEM spent on inpatient care, a figure that is higher Medical personnel than in most countries in the European Region. The physician/population ratio increased in At the same time, the bed utilization rate is Azerbaijan in the 1980s. It then stabilized and only 30%, while the workload on hospital only began to fall in 1997–1998. In 1999 it physicians is even less (Ministry of Health, was 357 per 100 000 population, which is 2001). close to the NIS average. The level of hospital admissions has fallen Similar trends are seen for dentists and substantially since the mid-1980s (to 5 per 100 pharmacists, whose numbers contracted population in 1998) and is one of the lowest in sharply in 1998. In 1999, the ratios for these the European Region. categories were slightly lower than the NIS The average length of hospital stay remains averages. considerable and in 1998 was 17.5 days, one The trend for nurses is somewhat different, in of the highest figures for this indicator in that their ratio has fallen steadily since the end WHO’s European Region. of the 1980s. In 1999, the nurse/population ratio was also slightly lower than the NIS average and close to the level for the European Average length of stay in hospital in days Region as a whole. 20
18 Trends in physician/population ratio 16 600
550
14 500
Length of stay in days 450
12 400
350
10 300 81 83 85 87 89 91 93 95 97 99 250 Year
Azerbaijan EU average per 100 000 of physicians Number 200 CAR average NIS average 150
100 81 83 85 87 89 91 93 95 97 99 Hospital admissions Year per 100 population Azerbaijan EU average 30 CAR average NIS average
25
20
15
10
5 Hospital admissions per 100 population admissions Hospital
0 81 83 85 87 89 91 93 95 97 99 Year Azerbaijan EU average CAR average NIS average
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 22 REFERENCES
REFERENCES
COUNCIL OF EUROPE (1999). Recent demographic developments in Europe – 1999. Strasbourg, Council of Europe Publishing. ECONOMIST INTELLIGENCE UNIT, 2001. Country report (www.eiu.com). STATE COMMITTEE ON STATISTICS, Baku, 2000. MINISTRY OF HEALTH, 1999. Overall plan for reorientation of the health system and reform in the organization and delivery of medical care to the population. Baku. MINISTRY OF HEALTH, 2001. Health care reform (www.mednet.az). UNDP AZERBAIJAN, 2000. Azerbaijan Human Development Report. Baku. WHO LIAISON OFFICE IN AZERBAIJAN, 1999. Azerbaijan Country Health Report. WHO REGIONAL OFFICE FOR EUROPE, 1997. Smoking, drinking and drug taking in the European Region. Copenhagen (Alcohol, Drugs and Tobacco programme). WORLD BANK, 2000. Making transition work for everyone. Poverty and inequality in Europe and Central Asia.
HIGHLIGHTS ON HEALTH IN AZERBAIJAN 23 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 2001
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 Directorate of Informatics and Statistics of the Ministry of Health of Azerbaijan. All rights in this document are reserved by the WHO Regional Office for Europe. The document may nevertheless be freely reviewed, abstracted or reproduced (but not for sale or for use in conjunction with commercial purposes) provided that due acknowledgement is made to the source. The Regional Office encourages the translation of this document, but permission must be sought first.
KEYWORDS: HEALTH STATUS, LIFESTYLE, ENVIRONMENTAL HEALTH, DELIVERY OF HEALTH CARE, COMPARATIVE STUDY, AZERBAIJAN. The views expressed in this document are those of WHO. Comments or additional information should be forwarded to:
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