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Demographic and Health Challenges Facing Albania in the 21St Century Authorship

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Demographic and Health Challenges Facing Albania in the 21St Century Authorship DEMOGRAPHIC AND HEALTH CHALLENGES FACING ALBANIA IN THE 21 CHALLENGES FACING DEMOGRAPHIC AND HEALTH DEMOGRAPHIC AND HEALTH CHALLENGES ST FACING ALBANIA CENTURY IN THE 21ST CENTURY DEMOGRAPHIC AND HEALTH CHALLENGES FACING ALBANIA IN THE 21ST CENTURY AUTHORSHIP This report is written by Dr Arjan Gjonça1, Dr Genc Burazeri2, Dr Alban Ylli3 Blerina Subashi and Rudin Hoxha4 have contributed in data provision and manipulations as well as gave feedback on the results of analyses. ISBN 978-9928-149-91-6 1 Dr Arjan Gjonça is a Professor of Demography at Department of International Development, London School of Economics and Political Science 2 Dr Genc Burazeri is a Professor of Epidemiology at Medical University of Tirana. 3 Dr Alban Ylli is a Professor of Epidemiology and Public Health at Medical University of Tirana and Institute of Public Health in Albania. 4 Blerina Subashi and Rudin Hoxha are demographers/statisticians at Institute of National Statistics in Albania 2 Table of content EXECUTIVE SUMMARY .................................... 15 2.4. Cause-specific mortality in Albania INTRODUCTION ............................................... 17 from a regional perspective.............................. 47 2.5. Infant, Neonatal, and Child Demographic change and challenges Mortality, and the Related 1 in Albania, a regional perspective .................... 19 Causes of Death ............................................... 53 1.1. Introduction ..................................................... 20 2.5.1. Neonatal Mortality ........................................... 54 1.2. Data and methods ............................................ 20 2.5.2. Under-5 Mortality in Albania ........................... 57 1.3. Demographic transition and 2.6. Mortality and causes of death the major shift in age structure amongst children (5-18 years) of the country’s population ............................. 20 and young adults (19-29 years) ...................... 58 1.31. From the highest growth rate in Europe to 2.7. Adult Mortality and Causes a declining population size - Albania’s of Death (30-69 years) .................................... 59 demographic transition route. ......................... 20 2.8. Mortality and Causes of Death 1.32. Rapid fertility reduction amongst Older People (70+ years) .................. 61 in a very short period of time .......................... 21 2.9 Concluding Notes ............................................. 62 1.33. The continuous improvement in mortality – the paradox of Albania’s success “lives on” ............................................. 25 Recent changes in the morbidity 1.34. Unprecedented Emigration 3 and risk factors, in Albania .............................. 65 Rates – Albania’s migration 3.1 Morbidity ......................................................... 66 flows are not stopping ..................................... 30 3.1.1. The All-cause Morbidity Rate .......................... 66 1.35. The imbalance of sex selection 3.1.2 Child morbidity ................................................ 68 at birth – The patriarchal society 3.1.3 Morbidity in Middle-aged Individuals .............. 70 still dominant ................................................... 32 3.1.4 Older people morbidity .................................... 76 1.4. Population Ageing in Albania 3.2 Burden of disease ............................................. 81 – “Greying from the middle” ........................... 33 3.2.1 Overall Burden of Disease 1.5. Concluding notes ............................................. 36 in the Albanian Population .............................. 81 3.2.2 Burden of Disease from Specific Causes Non-communicable diseases (NCDs) ............... 83 2 Changes in mortality 3.3 Risk factors ....................................................... 86 and causes of death, in Albania ....................... 39 3.3.1 Main Risk Factors for Mortality and 2.1. Introduction ..................................................... 40 Morbidity within the Albanian Population ........ 87 2.2. Data and methodology .................................... 41 3.3.2 Hypertension - the general picture.................. 90 2.3. Overall Mortality and 3.3.3 Dietary risks ..................................................... 94 Cause of Death Patterns (all ages) ................... 42 3.3.4 Smoking ........................................................... 96 3 3.3.5 High BMI .......................................................... 98 4.4.4. Strengthening Childcare – An imperative 3.3.6 Hyperglycaemia/Diabetes ............................. 100 for the Future ................................................. 126 3.3.7 Other Risk Factors .......................................... 100 4.4.5. Health Information System – 3.4. Concluding notes ........................................... 104 A Modernised Path for the Future ................. 126 4.4.6. Strengthening Governance for Health and Wellbeing: Health and care provision, Inter-sectorial Collaboration ........................... 127 4 in Albania ....................................................... 107 4.4.7. The Decentralisation and Integration 4.1. Introduction ................................................... 108 of Health and Social Services The Health System in Albania ....................... 108 - improving the Pace of Implementation 4.2. Healthcare expenditure .................................. 109 of the Current Policy ...................................... 127 4.2.1 Health-related Household Expenditure 4.5. Health inequity .............................................. 127 in Albania ....................................................... 109 4.5.1. Inequality in the ADHS 2017-2018 .............. 128 4.2.2. Health Expenditure in Albania: International 4.5.2. The Health Vulnerability Study Estimates and Comparisons ........................... 109 in Albania 2018-19........................................ 128 4.2.3. Out-off-pocket Payments in Albania and the Affordability of Healthcare ............... 113 4.2.4. Healthcare Expenditure, National Income, 5 Health and demographic challenge and Government Tax Revenue ....................... 115 in Albania ....................................................... 135 4.2.5. Health Financing Challenges for Albania ......... 116 5.1. Should we worry about 4.3. Heath workforce ............................................ 117 population numbers? .................................... 136 4.3.1. An Overview of Human Resources 5.2. Focusing on children and mothers in Albania ....................................................... 117 – an agenda for improving neonatal 4.3.2. Human Resources from and perinatal mortality .................................. 136 a Regional Perspective ................................... 117 5.3. Focusing on the elderly – a new 4.4. Healthcare services ........................................ 121 agenda for health and social care .................. 137 4.4.1. An Overview of the Healthcare 5.4. Mental Health – Lost in the System .............. 137 Infrastructure in Albania ................................ 121 5.5. Who should pay for healthcare 4.4.2. A Description of the Public Health in Albania? ..................................................... 138 Services in Albania ......................................... 122 4.4.3. Health System Changes in Albania – the way forward ......................................... 125 4 List of tables Table 3.3 Rate of Injuries and Infectious 1 Diseases (Cases per 100,000 Population): Primary Healthcare Registers, Table 1. Population change in Albania and 2008-2018 ......................................................67 the annual growth rate 1945 – 2019 Table 3.4 Hospital Discharges for Selected (about here) .....................................................21 Conditions (Episodes per 100,000 people) during 2015-2018 ..............................68 Table 3.5 The Prevalence of Selected Diseases 2 and Conditions in Individuals Table 2.1 Mortality Indicators for Albania aged 15-59 Years .............................................70 2011-2018 ......................................................42 Table 3.6 Most Frequent Diseases and Table 2.2 Mortality Indicators for Albania Conditions 2018 (Incidence Rate: and Selected Balkan Countries Cases per 100,000 Population) (2015-20) ........................................................43 among Individuals aged 30-69 Years; NCD National Registers ...................................70 Table 2.3 Cause-specific Mortality (all ages) for the Period 2012-18 (source: INSTAT)........44 Table 3.7 Distribution of Selected Chronic Conditions and their Risk Factors Table 2.4 Specific Mortality Rate (All Ages) in Albanian Men and Women aged for Selected Diseases 2012-18 .......................46 40-65 years (N=487,727), who Table 2.5 The Ratio of Neonatal Mortality Accessed the Check-up Programme to Infant Mortality ...........................................55 in June 2015-December 2016 .........................71 Table 2.6 Specific Mortality Rates for Selected Table 3.8 Correlates of Measured Hypertension Diseases 2012-2018 in the Albanian in the Sample of Albanian men Population aged 5-29 years ............................59 and women aged 40-65 years Table 2.7 Overall and Specific Mortality (N=487,727) who Accessed Rates for Selected Diseases the Medical Check-up Progamme 2012-2018 among the Albanian in June 2015-December 2016 .........................73 Population aged 30-69 years ..........................60 Table 3.9 Most
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