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Public Health Initiatives in Kazakhstan Public Health Challenges and Priorities for Kazakhstan Altyn Aringazina¹, Gabriel Gulis², John P. Allegrante³ 1Department of Population Health and Social Sciences, Kazakhstan School of Public Health, Almaty, Republic of Kazakhstan; 2Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark; 3Department of Health and Behavior Studies, Teachers College, and Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY USA Vol. 1, No. 1 (2012) | ISSN 2166-7403 (Online) DOI 10.5195/cajgh.2012.30 | http://cajgh.pitt.edu New articles in this journal are licensed under a Creative Commons Attribution 3.0 United States License. This site is published by the University Library System of the University of Pittsburgh as part of its D- Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. ARINGAZINA ET AL Abstract The Republic of Kazakhstan is one of the largest and fastest growing post-Soviet economies in Central Asia. Despite recent improvements in health care in response to Kazakhstan 2030 and other state-mandated policy reforms, Kazakhstan still lags behind other members of the Commonwealth of Independent States of the European Region on key indicators of health and economic development. Although cardiovascular diseases are the leading cause of mortality among adults, HIV/AIDS, tuberculosis, and blood-borne infectious diseases are of increasing public health concern. Recent data suggest that while Kazakhstan has improved on some measures of population health status, many environmental and public health challenges remain. These include the need to improve public health infrastructure, address the social determinants of health, and implement better health impact assessments to inform health policies and public health practice. In addition, more than three decades after the Declaration of Alma-Ata, which was adopted at the International Conference on Primary Health Care convened in Kazakhstan in 1978, facilitating population-wide lifestyle and behavioral change to reduce risk factors for chronic and communicable diseases, as well as injuries, remains a high priority for emerging health care reforms and the new public health. This paper reviews the current public health challenges in Kazakhstan and describes five priorities for building public health capacity that are now being developed and undertaken at the Kazakhstan School of Public Health to strengthen population health in the country and the Central Asian Region. Keywords: Central Asia, Kazakhstan, health care, health promotion, population health, public health Public Health Challenges and Perspective Priorities for Kazakhstan Introduction Altyn Aringazina¹, Gabriel Gulis², The Republic of Kazakhstan is one of the John P. Allegrante³ former Soviet republics that are now part of the 1 Department of Population Health and Social Commonwealth of Independent States (CIS). It has one Sciences, Kazakhstan School of Public of the largest and fastest expanding economies in Health, Almaty, Republic of Kazakhstan; 2Unit for Health Promotion Research, Central Asia, growing an estimated 9% between 2000 th University of Southern Denmark, Esbjerg, and 2007. In 2011, Kazakhstan marked the 20 Denmark; 3Department of Health and anniversary of post-Soviet independence by introducing Behavior Studies, Teachers College, and new social policies designed to strengthen its domestic Department of Sociomedical Sciences, socioeconomic standing and political position in the Mailman School of Public Health, Columbia international community. In addition, the central University, New York, NY USA government of Kazakhstan has prioritized several goals aimed at diversifying the economy beyond its reliance on oil, natural gas, and other extractive industries, decreasing dependence on the government sector, and increasing competitiveness of the state as a whole. A This work is licensed under a Creative Commons Attribution 3.0 United States License. This journal is published by the University Library System of the University of Pittsburgh as part of its D-Scribe Digital Publishing Program, and is cosponsored by the University of Pittsburgh Press. Central Asian Journal of Global Health Volume 1, No. 1 (2012) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2012.30 | http://cajgh.pitt.edu CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH key area of the central government’s interest is the regional average of 75 for both genders.1 The trend in improvement of population health. life expectancy in Kazakhstan is similar to that observed in the other CIS. Similar to other nations, female life Despite strong macroeconomic indicators and expectancy at birth exceeds that for males by 11 years. considerable progress in building civil society, efforts to democratize its system of higher education and related institutions and modernize infrastructure to support Causes of Mortality population health, numerous challenges remain in delivering public health services to a population of over The WHO estimates that, with only a few 16 million people, 59% of whom now live in the two exceptions, the rates of mortality due to the main largest urban centers: Almaty and the capital city of diseases are above the averages for other regional states. Astana. Although many health status measures show According to WHO, noncommunicable chronic diseases Kazakhstan to be ahead of most nations of the region, (cardiovascular diseases, including diabetes, and cancer) Kazakhstan continues to lag behind nations with the size accounted for about 85% of all deaths in Kazakhstan, of its economy on several important health and injuries about 11%, and communicable diseases about 1 environmental indicators.1 2%. Cardiovascular diseases accounted for 57% of all mortality.4 Infant mortality in 2010 was 29 deaths per This paper briefly reviews the current health 1,000 live births and maternal mortality was estimated status and features of health care in Kazakhstan and in 2008 to be 25 deaths per 100,000 births. describes the current public health challenges. We also present five priorities for public health capacity building that are now being developed at the Kazakhstan School Infectious and Sexually Transmitted Diseases of Public Health to strengthen population health in the country and the Central Asian Region. Blood-borne diseases such as Hepatitis C and HIV, sexually transmitted infections, and tuberculosis still constitute a challenge for the public health system Socio-demographic and Health Status Profile in Kazakhstan. As of the end of 2010, Kazakhstan reported to the WHO Regional Office for Europe and The population of Kazakhstan is currently the European Centre for Disease Prevention and Control estimated (as of 2011) to be 16.5 million, with a growth a cumulative total of 15,754 HIV and 1,242 AIDS cases, rate of 1.235%.2 The World Bank3 has estimated the including 881 deaths due HIV/AIDS.5 For the year 2010 Gross National Product to be $149.06 billion in 2010, alone, 1,988 HIV and 256 AIDS cases, with 165 deaths with a per capita gross national income of $6,280, due to HIV/AIDS, were reported. The rate of newly which is below the average of other European Region diagnosed HIV infections in 2010 was 12.4 per 100,000 states. populations. Although Kazakhstan currently has a relatively low prevalence rate of HIV infection, there are a number of factors in place that create the potential Life Expectancy for a dramatic increase, including those of migration, The World Health Organization (WHO) health injection drug use, commercial sex work, and the profile for Kazakhstan, which is located within the marginalization of vulnerable groups.6 WHO European Region, estimates the average overall Kazakhstan has a prevalence rate for life expectancy at birth to be 64 years (59 years for tuberculosis (TB) of 198 per 100,000, which, when males and 70 years for females), which lags behind the This work is licensed under a Creative Commons Attribution 3.0 United States License. This journal is published by the University Library System of the University of Pittsburgh as part of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. Central Asian Journal of Global Health Volume 1, No. 1 (2012) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2012.30 | http://cajgh.pitt.edu ARINGAZINA ET AL compared to 63 per 100,000 people for other nations in Population Risk Factors the WHO European Region, is the highest in the region. Although the adult risk factors of blood While working on a region-wide initiative to improve glucose, blood pressure, and the rate of female obesity the effectiveness of the health system in response to TB, are higher in Kazakhstan than other countries in the Project HOPE initiated an anti-TB strategy by region, male obesity and adult tobacco use is lower. In implementing Directly Observed Therapy-Short Course 2008, the rate of obesity among adult males aged 20+ (DOTS) in 1994. Since then, the TB program has was 20.2, while adult female obesity was 27.4. expanded to become a region-wide disease management According to data collected by the National Center for program. In 2009, Project HOPE implemented a five- Healthy Lifestyle Development, the average smoking year, USAID-funded partnership with Population rate in 1998 was 28%, which had declined to 27% by Services International (PSI) to increase access to TB 2007 and where it has remained as of 2011. Average prevention and treatment among at-risk populations in alcohol
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