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A Prescription for Public Health Action in South Eastern Europe

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A Prescription for Public Health Action in South Eastern Europe osipubpolicybernd|v1 10/5/03 13:17 Page 1 cardiovascular disease sustained investment cervical cancer regional cooperation smoking/tobacco disease surveillance injuries building capacity domestic and sexual violence prevention mental health treatment HEALING THE CRISIS disabilities education sexually transmitted infections training hiv/aids research malnutrition access to information lack of immunisation multisectoral approaches alcohol collaboration intravenous drug use community-based services human trafficking commitment cardiovascular disease sustained investment Public Health in South Eastern Europe cervicalis cancerailing as a result regional of political cooperation and smoking/tobacco disease surveillance injuries building capacity domestic and sexualeconomic violence transformations preventionand the mental health treatment disabilitiesHealing education sexually transmitted consequences of war. Yet too little is training research access to information lack of immunisation ڞinfections hiv/aids malnutrition being done to diagnose and treat the multisectoralregion’s approaches health problems.alcohol This policy collaboration intravenous drug use community-based services human A Prescription for Public Health Action in South Eastern Europe brief prescribes targeted, sustained the Crisis trafficking commitment cardiovascular disease sustained investment cervical cancer regional cooperation investment programs by international smoking/tobaccoagencies to improve public disease health surveillance and injuries building capacity domestic and sexual violence prevention mental strengthenhealth regional treatment stability. disabilities education sexually transmitted infections training hiv/aids approaches alcohol ڞresearch malnutrition access to information lack of immunisation multisectoral collaboration intravenous drug use community-based services human trafficking commitment A Prescription for cardiovascular disease sustained investment cervical cancer regional cooperation smoking/tobacco disease surveillance injuries building capacity domestic and sexual violencePublic prevention Healthmental Action health treatment disabilities education sexually transmitted infections trainingin Southhiv/aids Eastern research malnutrition Europe access to information lack of immunisation multisectoral approaches alcohol collaboration intravenous drug use OPEN SOCIETY INSTITUTE community-basedNetwork services Public Health Programshuman trafficking commitment cardiovascularInformation disease Review sustained investment Department for International cervicalDFID cancerDevelopment regional cooperation smoking/tobacco disease surveillance injuries building capacity domestic Bernd Rechel and Martin McKee and sexual violence prevention mental health treatment disabilities education sexually transmitted infections training hiv/aids research malnutrition access to information lack of immunisation multisectoral approaches alcohol collaboration intravenous drug use community-based services human Healing the Crisis: A Prescription for Public Health Action in South Eastern Europe Information Review Bernd Rechel and Martin McKee London School of Hygiene & Tropical Medicine Open Society Institute UK Department for International Development United Nations Children's Fund Regional Office for CEE/CIS and Baltic States © 2003 by the Open Society Institute. All rights reserved. ISBN 0 902657 73 9 Published by the London School of Hygiene & Tropical Medicine For more information, contact: European Centre on Health of Societies in Transition London School of Hygiene & Tropical Medicine Keppel Street London WC1E 7HT United Kingdom The opinions expressed in this document do not necessarily reflect the policies of the London School of Hygiene & Tropical Medicine, the Open Society Institute, the UK Department for International Development, or the United Nations Children's Fund. Designed by Jeanne Criscola│Criscola Design ii South Eastern Europe Acknowledgements This document is the outcome of a project undertaken in 2003 by the London School of Hygiene and Tropical Medicine (LSHTM), the Open Society Institute (OSI), UNICEF Regional Office for Central and Eastern Europe, the Commonwealth of Independent States and the Baltic States (UNICEF), and the United Kingdom Department for International Development (DFID). The project's core team included Bernd Rechel and Martin McKee of LSHTM, Persephone Harrington, Nina Schwalbe, Laura Silber, Emilia Tontcheva, and Mabel Wisse Smit of OSI, Mary Black and Ann- Lis Svensson of UNICEF, and Alison Forder, Jürgen Schmidt, and Rebecca Terzeon of DFID. The core team would also like to thank the following individuals for their efforts in gathering, annotating, and contributing to the project's relevant documents: Ilir Begolli, Vesna Bjegovic, Ivana Bozicevic, Ledia Çurri, Lucica Ditiu, Anca Dumitrescu, Arjan Gjonca, Dragan Gjorgjev, Dominic Haazen, Amela Lolic, Stipe Oresokovic, Viorel Soltan, Ozren Tosic, Fimka Tozija, Christian Vladescu, and Caroline White. The team is especially grateful to Will Kramer for his help in editing this report. The summary report of the project was developed in consultation with stakeholders at the national level. A draft of the summary report was also presented at the sixth meeting of the National Health Coordinators from South Eastern Europe, organized by the Stability Pact’s Initiative for Social Cohesion, where participants provided invaluable feedback. We are deeply grateful to all the individuals and organizations that gave their time and energy to this project. Funding for this project was provided by the Open Society Institute. iv Contents List of Tables ........................................................................................... vi List of Figures.......................................................................................... vi 1 The Urgent Need to Improve Public Health....................................1 1.1 Albania .............................................................................................................5 1.2 Bosnia and Herzegovina .............................................................................6 1.3 Bulgaria............................................................................................................6 1.4 Croatia..............................................................................................................6 1.5 UN-administered province of Kosovo .....................................................7 1.6 Macedonia.......................................................................................................7 1.7 Moldova ...........................................................................................................7 1.8 Romania...........................................................................................................8 1.9 Serbia and Montenegro ...............................................................................8 2 The Challenges of Assessing Health.................................................9 3 Patterns of Ill Health in South Eastern Europe............................11 3.1 Trends in Life Expectancy: Increasing Mortality Gaps.....................11 3.2 Immediate Causes of Mortality and Morbidity ....................................14 3.3 Infants and Children...................................................................................22 3.4 Adolescents..................................................................................................26 3.5 Women...........................................................................................................28 3.6 Lack of micronutrients ..............................................................................33 3.7 Specific Diseases........................................................................................35 4 Promoting Healthy Societies...........................................................41 4.1 The Risk Factors .........................................................................................41 4.2 Underlying Factors .....................................................................................48 5 Country Responses...........................................................................69 5.1 Health Care Reforms..................................................................................69 5.2 Public Health Interventions......................................................................70 6 The Scale and Nature of International Assistance........................77 6.1 World Bank ...................................................................................................78 6.2 European Union...........................................................................................78 6.3 Other Donors................................................................................................80 6.4 Stability Pact for South Eastern Europe...............................................80 6.5 Examples.......................................................................................................81 7 Best Practices from the Region.......................................................89 7.1 Fostering a Multisectoral Approach ......................................................89 7.2 Reorienting Training ..................................................................................89 7.3 Investing in People.....................................................................................90 7.4 Implementing Reliable
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