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HIGHLIGHTS ON HEALTH IN

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 SYSTEM...... 21 REFERENCES ...... 24

HIGHLIGHTS ON 2001 E72377 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 ( 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 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 of the , 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 (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 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 (http://www.who.dk/ – Country Information). A list of references and a glossary are given at the end of this document.

HIGHLIGHTS ON HEALTH IN ARMENIA OVERVIEW

OVERVIEW

In contrast to most newly independent states Premature mortality from cancer is close to the (NIS), Armenia’s falling birth rate since 1990 average for the countries of the European has not led to a natural decline in population, Union. However, premature mortality from because mortality in the continues to breast cancer is tending to rise. Armenia heads remain at a fairly low level. The greatest the rest of the NIS for this indicator and impact on population trends has come from the belongs to the group of countries in the Region major earthquake in 1998 and the with the highest rates. displacement of hundreds of thousands of Mortality from external causes of injury and refugees as a result of the conflict with poisoning has been relatively low, except in . 1988 when there was a major earthquake. Life expectancy in Armenia, as in other trans- According to the latest available figures, Caucasian countries, has traditionally been and mortality from external causes of injury and still remains very high, although possible poisoning in Armenia is one of the lowest in inflation of the figure as a result of under- WHO European Region. reporting of deaths cannot be ruled out. Registered mortality from diabetes has been Furthermore, Armenia did not experience as rising steadily in Armenia since the mid- sharp a drop in life expectancy as a number of and is currently at one of the highest levels in other NIS in 1992–1994. According to the WHO European Region. latest available data, life expectancy in Armenia in 1999 was above the average for In recent years morbidity from tuberculosis in WHO European Region and the highest among the Republic has been increasing, although not as dramatically as in other NIS. A rise has the NIS. been seen in morbidity from , but not in Armenia has declined to the extent experienced in neighbouring considerably since the late 1980s and is Azerbaijan. currently one of the lowest in the NIS. The number of doctors, nurses and hospital Maternal mortality remains below the average beds per 100 000 population has fallen since for the NIS, but has been showing an upward 1990. trend since 1992. The number of abortions per 1000 live births in Armenia is substantially The number of hospital admissions and the below the average for the NIS and somewhat number of outpatient consultations per head of lower than the average for the countries of the population have fallen during the same period European Region. and are now among the lowest in the WHO European Region. Premature mortality (in the age group 0–64 years) from cardiovascular disease is lower The latest available figures on health care than in other NIS, but is significantly above expenditure (as a % of GDP) show Armenia, the average for western European countries. like other trans-Caucasian countries, to be among the lowest spenders in Europe.

HIGHLIGHTS ON HEALTH IN ARMENIA 1 THE COUNTRY AND ITS PEOPLE

THE COUNTRY AND ITS PEOPLE

Armenia gained its independence in 1991, in the wake of a nation-wide referendum. The Basic data on Armenia and the WHO European Region is a republic headed by a President and has a 190-member Armenia Europe (1999) (1998) The country is divided into ten administrative regions (marz) and the capital is , with Population (millions) 3.8 a population of 1.2 million. The administrative Population aged regions are in turn subdivided into 931 S 0–14 years. % 24.8 19.8 districts, of which 47 are , 12 are urban S 15–64 years. % 66.4 66.5 settlements and 871 are rural districts. S • 65 years. % 8.8 13.7 Area. km2 29 743 Population density per km2 126.7 31 Urban population (%) 70.0 72.6 Births per 1000 population 9.6 10.95 Deaths per 1000 population 6.3 10.85 Natural growth rate per 3.3 0.1 1000 population (GDP) per person in US$. 2072 ɚ 13 585 PPP* a1998 * PPP–

Age pyramid, 1981 and 1998

85+ 1981 80–84 1998 75–79

70–74 Males Females

65–69

60–64

55–59

50–54

45–49

40–44

35–39 Age group (years) 30–34

25–29

20–24

15–19

10–14

5–9

0–4

250000 200000 150000 100000 50000 0 50000 100000 150000 200000 250000 Population

HIGHLIGHTS ON HEALTH IN ARMENIA 2 THE COUNTRY AND ITS PEOPLE

Demography As in most other European countries, fertility exodus of ethnic , chiefly from in Armenia has been falling steadily, rural areas in Armenia. It is notable that the particularly during the past decade. This was Armenian refugees were made up of families foreshadowed by a substantial drop in the total of smaller size and with fewer family members fertility rate, which stood at 4.7 per 1000 of reproductive age than the in 1959, 2.3 in 1980 and 1.2 in families. Since most of the refugees had little 1999. Nevertheless, in contrast to most other hope of returning to their former homes, the NIS in the European part of the former USSR, Armenian Government made it official policy the Republic has continued to show a fairly to integrate them into the Armenian population high natural growth of population. At the same (UNDP Armenia, 2000). time, general mortality is fairly low and the population is relatively young. The mid-year population of Armenia in 1999 was 3.8 Family structure million. The number of registered marriages per 1000 population in Armenia has fallen sharply in Two factors have had a notable effect on recent years (from 8.0 in 1990 to 3.0 in 1998). population figures for Armenia, one being the The number of divorces per 1000 population, destructive earthquake of 1988 and the other which traditionally was low, has also gone the displacement of hundreds of thousands of down (1.2 in 1990 and 0.4 in 1998). The refugees in the wake of the conflict with proportion of births out of wedlock increased Azerbaijan. between 1990 and 1998 from 9.3% to 12.8% The earthquake, in the region centred on the of total births. In this case, the increase is a town of , caused 25 000 deaths and led reflection of the marked drop in the general some hundreds of thousands of people to leave birth rate, since the absolute number of the earthquake , moving mainly to children born, as children born outside Yerevan. wedlock has barely changed (Council of As a result of the conflict in Nagorno- Europe, 1999). , some 320 000 refugees entered Armenia, mainly from urban areas in Migrant population and ethnic profile Azerbaijan. At the same time there was a mass According to official data, net migration figures for Armenia since 1980 have been consistently negative (i.e. more emigrants than Natural population growth rate immigrants). In 1992–1996, 85% of emigrants 40 went to other NIS (70% leaving for the

35 Russian Federation and 12% for ). The remainder generally went to the 30 of America (8.6%), (3.1%) or 25 (1%). 20 Armenia is a country that is ethnically 15 homogenous, with national minorities 10 accounting for less than 3% of the population.

5 These are , , , Azeris

Net change per 1000 population Net and (UNDP Armenia, 2000). 0

-5

-10 Education, language, religion 81 83 85 87 89 91 93 95 97 99 The literacy rate among the adult population of Year Armenia was 98.8% in 1997. Nearly 60% of Armenia EU average CAR average NIS average the population over 16 years of age has completed at least secondary education. The

HIGHLIGHTS ON HEALTH IN ARMENIA 3 THE COUNTRY AND ITS PEOPLE official language of the country is Armenian. provided the basis for the economic reforms Armenia was converted to in 301 initiated in 1994 with the backing of the A.D. and was the first Christian country in the international financial institutions and the world. The majority of the population belong support of donors. to the Armenian Apostolic Church, which is During the subsequent two years, owing to the headed by a Catholicos. high fiscal and tax policies, and the decline in real income have been halted. Economy GDP in Armenia has been rising since 1994, The Armenian economy was in steep decline but the economic crisis in in 1998 and a during the period 1991–1993, with declining rate of growth in the agricultural hyperinflation, soaring prices and falling sector has resulted in an economic slowdown production. By 1993 gross domestic product in 1999 (UNDP Armenia, 2000). (GDP) had fallen to 60% of the 1989 figure. The introduction of a new national currency unit, the dram, in 1993 allowed the economic situation to be brought under control and

GDP per person in US $ (purchasing power parity PPP), latest available data

EU (1999) (1998) Russian Federation (1998) (1998) (1998) (1998) NIS (1998) Kazakstan (1998) (1998) Ukraine (1998) CAR (1998) (1998) (1998) Azerbaijan (1998) Armenia (1998) (1998) Republic of (1998) (1998)

0 2000 4000 6000 8000 10000 12000 14000 16000 18000 20000 22000 PPP in US $ per person

HIGHLIGHTS ON HEALTH IN ARMENIA 4 HEALTH STATUS

HEALTH STATUS

Life expectancy Life expectancy at birth in Armenia, as in According to the latest available data, life other trans-Caucasian countries, has expectancy at birth in Armenia is above the traditionally been, and remains, very high. average for WHO European Region. Along However, the real figure for life expectancy in with Georgia, Armenia heads the NIS for life Armenia could well be somewhat lower as expectancy at birth. deaths may have been under-recorded, It is notable that, in Armenia, the difference in especially in the rural areas of the country. life expectancy at birth between males and Life expectancy curves for Armenia show a females is one of the smallest of all the sharp dip in 1988 as a result of the severe countries in the European Region. In 1999, the earthquake. However, the Republic did not figure was 4.6 years, chiefly owing to the experience as marked a drop in life expectancy comparatively long lives of males. during 1992–1994 as was the case in a number of other NIS.

Selected heath indicators in Armenia and the European Region

Armenia Europe (1999) (1998) Life expectancy 74.9 73.6 S Men 72.6 69.6 S Women 77.2 77.6 Infant mortality per 1000 live birth 15.7 11.1 Maternal mortality per 100 000 live birth 32.9 19.0 Standardized death rate (SDR) for all causes of death per 100 000 population 857 961 SDR for cardiovascular diseases per 100 000 population 479 476 SDR for malignant neoplasms per 100 000 population 133 183 SDR for injuries and poisoning per 100 000 population 32.4 84.7 SDR for diseases of the respiratory organs per 100 000 population 51.6 60.6 SDR for diseases of the digestive system per 100 000 population 26.6 38.0 SDR for infectious and parasitic diseases per 100 000 population 10.3 13.2 New cases of tuberculosis per 100 000 population 37.7 40.4ɚ New cases of syphilis per 100 000 population 11.6 57.5ɚ New cases of AIDS per 100 000 population 0.21 1.4ɚ a1999

HIGHLIGHTS ON HEALTH IN ARMENIA 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 NIS (1999) EU: the countries of the European Union CAR (1998) FYM: the former Yugoslav Republic of 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 ARMENIA 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 Life expectancy (years)

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 Armenia EU average Armenia EU average CAR average NIS average CAR average NIS average

Main causes of death and disease According to most of the mortality indicators, From the structure of premature mortality in Armenia is below the average for the the Republic, the leading causes of death are European Region. Premature mortality in diseases of the cardiovascular system, Armenia has been falling steadily during the followed by malignant neoplasms. period 1994–1998. The main contributory In the structure of mortality, the relatively high factor has been the decline in male mortality, proportion of deaths from ill-defined whereas female mortality for the same period conditions in the older age groups (65 years has barely fallen. and above) is noteworthy. This could indicate certain pecularities in national practice of coding causes of death.

Structure of mortality (in %) by main cause of death and age group in Armenia (1999) compared with the average for the European Region (1998)

0–64 years 65 years and above Cause of death Armenia Europe Armenia Europe Cardiovascular diseases 34.8 30.8 66.2 60.0

Malignant neoplasms 25.0 23.0 10.4 16.6

Accidents, injury and poisoning 10.8 19.7 1.3 2.6

Diseases of the respiratory system 5.2 5.4 5.3 6.9

Infectious and parasitic diseases 2.9 2.9 0.3 0.6

Diseases of the digestive system 4.5 5.6 2.7 3.0

Ill-defined conditions 1.0 2.6 7.1 4.0

Other diseases 15.8 10.0 6.7 6.3

HIGHLIGHTS ON HEALTH IN ARMENIA 7 HEALTH STATUS

The pattern of hospital admissions is Mortality from cerebrovascular diseases is also somewhat different from the European below the average for the countries of the average, in that in Armenia a substantially European Region and one of the lowest in the higher proportion of patients are hospitalized NIS. for infectious and parasitic diseases.

Inpatients by disease category Trends in mortality from (% of all patients hospitalized) cardiovascular diseases, 0–64 years Armenia Europe 300 Disease category (1999) (1998) Infectious and parasitic 250 6.6 3.4 diseases 200 Malignant neoplasms 5.0 6.7

150 Cardiovascular 10.1 12.5 diseases 100 Diseases of the 10.7 10.1 respiratory system 50 Standardized death rate per 100 000 Standardized Diseases of the 10.6 10.0 digestive system 0 81 83 85 87 89 91 93 95 97 99 Injury and poisoning 7.4 8.4 Year Armenia EU average CAR average NIS average Other diseases 49.6 48.7

Mortality from cardiovascular Cardiovascular diseases diseases, 0–64 years, Premature mortality from cardiovascular latest available data Turkmenistan (1998) diseases in Armenia has varied with time: an (1999) initial protracted rise in mortality in Russian Federation (1999) 1981–1993 was followed by a downturn from CAR (1998) 1994. During the latter period, there was a Belarus (1999) NIS (1999) small rise in mortality in 1995. According to Ukraine (1999) the latest available data, premature mortality Uzbekistan (1998) from cardiovascular diseases in Armenia in Kyrgyzstan (1999) Georgia (1994) 1999 was the lowest in the NIS, but remains Republic of Moldova (1999) substantially above the average for the Tajikistan (1995) countries of the European Union. Azerbaijan (1999) Latvia (1999) A similar picture is observed for mortality Estonia (1999) from ischaemic heart disease. According to the Lithuania (1999) latest available data, the level of this cause of Armenia (1999) EU (1997) mortality in Armenia is one of the lowest in 0 50 100 150 200 250 300 the NIS. Standardized death rate per 100 000

HIGHLIGHTS ON HEALTH IN ARMENIA 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 Armenia EU average Armenia 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

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 ARMENIA 9 HEALTH STATUS

Malignant neoplasms Trends in premature mortality from malignant Premature mortality from neoplasms in Armenia are similar to those in trachea/bronchus/lung cancer in Armenia lies most of the NIS. Rising mortality in the 1980s midway between the levels for NIS with high was followed by a decline in the . mortality (republics in the European part of the However, mortality from malignant neoplasms former USSR and Kazakhstan) and those with in Armenia is considerably below the average low mortality (the remaining central Asian for the NIS and close to the average for the republics (CAR), Azerbaijan and Georgia). countries of the European Union.

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

75 20

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 Armenia EU average Armenia EU 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

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 ARMENIA 10 HEALTH STATUS

External causes of injury and poisoning The trend in mortality rates for external causes According to the latest available data, of injury and poisoning in Armenia is quite mortality from external causes of injury and different from that in most other NIS, mainly poisoning in Armenia is one of the lowest in because of the steep increase in such causes of WHO European Region. death in 1988 as a result of the severe The increase in the number of homicides in earthquake. On the other hand, the typical Armenia in 1992 is associated with the armed picture of the rest of the NIS (a fall in conflict with Azerbaijan in Nagorno- mortality as a result of the anti-alcohol Karabakh. campaign in 1986–1987, followed by a sharp rise in 1992–1994) was little apparent in Armenia.

Trends in mortality Trends in mortality from homicide from external causes Armenia (1988) = 538 100 300

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 Armenia EU average Armenia EU average CAR average NIS average CAR average NIS average

Mortality from homicide, Mortality from external causes, latest available data latest available data Russian Federation (1999) Russian Federation (1999) Kazakhstan (1999) Belarus (1999) Latvia (1999) NIS (1999) NIS (1999) Estonia (1999) Estonia (1999) Latvia (1999) Lithuania (1999) Ukraine (1999) Ukraine (1999) Republic of Moldova (1999) Kazakhstan (1999) Belarus (1999) Republic of Moldova (1999) CAR (1998) Kyrgyzstan (1999) Kyrgyzstan (1999) CAR (1998) Turkmenistan (1998) Turkmenistan (1998) Tajikistan (1995) Tajikistan (1995) Lithuania (1999) Uzbekistan (1998) Azerbaijan (1999) Georgia (1994) Uzbekistan (1998) EU (1997) Armenia (1999) Armenia (1999) EU (1997) Azerbaijan (1999) Georgia (1994) 0 50 100 150 200 250 0 5 10 15 20 25 30 Standardized death rate per 100 000 Standardized death rate per 100 000

HIGHLIGHTS ON HEALTH IN ARMENIA 11 HEALTH STATUS

During the period 1991–1994, mortality from Similarly, morbidity rates from mental road traffic accidents fell by a factor of disorders in general and from alcoholic approximately four in Armenia, reaching one psychosis in particular are among the lowest in of the lowest levels for any country in the the Region. European Region. Infectious diseases Mental health Mortality from infectious and parasitic Mortality from suicide and self-inflicted injury diseases in Armenia has long been one of the in Armenia, as in Azerbaijan, has remained lowest in the NIS. steady at one of the lowest rates in WHO European 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 Standardized death rate per 100 000 Standardized Standardized death rate per 100 000 Standardized 10 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 Armenia EU average Armenia EU average CAR average NIS average CAR average NIS average

Mortality from suicide and Mortality from infectious and self-inflicted injury, parasitic diseases, latest available data 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 ARMENIA 12 HEALTH STATUS

In 1994–1998 an increase in morbidity from tuberculosis was observed, but not on the same Incidence of malaria scale as in most other NIS. Morbidity from per 100 000 population syphilis in Armenia also barely increased in 500 1991–1996, and thereafter began to fall. 450 In the late 1990s, an increase was recorded in 400 morbidity from malaria (30.8 per 100 000 350 population in 1998). In 1999, this figure fell to 300 16 per 100 000 population. 250 Armenia is one of the countries with a low 200 150 level of HIV infection. Between 1979 and cases per 100 000 New 1995 only three cases of AIDS were recorded. 100 According to the latest available data from the 50 National AIDS Control Centre, 84 cases of 0 HIV-infection and 15 clinically diagnosed 81 83 85 87 89 91 93 95 97 99 cases of AIDS had been recorded by mid-1999 Year Armenia EU average (UNDP Armenia, 2000). CAR average NIS average

Incidence of tuberculosis Incidence of syphilis per 100 000 population per 100 000 population 160 300

140 250 120

100 200

80 150

60

New cases per 100 000 New 100 40 New cases per 100 000

20 50

0 81 83 85 87 89 91 93 95 97 99 0 Year 81 83 85 87 89 91 93 95 97 99 Year Armenia EU average Armenia EU average CAR average NIS average CAR average NIS average

HIGHLIGHTS ON HEALTH IN ARMENIA 13 HEALTH STATUS

Other diseases Armenia is one of the group of countries in the Mortality from respiratory diseases has been European Region with the highest mortality slowly declining in Armenia since 1982, and rates from diabetes. The figure for Armenia in 1998 the country had one of the lowest rates increased by a factor of almost four in among the NIS and was below the average for 1981–1998, during which period the incidence the countries of the European Union. and prevalence recorded for diabetes was Mortality from diseases of the digestive comparatively low. This contradiction could system has, for a number of years, remained reflect errors in coding causes of death, as well among the lowest in the NIS and in WHO as a genuinely high level of mortality among European Region as a whole. diabetes patients.

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 81 83 85 87 89 91 93 95 97 99 0 81 83 85 87 89 91 93 95 97 99 Year Year Armenia EU average Armenia 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 20406080100120

Standardized death rate per 100 000 Standardized dear rate per 100 000

HIGHLIGHTS ON HEALTH IN ARMENIA 14 HEALTH STATUS

Mortality among children under the age of five Trends in mortality from diabetes is also below the average for the NIS. 50 Mortality from external causes of injury and 45 poisoning in the age group 5–19 years, which

40 is one of the principal causes of death among

35 adolescents, decreased substantially during the 1990s. In 1999, the rate was 8 per 100 000, 30 below the average for the countries of the 25 European Union. 20

15

Standardized dearth rate per 100 000 Standardized 10

5 Infant mortality rate per 1000 live births 0 60 81 83 85 87 89 91 93 95 97 99 Year

Armenia EU average 50 CAR average NIS average

40

30

Disability 20

The incidence of disability in Armenia in 1998 births per 1000 live Deaths was 350 per 100 000 population, which is 10 below the average for the NIS.

0 81 83 85 87 89 91 93 95 97 99 Health of children and adolescents Year Infant mortality in Armenia is low in Armenia EU average comparison with other NIS. In 1999, it was CAR average NIS average 15.7 per 1000 live births. A halt in the decline in infant mortality occurred in 1996, principally as a result of a steep rise in early Infant mortality rate neonatal (0–6 days after birth) deaths in this per 1000 live births period, which could have been associated with Turkmenistan (1998) CAR (1998) a change during this period in practices for Kyrgyzstan (1999) registering births and deaths among the Uzbekistan (1998) newborns. kazakhstan (1999) Tajikistan (1999) The fall in infant mortality has been largely Republic of Moldova (1999) owing to programmes for the control of acute NIS (1999) respiratory and diarrhoeal diseases. From 1991 Russian Federation (1999) to 1997, infant mortality from these causes Georgia (1994) went down by 21% and 45%, respectively Azerbaijan (1999) Armenia (1999) (UNDP Armenia, 2000). Ukraine (1999) In 1998, immunization coverage of children Belarus (1999) Latvia (1999) under one year of age against diphtheria and Estonia (1999) tetanus was 90.3%, against measles 93.5%, Lithuania (1999) against tuberculosis 95%, against pertussis EU (1997) 82.4% and against poliomyelitis 96.4%. 0 10203040 Deaths per 1000 live births

HIGHLIGHTS ON HEALTH IN ARMENIA 15 HEALTH STATUS

According to national data, the prevalence of An increase in premature mortality from breast poor physical development among children cancer is of concern. Armenia has the highest under five years of age, which is an indication rate for this cause of death in the NIS and is of malnutrition and vitamin deficiency, varied one of the group of countries with the highest between 9.1% in urban areas and 15% in rural rates in the Region. areas in 1998. Moderate anaemia was found in 26% of children in the age group 12–23 months and in 25% of children aged 24–59 months (UNDP Armenia, 2000). Trends in maternal mortality

100

Women’s health 90 Maternal mortality in Armenia (32.9 per 80 100 000 live births in 1999) remains somewhat 70 below the average for the NIS, but since 1993 60 it has shown an upward trend. The majority of 50 cases of maternal death occur in the age group 40 20–29 years. The most frequent cause is 30

haemorrhage, hypertensive disorders and 100 000 live per Deaths births complications associated with abortion. 20 On the other hand, the number of registered 10 abortions has been falling since 1997, after 0 showing an upward trend in 1991–1996, and in 81 83 85 87 89 91 93 95 97 99 Year 1999 was 395 per 1000 live births. Armenia EU average The figure for Armenia is considerably lower CAR average NIS average than the average for the NIS and somewhat lower than the average for the countries of the European Region. Maternal mortality rate per 100 000 live births, latest available data

Number of abortions Tajikistan (1995) Georgia (1999) per 1000 live births Kazakhstan (1999) 2200 Kyrgyzstan (1999) 2000 Russian Federation (1999) 1800 Turkmenistan (1996) Azerbaijan (1999) 1600 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 Year 0 10203040506070 Armenia EU average Deaths per 100 000 live births CAR average NIS average

HIGHLIGHTS ON HEALTH IN ARMENIA 16 HEALTH STATUS

In 1999, premature mortality among women in During the past decade, there has been a Armenia from cervical cancer was close to the substantial increase in the prevalence of average for the NIS. anaemia among pregnant women.

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 10 25

8 20

6 15

10 4

2 5 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

Armenia EU average Armenia 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 ARMENIA 17 LIFESTYLES

LIFESTYLES

Tobacco consumption Alcohol consumption According to the latest available data, the Armenia is among the countries with a prevalence of smoking in Armenia is very relatively low level of alcohol consumption high, with 69% of men and 6.2% of women per head of population (2.6 litres of absolute smoking in 1998 (UNDP Armenia, 2000). alcohol in 1998) (UNDP Armenia, 2000). According to data from a survey carried out in The low incidence of alcoholic psychosis (0.89 1993 among senior school children in the age per 100 000 of population in 1999) and of group 14–16 years, 57.5% of boys and 21% of cases of alcohol dependency is associated with girls were regular smokers (WHO Regional local traditions regarding alcohol Office for Europe, 1997). consumption. Annual cigarette consumption per head of population in Armenia has been regularly Illicit use of narcotics above the average for the NIS. The narcotics in most frequent use in Armenia Mortality from lung cancer, an indirect are marijuana and opium derivatives (WHO indicator of the level of smoking, was below Regional Office for Europe, 1997). According the average for the NIS in 1999. After a brief to data from the Toxicology Centre, the decline during the first half of the 1990s, it has number of registered drug abusers has remained practically at the same level since increased from 610 in 1996 to 1438 in 1998. 1996, and in the older age groups (above 65 However, according to data from the Ministry years) has even begun to increase. of Internal Affairs, the real number of drug abusers is 15–20 times this figure (UNDP Armenia, 2000).

Nutrition The average daily calorie consumption per Number of cigarettes consumed head in Armenia (2352 kcal per person per day per person per year in 1998) is below the average for the NIS and 3200 3000 below the standard set by the Ministry of 2800 Health (2412 kcal). As in most other NIS, 2600 average calorie consumption went down 2400 during the first half of the 1990s, but has since 2200 begun to rise once more. Corresponding trends 2000 have also been observed in consumption of 1800 1600 fats and proteins, although the consumption of 1400 proteins remains comparatively low, most Number of cigarettes Number 1200 probably reflecting a drop in the consumption 1000 of meat. According to data from the Ministry 800 of Statistics, actual consumption of bread, 600 400 and , and oil is close 90 91 92 93 94 95 96 97 98 99 to biological standards. The consumption of Year potatoes is above the norm, while consumption Armenia EU average of meat and milk is substantially below it CAR average NIS average (UNDP Armenia, 2000).

HIGHLIGHTS ON HEALTH IN ARMENIA 18 ENVIRONMENT AND HEALTH

ENVIRONMENT AND HEALTH1

Air pollution Because of a drop in industrial production, the supplied according to a timetable, people volume of air pollution has fallen in Armenia receiving water for 2–6 hours a day, despite in recent years, as in many other NIS. In adequate supplies of water at source. This is addition, the Armenian nuclear power station because of the unsatisfactory state of the piped was shut down in 1989, which led to an energy network. Almost half the water supply pipes in crisis in the Republic and brought heavy the Republic are pressure conduits in industry virtually to a standstill, with the intermittent operation and frequently cut off exception of power stations in the cities of because of the high cost of electric power. In Yerevan and . Since then, a drop has addition, because the pipes are worn out a been observed in total emissions of pollutants large amount of water is lost in the distribution into the air from stationary sources, and an network. increase in the proportion of total air pollution Because of the above, water supplied through attributable to emissions from motor vehicles. the centralized network frequently does not Emission of harmful substances into the air in comply with microbiological standards, which Armenia is largely attributable to the chemical leads to problems in delivery of water from the industry, the power supply industry and the source to the consumer, i.e. from what is building industry. These are all generally termed secondary pollution of water. The located in the five urban areas of Yerevan, increased risk to health is reflected not as an , Hrazdan, and Alaverdi. increase in general morbidity from intestinal The figures recorded for these urban areas are infections but as an increase in the number of two to six times higher than the maximum outbreaks of water-borne infections, which permissible concentrations for such major may affect a large number of people. In 1998, pollutants as dust, sulphur dioxide, carbon for example, 11 outbreaks of intestinal monoxide and nitrogen dioxide. Note that air infection were recorded, principally dysentery. quality is generally monitored on the basis of The Republic has some 56 open bodies of the above components. The presence and water, including 50 rivers and 6 . The content in the air of many other substances major rivers are the frontier rivers Araks and with a marked harmful effect on human health, , and the largest body of water is such as benzo[a]pyrene, lead, ammonia and Sevan. The total yield of water from chlorine are generally not determined or only surface water sources is 6.5–7 million m3. determined at irregular intervals. In the Republic, all urban areas and district centres are served by sewer systems, as are Water management and sanitation some 20% of rural settlements. The total amount of waste water discharged into bodies A feature of Armenia is that 95.5% of water 3 supplies come from groundwater sources that of water in 1988 was some 760 million m . All provide water of constant quality. Water waste water from population centres with quality in places with a direct water supply sewer systems is discharged into open bodies generally meets national standards for of water, with the exception of the town of organoleptic, toxicological and Artashat, which has biological ponds. Apart microbiological indicators, as well as WHO from a number of small, primitive and recommended standards. In almost all urban relatively ineffective waste water treatment areas and in most rural settlements, water is plants, the Republic has 20 large urban treatment installations carrying out a series of

1 Unless otherwise stated the data given have been taken from Armenia’s National Environmental Health Action Plan. (Ministry of Health and Ministry of the Environment of Armenia, 1999).

HIGHLIGHTS ON HEALTH IN ARMENIA 19 ENVIRONMENT AND HEALTH processes for treatment and disinfection of Occupational health waste water. However, all without exception The volume of industrial production in the fail to provide an adequate level of treatment country has fallen sharply and the number of and disinfection of waste water, principally jobs has gone down. There has been an because of insufficient design capacity and increase in the number of small, chiefly ineffective operation as a result of poor artisanal, production plants that operate in a maintenance. semi-legal fashion, without registration or The treatment installations at Yerevan are thus permits. Such production plant also operate able to treat only 40% of the waste water without occupational health services, produced, those at Vanadzor only 48% and unions or insurance schemes. Observance of those at Oktemberyan some 75%. elementary workplace safety requirements is quite unsatisfactory, with no individual protective equipment or first aid equipment Waste and soil being provided. It is clear that under such 3 Some 12 700 m of domestic waste is conditions the statutory procedures for 3 produced each day in the Republic, 10 200 m evaluation of the occupational health of 3 a day in urban areas and 2 500 m in rural workplaces are inoperative. This is partly a areas. To date, the only means of dealing with result of the low level of awareness of health- solid domestic waste has been to transport it to related issues on the part of both workers and dumps. legislators, and partly of the absence of any According to the statistics, Armenia has 54 mechanism to make employers liable for managed solid waste dumps in use, which are failing to apply the appropriate health operated by enterprises specializing in measures or for damage to the health of their municipal waste management. They cover an workers. area of 196.0 hectares. These dumps annually As a result, occupational diseases in Armenia receive some 1.5 million tonnes of domestic are diagnosed very late, when the workers are waste from the towns and cities and five rural already unfit for work and unable to return to districts. Most dumps in Armenia do not meet their jobs. Because of the shortage of doctors health and environmental requirements. and specialized medical diagnostic equipment, Analysis of the soil in the cities of Armenia is only 5–7% of cases of suspected occupational carried out only in small areas and as part of disease are identified by regular preventive individual research projects. However, results medical examinations at production plant. have shown the soil, in at least two cities, The principal occupational diseases are lung Yerevan and Vanadzor, to be polluted with disorders, followed by neurological disorders heavy metals, chiefly lead and mercury, in (vibration disorders make up 40% of all cases, quantities above permissible levels. while acoustic neuritis account for some 30%) Pesticides pose a major problem in Armenia. and skin disorders. Disorders of the Up to 1990, a centralized system existed for musculoskeletal system and cancer of the purchase and distribution of pesticides by a occupational origin are generally not single State organization. At present, the diagnosed. import and use of pesticides is virtually uncontrolled, with standards and regulations flouted and no account being taken of concentrations or permissible loads per hectare.

HIGHLIGHTS ON HEALTH IN ARMENIA 20 HEALTH CARE SYSTEM

HEALTH CARE SYSTEM

Reform of the health system Health care expenditure and health In 1995, the adopted system funding a Programme for development and reform of In Armenia, health care expenditure in 1997 the Armenian health system during the period came to 1.3% of GDP, which is below the NIS 1996–2000. The basic areas where reform was average (WHO Liaison Office in Armenia, required were identified as management, 1999). The steep drop in Armenia’s GDP in infrastructure/system of health care the 1990s is still having a very adverse effect. establishments, finance and medical training. The resources allocated to health care by the Since late 1995, the health care system has State are only sufficient to provide care for the been completely decentralized. The system of most vulnerable population groups. In health care establishments has been Armenia these include the disabled; war restructured to strengthen primary health care veterans; children below the age of 18 with a and optimize hospital care. single parent; disabled children under the age March 1996 saw the adoption of the Medical of 16; families with four or more children; the Care Act, which legalized funding from a families of war victims; prisoners; children of variety of sources (such as the State budget, disabled parents; Chernobyl clean-up workers; municipal budgets, medical insurance and and rescue workers (WHO Regional Office for direct payment by the patient). In 1998, all Europe, 2001). State health care establishments were turned In accordance with the new financial into State-owned joint-stock companies (WHO arrangements (July 1997), funding of primary Liaison Office in Armenia, 1999). health care is calculated per head of population and funding for hospitals by the amount of

Total health care expenditure as a percentage of GDP, Health care resources and their utilization latest available data in Armenia compared with European averages EU (1998) Estonia (1999) Armenia Europe Lithuania (1998) (1999) (1999) Belarus (1999) Latvia (1999) Hospital beds 620 778 Armenia (1993) per 100 000 population Turkmenistan (1996) Physicians Ukraine (1998) 305 362 per 100 000 population Republic of Moldova (1999) Uzbekistan (1999) Hospital admissions b 5.8 18,1 NIS (1999) per 100 population CAR (1998) Russian Federation (1995) Average hospital stay. b 12.8 12,2 days Kazakhstan (1999) Kyrgyzstan (1999) Health care expenditure a b Azerbaijan (1999) 1.3 6,1 as a percentage of GDP Tajikistan (1998) Georgia (1998) a1997 (Source: Country health Report for Armenia, 1999) 0246810 b1998 Percentage of GDP

HIGHLIGHTS ON HEALTH IN ARMENIA 21 HEALTH CARE SYSTEM care delivered. Repayment of expenditure by Inpatient services health care establishments is handled by the In 1999, hospital care in Armenia was State Health Agency, established in 1998. provided by 174 hospitals. Highly qualified According to the latest available data, health care is given by the Republic Hospital and insurance in Armenia is now at the stage specialized institutes in Yerevan. In addition, where the requisite legislation is in the capital has special hospitals providing preparation. paediatric and obstetrical care. It should be noted that most patients in Armenia (91% in 1999) are obliged to make “informal” payments either in cash or in the form of food, especially in rural areas (World Number of hospital beds Bank, 2000). per 100 000 population 1600

Outpatient services 1400 Primary health care in Armenia is provided in regional polyclinics or in rural posts 1200 or stations, with a standard staffing structure of 1 doctor per 1000–2000 persons and 1 1000 paediatrician for every 700–800 children. There are 500 rural feldsher posts, one for 800 Beds per 100 000 population Beds each village. These posts are staffed by 600 middle-level medical personnel and provide basic care for children and adults, care for 400 pregnant women and emergency care, and 81 83 85 87 89 91 93 95 97 99 assess the physical development of children. A Year group of villages can have an outpatient centre Armenia EU average CAR average NIS average with a general practitioner, who will provide basic curative and preventive care.

Hospital bed rates, latest available data Trends in the average number of contacts with primary health care Belarus (1999) establishments Russian Federation (1999) NIS (1999) 14 Lithuania (1999) Ukraine (1998) 12 Azerbaijan (1999)

10 Latvia (1999) Republic of Moldova (1999) 8 Kyrgyzstan (1999) Kazakhstan (1999) 6 Estonia (1999) Turkmenistan (1997) 4 EU (1998)

Outpatient contacts per year person Outpatient 2 Tajikistan (1999) CAR (1999) 0 Armenia (1999) 81 83 85 87 89 91 93 95 97 99 Uzbekistan (1999) Year Georgia (1999)

Armenia EU average 400 600 800 1000 1200 CAR average NIS average Beds per 100 000 population

HIGHLIGHTS ON HEALTH IN ARMENIA 22 HEALTH CARE SYSTEM

The number of hospital beds in Armenia, as in The number of hospital admissions has fallen most other NIS, went down considerably in the considerably since the mid-1980s (5.8 per 100 1990s (620 per 100 000 population in 1999). population in 1999) and is one of the lowest in This is lower than the NIS average and close the Region. to the average for countries in the European There has been a noticeable drop in the Union. average length of stay in hospital since 1995. During the same period, the bed occupancy In 1999 it was 12.8 days, which is below the rate fell from 70% to 30%. This was caused by NIS average and close to the average for WHO a shortage of resources for the hospital European Region. treatment of chronic patients (WHO Liaison Office in Armenia, 1999). Medical personnel In the 1980s the physician/population ratio in Average length of stay in hospital Armenia increased steadily. During the first in days half of the 1990s the number of physicians fell 20 by about 25%. Thereafter the figure has remained relatively stable, at 305 per 100 000 population in 1999, which is below the NIS 18 average and below the average for the countries of WHO European Region as a 16 whole. The number of middle-level medical personnel 14 in Armenia during the past decade has been Length of stay in days falling at a much faster rate than the number of 12 physicians. This has led to a nurse/physician ratio in Armenia that is the lowest of all the 10 countries in the European Region. 81 83 85 87 89 91 93 95 97 99 Year Armenia EU average CAR average NIS average

Hospital admissions Trends in physician/population ratio per 100 population 600

30 550

500 25 450

20 400

350 15 300

10 250

Number of physicians per 100 000 per physicians of Number 200

Hospital admissions per 100 population per admissions Hospital 5 150

0 100 81 83 85 87 89 91 93 95 97 99 81 83 85 87 89 91 93 95 97 99 Year Year

Armenia EU average Armenia EU average CAR average NIS average CAR average NIS average

HIGHLIGHTS ON HEALTH IN ARMENIA 23 REFERENCES

REFERENCES

MINISTRY OF HEALTH AND MINISTRY OF THE ENVIRONMENT OF ARMENIA, 1999, Natsional’nyj plan dejstvi po gigiene okryzhayushchej sredy dlya Armenii [National Environmental Health Action Plan, Armenia]. Yerevan. , 1999. Recent demographic developments in Europe, Council of Europe Publishing, Strasbourg, October 1999. UNDP, 2000. Armenia: Common Country Assessment. WHO LIAISON OFFICE IN ARMENIA, 1999. Armenia, Country Health Report, August 1999. WHO REGIONAL OFFICE FOR EUROPE, 1997. Smoking, drinking and drug taking in the European Region. Copenhagen, WHO Regional Office for Europe (Alcohol, Drugs and Tobacco programme).

WHO REGIONAL OFFICE FOR EUROPE, 2001. Health care systems in transition. Armenia. Copenhagen, WHO Regional Office for Europe, Draft. , 2000. Making Transition Work for Everyone: Poverty and Inequality in Europe and Central .

HIGHLIGHTS ON HEALTH IN ARMENIA 24 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, or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The map on the front page (Copyright 1999 Lonely Planet Publications) has been adapted from that on the Lonely Planet web-site (http://www.lonelyplanet.com) with their permission and the copyright remains with the Lonely Planet Publications. This document has been produced by the Health Information Unit of the WHO Regional Office for Europe in collaboration with the National health Information Analytical Centre, Ministry of Health of Armenia. All rights to 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 of this document, but permission must be sought first.

KEYWORDS: HEALTH STATUS, LIFESTYLE, ENVIRONMENTAL HEALTH, DELIVERY OF HEALTH CARE, COMPARATIVE STUDY, ARMENIA. 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] Web: http://www.who.dk