#11
Asia Times
December 13, 2001
Democracy inoculation lets disease wave the red flag
By Gustavo Capdevila

GENEVA - A United Nations agency has warned of the grave crisis facing health services in the countries of eastern and central Europe, and the members of the Community of Independent States (CIS).

The most impoverished populations of the formerly communist nations are exposed to new outbreaks of disease and epidemics, which has led to a sharp decline in life expectancy in the region, according to the International Labor Organization (ILO) report. Citing a survey of 8,600 families in the Ukraine and statistics provided by the government of that country of 51 million, the study indicates that 88 percent of the population finds it difficult or impossible to obtain health care.

But the situation is even more serious in other countries, said Guy Standing, director of the ILO program on socio-economic security, who pointed to the desperate situation in Moldavia and Armenia. In Moldavia, population 4.4 million, the poorest country in Europe, health services are on the verge of collapse, and health professionals, when paid, receive their salaries months behind schedule. The study also notes that 82 percent of Hungary's 11 million people face difficulties gaining access to or affording medical care.

The report, drawn up in conjunction with Public Services International (PSI), a global trade union federation for public sector unions that represents 20 million public sector workers around the globe, was presented last week by the ILO at a meeting of trade unionists and specialists. The ILO and the PSI - a non-governmental organization for the public sector within the ILO - noted that the economic situation in a number of countries in the region has driven health services to the brink. In many cases, health professionals are earning less than the minimum salary. In Moldavia, for example, doctors currently earn US$12 a month, Standing said.

The decline in health services in eastern and central Europe has contributed to a drop in life expectancy, often dramatic. For instance, the life expectancy rate has plummeted from 68 to 58 in Russia over the past decade. A large number of illnesses that were under control or had even disappeared have cropped up again, and are on the rise, including diphtheria, cholera and tuberculosis, especially in the countries of the former Soviet Union.

The crisis is a result of spending cuts by governments and the decentralization of health financing, said Standing.

"The evidence shows that if you cut health care services to the extent that they have been cut, you run down their capacity to function," PSI representative Alan Leather said. "In many hospitals there are no drugs, no bandages, nothing to support patients, who have to supply them for themselves."

In the Ukraine, patients undergoing surgery must pay not only the doctor, but must also cover the costs of the medicine and the rest of the care provided by the hospital, he pointed out. Many patients who cannot afford to pay for treatment simply do not receive any - the results of which are reflected in the declining life expectancy rates, said Leather.

The worst situation is seen in the countries of the former Soviet Union. But, Leather observed, while conditions in the countries of central and eastern Europe are "certainly better, they are not good, because even in those countries you would still be expected to pay something to the doctor or nurse for any kind of treatment".

Although health care services have not been widely privatized in the region, the cost of drugs is high, due to the privatization of the pharmacies. Under the socialist public health systems of the past, medicines were provided free of charge to anyone who presented a prescription. Dentist clinics and rehabilitation spas have also been privatized, although few hospitals have. Under the communist regimes that governed the region, many rehabilitation clinics and spas were connected to state enterprises, which to some extent were "the center of life", said Standing. But as the enterprises have been sold into private hands, "they have been outsourcing, privatizing or abandoning their social facilities", he added.

Another consequence of the trend towards privatization was the elimination of safety committees or departments in many companies. The ILO official cited a marked rise in on-the-job accidents and injuries, as well as work-related illnesses, "which is leading to a long-term erosion of people's health".

(Inter Press Service)

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