Health crisis in Belarus as reflected by cause-of-death and regional mortality trends and patterns
VII, 81 pages. Rostock, University of Rostock (2012)
The increase in mortality observed in the former USSR, and, after its collapse, in the Newly Independent States, represents a trend that is unprecedented in peacetime, and it has therefore stimulated extensive research. Yet this research has mainly focused on Russia, while mortality in Belarus has received very little attention. Until now, research evidence on Belarus had been fragmented and scattered, largely because of a lack of detailed and comparable mortality data. This thesis is the first study that provides a systematic analysis of mortality in Belarus over the last half century. Two main aspects, methodological and substantive, are dealt with here. The methodological part is the work on the reconstruction of continuous time series by causes of death. It relies on the method of reconstruction previously applied in similar mortality studies in the USSR, Russia, Ukraine, and the Baltic countries. A distinguishing feature of this method is that it cannot be adopted uniformly for any population; each time when it is applied the specifics of the country studied must be taken into account. The substantive part employs the analysis of the reconstructed data, data on socioeconomic indicators, recent regional mortality data, and individual data on self-perceived health. Focusing on both long-term and recent trends in health and mortality, this thesis consists of four papers. The first paper is devoted to the reconstruction and analysis of long-term mortality trends by causes of death in Belarus over the period of 1965 onwards. Using aggregate mortality data and data on socioeconomic indicators, the second paper explores the peculiarities of recent mortality trends in Belarus, relative to trends in neighboring Russia and Lithuania; and proposes possible explanations for the observed patterns. Using detailed cause-specific mortality data at the oblast and rayon levels, the third paper provides new evidence on the geographical diversity of overall and cause-specific mortality in Belarus. It also explores the potential mortality effects of the Chernobyl accident, and provides an analysis of the factors underlying regional mortality variations. Using individual-level data, the fourth paper analyzes recent trends in self-perceived health in Belarus, and assesses factors that have been associated with perceptions of health status over the last decade. One of the main outcomes of this study is that the harmonized cause-specific mortality series for Belarus are now freely available to the international research community. In the future, these data will serve as a foundation for in-depth mortality research in Belarus, and as a useful basis for comparative studies. The analysis of long-term mortality trends by causes demonstrates that it is reasonable to describe the epidemiologic situation in Belarus as a chronic health crisis. The inefficiency of the health care system in tackling cardiovascular diseases and the excessive alcohol consumption among Belarusians have been the main drivers of this crisis. The main distinguishing feature of the Belarusian health crisis is the gradual, rather than abrupt, increase in mortality during the early years of the transition. While in the 1990s it may have been possible to interpret this as evidence of the advantages of the ‘special Belarusian path’, now it is evident that this achievement was only a temporary phenomenon. It is true that Belarus, which followed the slowest transition path, experienced the lowest increase in mortality in the early 1990s. However, the initial advantage that Belarus enjoyed due to its choice of a ‘preservation’ model now appears to have turned into a prolongation of the adverse health trend that has its origins in the past. Previous studies have demonstrated that alcohol consumption and the abrupt change in economic conditions are the most important factors underlying the mortality changes in Russia and the Baltic countries. The results of this study, which are based on regional mortality data, confirm the significance of these factors. They also point to the possible relevance of other factors, including culture, traditions, and the environment. For example, the finding that mortality is lower in the southwestern part of Belarus than in the eastern part of the country can likely be attributed to historical and cultural factors. The elevated mortality from diseases of the respiratory system found in the north and northwest of Belarus might be linked to the proximity to highly polluted industrial centers. Although many people believe that the Chernobyl accident has had a very significant impact on mortality trends in Belarus, the results of this study do not provide sufficient grounds to support the assumption that the Chernobyl accident is one of the main mortality determinants. While most of the inferences in this study were based on the aggregated mortality data, it was also important to look at how individuals perceived their own health status. The analysis of the micro-data suggests that there has been a notable improvement in self-perceived health. This improvement is in line with the improved economic situation in the country and with the morbidity statistics, which show a marked reduction in disability rates. However, this more positive assessment of personal health does not appear to be connected with actual trends in life expectancy, which have been stagnating over the last decade. Given the prominent role of mortality from external causes, this observation does not appear to be paradoxical. Mortality from external causes mainly affects individuals of working age who are often in good health. Seemingly, improvements in individual health may contribute to some decrease in mortality, particularly at older ages, but this positive impact is offset by excessive premature mortality.