Page 69 - BNE_magazine_bne_September 2019

bne September 2019 Opinion 69 COMMENT:
Tackling Ukraine’s health crisis
requires emergency reforms
bne IntelliNews
Volodymyr Zelenskiy realizes his country faces daunting challenges in the health sector. When the Ukrainian president’s campaign promised improved hospitals, increased doctors' pay, free medical exams, and healthier lifestyles, it was not pandering but instead putting forward an earnest platform for fixing Ukraine’s health services.
Now that it has secured a historic victory in Ukraine’s parliamentary elections, Zelensky’s government needs to bolster its actions to address these crises. Ukraine is dealing with a multiyear measles outbreak, as well as the second largest HIV epidemic in Eastern Europe and Central Asia. Even if Zelensky manages to address these issues, the long-term impact of chronic diseases caused by smoking (and emerging trends like e-cigarettes) could ultimately undermine his work.
With comprehensive and holistic reforms, Ukraine’s new president could demonstrate how a transparent, democratic system can succeed at the heart of the former Soviet bloc, offering a powerful rebuttal to Vladimir Putin’s narrative surrounding the supposed impotence of liberal democracies.
Corruption and entrenched interests at the heart
of the system
As a health inspector in an Eastern European country explained to me, the region is set for a fully-fledged healthcare disaster, with consequences for both demographics and global competitiveness. Low salaries for physicians drive “brain drain” and corruption, while poor policy choices prevent the modernization of regional healthcare systems. Bribery and corruption create a strong social divide, wherein the poor suffer and the rich can travel abroad to receive quality healthcare not available at home. Powerful entrenched interests in Ukraine have used their clout to stymie overdue change.
Ukraine’s American-born health minister Ulana Suprun, in office in 2016, has run up against those entrenched elites
in challenging this corruption and making Ukraine healthy again. The low salaries of medical doctors mean it is “not uncommon” for patients to have to bribe them for better treatment. Insufficient pay also drives the country’s most competent physicians abroad. In Central and Eastern Europe, Ukraine ranks second-to-last in The Lancet‘s Healthcare Access and Quality Index. To convince the public his promises are genuine, Zelensky must address these divides and the corruption which drives them.
Disinformation driving infectious disease outbreaks
Indeed, corruption in the Ukrainian health sector is a matter of life and death. The culture of mistrust has dire implications for Ukraine’s responses to contagious disease outbreaks. The country has proven especially susceptible to disinformation regarding vaccines; the World Health Organisation (WHO) ranked Ukraine in a global top ten of countries with the largest rates of unvaccinated children, compounded by an epidemic of faked vaccination certificates.
That explains why Ukraine has been unable to corral
a multiyear measles outbreak, with 54,000 cases last year
and 35,000 new cases in the first three months of 2019. It also plays into Ukraine’s HIV infection rate, the second highest in Europe. Without restored public trust, Zelensky and his team will not be able to combat the disinformation – frequently spread by Russia-linked accounts – driving these high rates
of infection.
Creeping, chronic dangers: tobacco and e-cigarettes
Beyond measles and HIV, Zelensky’s reforms must also take
a longer-term view of chronic diseases, especially those linked to smoking. Ukrainian smoking rates are higher than in many EU countries, and in the absence of laws regulating their usage and sale, Ukraine is particularly unequipped to handle the explosive growth of e-cigarettes or “reduced risk products” like Philip Morris International’s IQOS and Juul.
Ukraine’s failure to implement e-cigarette regulations comes despite the Global Youth Tobacco Survey finding over 40% of Ukrainian teens (aged 13-15) had tried e-cigarettes and nearly one in five use them regularly. 13.5% of Ukrainian teens are also smoking tobacco regularly, and over 46% admit they have at least tried it.
How the industry exercises influence in Kyiv
Last year, for example, an investigation by the Campaign for Tobacco-Free Kids discovered dozens of violations of laws against tobacco advertising targeting children near Kyiv schools. Meanwhile, Philip Morris is trying to recreate the Japanese success of “harm reduction products” like IQOS in Ukraine and across Eastern Europe. In Ukraine, this has meant promoting “IQOS-friendly” bars and restaurants, as well as having IQOS-branded sports cars roam the streets and IQOS- sponsored food festivals and fashion events target children and teenagers.
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