Research

The project compares 8 former Soviet countries with considerable variations in life-expectancy, culture, religion and lifestyle. It includes some more European, some more Asiatic countries and Christian as well as Muslim populations. While the evidence of poor and deteriorating health in the population of the Russian Federation with 250 million people is incontrovertible, aggregate evidence cannot answer the question: Why are some former Soviet citizens healthier than others?

Table 1 indicates that on average middle-aged Russian and Ukrainian males are almost twice as likely to die than in Armenia or Georgia. Furthermore, whatever the national mean, there are wide variations in longevity in every country.

The project would enable us to address the issue: why are there variations of this kind between countries and within countries between regions? What factors have lead health in some countries to improve since independence, whilst it has declined dramatically in others?

TABLE 1: CHANGES IN MALE MORTALITY, AGE 40-59 IN POST-COMMUNIST COUNTRIES (countries in project proposal) deaths per 1000 relevant population

*not fully comparable
Source: UNICEF, Regional Monitoring Report No. 5 (Florence: International Children Development Centre, 1998) Table 4.6. Data for Kazakhstan and Kyrgyzstan for 1995.

The project combines a number of different data sources for each country. In the first stage of the project, aggregate statistics will be collected at a national and regional level in order to calculate standardised mortality, infant mortality and other trends over time. In the first stage of the project, surveys will be conducted using standardised formats of 2000 individuals in each country, but 4000 in Russia and 2500 in Ukraine to reflect the size and diversity of those countries. The survey will enable the collection of information about living conditions (housing, health, education, income), about alcohol and tobacco use, about psycho-social attitudes including locus of control and optimism/ pessimism, use of health services both formally and informally, social capital and religion along with a range of lifestyle variables which would enable the identification and differentiation of lifestyle groups.

These surveys would be produced in the first instance as national level reports which can be disseminated in the relevant countries in the relevant languages.These surveys would later be combined in Stage 3 in to a multi-national data file from which it would be possible to look at differences between countries in a comparative way and from which it would be possible to build a multi-level causal model to establish which factors are most important for health outcomes.

In Stage 2 of the project, a series of intensive regional studies would be carried out. These studies would take place in only three of the selected countries - the largest three exhibiting some of the worst health problems: Russia, Ukraine and Kazakhstan. Three regions would be chosen in each country based upon the analysis of the aggregate health statistics carried out in Stage 1: a region with good health, one with poor health and one with average health. In each of these sub-regions there would be in-depth interviews with 50 respondents about their health and lifestyle behaviour. Medical history and health checks would be provided for these respondents. There would also be 3 focus groups carried out in each region with targeted population groups such as men aged 40-59, women responsible for family health care and so on. The focus group profiles would be identified in the course of the project. In these regions there would also be expert interviews with health professionals at different levels of the health system including practitioners at the interface with the public. The results of the surveys and the statistical data would be discussed with these local level experts in order to take into account their responses. These regional studies would incorporate local information about the nature of the labour market, pollution levels and other environmental factor that could contribute to health outcomes. In addition, during Stage 2, there would be a special study of the Chernobyl region, replicating a study undertaken there in 1990 by the Belarusian partner. The Chernobyl study spans three of the countries under investigation: Ukraine, Belarus and Russia.

The data collection during Stages 1 and 2 of the project would be mainly the responsibility of the NIS partners but under the leadership and with central co-ordination from Partner 1 in order to ensure quality, comparability and consistency.

In Stage 3 of the project the data from the regional studies as well as the statistical data would be brought together in multi-national data sets enabling comparisons between countries as well as within countries. At this stage, a series of reports would be produced with the help of the three Western European partners which would address in a comparative and comprehensive way the main objectives of the study: Hence, there would be one report on tobacco and alcohol consumption, one about the consequences of socio-economic changes (employment, unemployment, income differences), one report concentrating upon social capital and use of the health services, one report about psycho-social factors affecting health and one report about the consequences of culture and lifestyle for health in different settings. There would be a report by the co-ordinator using multi-level causal modelling in order to indicate which of the factors identified might be the most important in which context. The final outcome of the research programme will be eight national reports and a final comparative report. The results of the project would be presented at both national and international.