rural health in central and eastern europe: an issue for contemporary science and research i.ciznar,...
TRANSCRIPT
Rural Health in Central and Eastern Europe:
an Issue for Contemporary Science and Research
I.Ciznar, T.Cook, R.Ungar, G.Gulis
Rural“there is no standard definition…. “
-imply rather than explicitly state
• different criteria
• different levels of analysis
• different methodologies
• POPULATION SIZE
-such as areas with “individuals living outside places of more than 1,000 people.”
• POPULATION DENSITY
-such as the OECD definition of rural communities as those having less than 150 persons per square km.
• LEVEL OF URBANIZATION
-such as not having an urban center with a population of more than 50,000 or being outside the commuting distance to an urban center.
• PRINCIPAL ECONOMIC ACTIVITY
-implying an economy based on agriculture.
Different Schemes and Thresholds for Defining RURAL
Each country: own definitions of urban and rural. -WHO
”…though the characteristics of rural people are different for each definition, in general, each definition provides a similar analytic conclusion.”
HIGHER MORTALITY RATES in rural areas, no matter how one chooses to define “rural.”
-Du Plesis, et al
Life Expectancy at Birth
65
70
75
80
1975 1980 1985 1990 1995 2000
Years
Year
sCCEE EU
WHO Report 2001
Mortality from Cardiovascular Diseases
0 100 200 300 400 500 600 700 800
FRA
NETH
BEL
FIN
SLE
CZE
SLO
HUN
BUL
ROM
RUS
Disease deaths / 100 000
WHO Report 2001
Central/Eastern Europe
Western Europe
0 50 100 150 200 250 300
AUS
FIN
SWIZ
BUL
ROM
RUS
SLE
SLO
CZE
HUN
Disease deaths / 100 000WHO Report 2001
Central/Eastern Europe
Western Europe
Mortality from Cancer
RURAL in our study is defined on the basis of:
• level of urbanisation.
• principal economic activity.
Nothern region is typical industrial, with high level of urbanisation (commuting zone) and higher population density.
Southern region is typical agricultural, with people living in small villages close to working place.
Questionnaire Survey ‘94-’97
SK Statistical Office WHO 2002 Report
Northern - Urban
Southern - Rural
Mortality Rates in Two Districts*
RURAL URBAN
male female male female
CVD 696 620 472 402 Cancer 266 259 185 162
*per 100.000
DrinkingWater
Local Wells (20%) - High Contamination (80%)
Usage of Local Well Water
in Rural Areas
• Hygiene = 97%
• Cooking = 95%
• Drinking = 85%
• Irrigation = 57%
Waste Disposal/Sewage
Lack of Sewage Facilities - Animal Deposits Near Drinking Water Sources - Insect Breeding Sites
Waste Water Treatment/Sewage
in Rural Areas
• 50% of the population is using municipal sewage and waste water treatment systems.
• 90% are located in urban areas.
• 70% of the local wells users in rural areas also use septic tanks.
• most septic tanks are emptied into a field, garden, pasture, etc.
AirPollution
Local Heating
&
Burning Household Waste
ChemicalExposures
Agricultural Workers - Household Gardeners (50-75%)
Socio-economicFactors
High Unemployment - Poor Diet - Stress - Unhealthy Lifestyles
HealthCare
Limited Health Care Services - Inadequate Preventive
Services
