Health lifestyles and political ideology in Belarus, Russia, and Ukraine

This paper examines the association of political ideology with health lifestyle practices and self-rated health in Belarus, Russia, and Ukraine. The political trajectory of post-Soviet societies has taken two divergent paths, either toward democracy or autocracy. The health trajectory has followed the same pattern with the more autocratic states continuing to experience a mortality crisis, while those former socialist countries that have embraced democracy and moved closer to the West have escaped this crisis. This paper investigates whether political ideology in three post-Soviet countries that are firmly (Belarus), increasingly (Russia), or recently (Ukraine) autocratic is related to health lifestyles and health self-ratings. Data were collected by face-to-face interviews (N = 8406) with a representative national sample of the adult population. The results show that respondents who are against restoring communism have healthier lifestyles and rate their health better than respondents who wish to see communism return.     

Health lifestyles in Ukraine

Objectives: Several studies have identified negative health lifestyles as a primary determinant of the mortality crisis in Europe’s post-communist states, but little is known about Ukraine. In order to address this gap in the literature, this paper provides data on Ukrainian health lifestyles.Methods: Data were collected by face-to-face interviews in the households (N = 2 400) of a random sample of respondents in Ukraine in November, 2001. The sample was selected using multi-stage random sampling with stratification by region and area (urban/rural). Data were analyzed using logistic regression.     

Health lifestyles in Ukraine

Summary. Objectives: Several studies have identified negative health lifestyles as a primary determinant of the mortality crisis in Europe’s post-communist states, but little is known about Ukraine. In order to address this gap in the literature, this paper provides data on Ukrainian health lifestyles.Methods: Data were collected by face-to-face interviews in the households (N = 2 400) of a random sample of respondents in Ukraine in November, 2001. The sample was selected using multi-stage random sampling with stratification by region and area (urban/rural). Data were analyzed using logistic regression.Results: Male gender was found to be the most powerful single predictor of negative health lifestyles as shown in the results for frequent drinking, heavy vodka use at one occasion, smoking, and diet. Males rated their health status better than females, but over one-third of the males and one-half of the females rated their health status as rather bad or bad.Conclusions: Gender and class differences in health lifestyle practices appear to be key variables, with working-class males showing the most negative practices. The results for health status suggest that the overall level of health in Ukraine is not good.

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Zusammenfassung. Gesundheitsrelevanter Lebensstil in der UkraineFragestellung: Mehrere Studien haben den negativen gesundheitsrelevanten Lebensstil als wichtigste Determinante der Mortalitätskrise in den europäischen postkommunistischen Ländern ermittelt, jedoch weiss man wenig über die Ukraine. Um dieser Lücke in der Literatur zu begegnen, will dieser Artikel Daten zu gesundheitsrelevanten Lebensstilen in der Ukraine liefern.Methoden: Die Daten wurden durch persönliche Interviews (N = 2 400) in Haushalten einer Zufallsstichprobe in der Ukraine im November 2001 gesammelt. Die Auswahl der Untersuchungsgruppe erfolgte mittels eines mehrstufigen randomisierten Samplingverfahrens, stratifiziert nach Region und geographischer Lage (Stadt/Land). Die Daten wurden mit dem logistischen Regressionsverfahren analysiert.Ergebnisse: Männliches Geschlecht wurde als die stärkste Prädiktorvariable für einen negativen gesundheitsrelevanten Lebensstil gefunden wie anhand der Ergebnisse für regelmässigen Alkoholkonsum, starkes Wodkatrinken während einer Gelegenheit, Rauchen und Ernährungsgewohnheit gezeigt werden kann. Männer stuften ihren Gesundheitsstatus besser ein als Frauen, aber über ein Drittel der Männer und mehr als die Hälfte der Frauen stuften ihn als schlecht bis sehr schlecht ein.Schlussfolgerungen: Geschlechter- und Klassenunterschiede erscheinen als Schlüsselvariablen für gesundheitsrelevante Lebensstil-Praktiken, wobei Männer aus der Arbeiterklasse die negativsten Praktiken aufzeigten. Die Ergebnisse zum Gesundheitsstatus deuten an, dass der allgemeine Gesundheitszustand in der Ukraine nicht gut ist.

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Résumé. Santé et modes de vie en UkraineObjectifs: Plusieurs études ont identifié des styles de vie négatifs comme déterminants principaux de l’accroissement de la mortalité dans les états post-communistes d’Europe, mais la situation en Ukraine est peu décrite dans la littérature. Afin de combler ce manque, cet article présente des données sur les modes de vie en Ukraine.Méthodes: Les données ont été rassemblées au cours d’entretiens individuels à domicile d’un échantillon aléatoire de répondants en Ukraine (N = 2 400, Novembre 2001). L’échantillon a été choisi au moyen d’un échantillonnage aléatoire en grappe, stratifié selon la région et la zone (urbaine/rurale).Résultats: Etre un homme est le prédicteur unique le plus important d’un mode de vie négatif, comme par exemple la consommation fréquente d’alcool et de grandes quantités de vodka en une fois, le tabagisme et l’alimentation inadéquate; les hommes se sont estimés en meilleure santé que les femmes. Mais plus d’un tiers des hommes et la moitié des femmes ont jugé leur état de santé plutôt mauvais ou mauvais.Conclusions: Le sexe et la classe sociale sont des déterminants importants des pratiques de santé, les ouvriers ayant les pratiques les plus négatives. Les résultats montrent qu’en général l’état de santé de la population ukrainienne n’est pas bon.

     

Health lifestyles in Russia

Utilizing data from the nationwide Russian Longitudinal Monitoring Survey (RLMS), this paper analyzes health lifestyles in Russia. Heavy alcohol use and smoking, a high-fat diet, and lack of leisure-time exercise are the principal culprits in fostering high rates of heart disease and other causes of premature mortality. This is especially the situation for middle-age, working-class males whose mortality is greater than any other segment of society. This paper focuses on alcohol use as a particularly lethal component of male lifestyles and presents a theoretical argument, grounded in the work of Weber and especially Bourdieu, that poor health lifestyles practices are largely the outcome of structural conditions (life chances) rather than agency (life choices). Societal and group norms and routine practices can adversely affect longevity and this is the case for Russian male blue-collar workers in the middle period of their life course.     

Childhood leukaemia in Belarus, Russia, and Ukraine following the Chernobyl power station accident: results from an international collaborative population-based case-control study

BACKGROUND: There is little evidence regarding the risk of leukaemia in children following exposure to radionuclides from the Chernobyl Nuclear Power Plant explosion on April 26, 1986. METHODS: This population-based case-control study investigated whether acute leukaemia is increased among children who were in utero or <6 years of age at the time of the Chernobyl accident. Confirmed cases of leukaemia diagnosed from April 26, 1986 through December 31, 2000 in contaminated regions of Belarus, Russia, and Ukraine were included. Two controls were matched to each case on sex, birth year, and residence. Accumulated absorbed radiation dose to the bone marrow was estimated for each subject. RESULTS: Median estimated radiation doses of participants were <10 mGy. A significant increase in leukaemia risk with increasing radiation dose to the bone marrow was found. This association was most evident in Ukraine, apparent (but not statistically significant) in Belarus, and not found in Russia. CONCLUSION: Taken at face value, these findings suggest that prolonged exposure to very low radiation doses may increase leukaemia risk as much as or even more than acute exposure. However the large and statistically significant dose-response might be accounted for, at least in part, by an overestimate of risk in Ukraine. Therefore, we conclude this study provides no convincing evidence of an increased risk of childhood leukaemia as a result of exposure to Chernobyl radiation, since it is unclear whether the results are due to a true radiation-related excess, a sampling-derived bias in Ukraine, or some combination thereof. However, the lack of significant dose-responses in Belarus and Russia also cannot convincingly rule out the possibility of an increase in leukaemia risk at low dose levels.     

Psychological distress, perceived health status, and physician utilization in America and West Germany

This paper reports on findings pertaining to levels of psychological distress, perceived health status, and physician utilization among a sample of Americans (N = 1204) and West Germans (N = 1266) living in Illinois and North-Rhine Westphalia, respectively. The conflicting perspectives of labeling theory and the clinical approach to cross-cultural variations in mental disorder are discussed. There were no significant differences between the two population groups with respect to anxiety tendencies or psychological distress generally, with the exception of Germans having significantly more tendency toward depression. In both countries, persons with the lowest expressions of anxiety were the most likely to perceive symptoms of physical problems as requiring a doctor's attention, thereby suggesting that anxiety operates to influence a denial of general readiness to deal with symptoms. Yet persons with the highest anxiety, depression, and overall psychological distress were most likely to report having experienced physical symptoms and visiting a doctor because of it. Persons with the highest anxiety, depression, and overall psychological distress also rated their health status the lowest.     

Gender, self-reported health, and health-related lifestyles in Poland

Little is known about gender differences in the health of individuals in the former Eastern Europe. Determinants of health and health-related lifestyles may operate differently there than in the West. Data from the 1994 Polish General Social Survey (PGSS) are used to estimate structural and psychosocial effects on self-reported health, risk behaviors, and social participation for women and men. Employment improves the chance of better health for men, whereas marital happiness increases the probability of better health for women; smoking declines with education among men but not among women; and excessive drinking increases for unhappily married men. Religiosity protects the health of both women and men. This research sheds light on the possible sources of gender differences in health in Poland.     

Health lifestyles in central Asia: the case of Kazakhstan and Kyrgyzstan

There is a growing body of evidence suggesting that negative health lifestyles are the principal social determinants of the mortality crisis in the former socialist states. Little is known, however, about health lifestyles in Central Asia, where the downturn in life expectancy was also experienced. This paper examines health lifestyles in Kazakhstan and Kyrgyzstan in order to fill an important gap in the literature. The data show, consistent with the improved longevity of the Kyrgyz population, that such lifestyles are more positive in Kyrgyzstan despite the somewhat better economic situation in Kazakhstan, where the mortality crisis continues.     

Psychological distress, unmet need, and barriers to mental health care for women.

Using data from the Commonwealth Fund 1998 Survey of Women's Health, this article describes the characteristics of women in need of mental health services for depression or anxiety, and identifies factors related to why women do not get needed care. Depressive/anxiety symptoms are common and access to care for psychological distress remains a problem for many women, especially for minorities, those with less education, and those without a usual source of health care. Sources of unmet need include patient factors, clinician factors, and characteristics of the health system, such as costs of mental health care.     

Psychological distress, hopelessness and welfare.

This article assesses the validity of the claim that welfare in itself has deleterious psychological consequences for single mothers. The analysis compares single mothers who are recipients of AFDC with single mothers who are not recipients in terms of their depressive symptoms (as measured by the CES-D) and hopelessness (as measured by Pearlin Mastery Scale). The analysis uses data from the National Longitudinal Survey of Youth and the National Survey of Families and Households. The authors find that higher levels of both depression and hopelessness among welfare recipients can be explained by their material hardship rather than the stigma attached to welfare. They show that AFDC recipients report similar levels of depression and hopelessness as jobless non-recipients as well as low-wage non-recipients. An additional finding is that long-term welfare recipients do not experience greater emotional problems than short-term welfare recipients. Finally, the paper shows that feelings of hopelessness mediate the relationship between material deprivation and psychological distress for both recipients and non-recipients.     

Cancer mortality in Russia and Ukraine: validity, competing risks and cohort effects

BACKGROUND: The dramatic increase in mortality in Russia and Ukraine in the late 1980s and 1990s has been due to increases in certain causes of death, particularly cardiovascular disease and accidents and violence. In contrast, there has been a slight fall in mortality from cancer. METHODS: This paper presents an analysis of trends and patterns in cancer mortality and examines four possible explanations for its recent fall: changes in data collection; cohort effects; competing mortality from other causes of death; and improvements in health care. RESULTS: All contribute to some extent to the observed changes, with each affecting predominantly different age groups. There is evidence of a significant underrecording of cancer deaths among the elderly especially in rural areas and of significant changes in coding practices in the early 1990s. Competing mortality from cardiovascular diseases and accidents can explain some reduction in male deaths from cancer in middle age. Birth cohort effects can explain some reduction among males after early middle age and among females at all ages. The impact of changes in health care are more difficult to identify with certainty but there is evidence of reduced deaths from childhood leukaemia. IMPLICATIONS: Recent changes in mortality in Russia are complex and their understanding will require a multidisciplinary approach embracing demography, epidemiology and health services research.     

Age and the gender gap in distress

Women report more psychological distress than men and recent evidence suggests that this gap increases with age. It has been argued that the widening differential in distress reflects the progressive and cumulative nature of women's disadvantaged work and family roles. Drawing on the cumulative disadvantage hypothesis and social stress theory, we test: (1) whether exposure to chronic stress accounts for an increasingly larger proportion of the gender effect on distress with age; and (2) whether women are increasingly more vulnerable to the effects of chronic stress on distress with age. Data are from the 1994 wave of the Canadian National Population Health Survey, a national probability sample of women and men aged 20 and older (N = 13,798). Exposure to long-term stress helps us understand gender differences in distress for those in their pre-retirement years. However, contrary to the cumulative disadvantage hypothesis, the model became increasingly less likely to explain such differences with age. Gendered vulnerability to long-term stress was not evident in the sample. The implications of these findings are discussed with particular reference to our ongoing efforts to understand health in the context of social structure and subjectivity.     

Child labor, gender, and health

It is often forgotten that child labor is part of a multi-generational problem due in part to the failure to educate girls. Although the literacy rate for women has improved over the last two decades, in many countries it is less than half that of their male counterparts. This in turn leads to nutritional deficiencies, poverty, and poor health. While many researchers address the immediate health effects of child labor on the child laborers, this article addresses the issue of child labor from a broader perspective, one that identifies child labor as a contributor to intergenerational poverty, malnutrition, and limited educational attainment. Child labor and nutrition are important issues in both educational attainment and health status.     

Self-care components of lifestyles: the importance of gender, attitudes and the social situation

Self-care practices of individuals are health related elements of lifestyles. In order to understand the influences that shape and maintain the self-care patterns of behaviour that determine health and functional ability, research frameworks for study of the social situations in which people live and the levels of influence among variables are needed. This paper reports on findings from an investigation of self-care practices in a population sample of persons over 45 yr of age in an attempt to study self-care in a lifestyle framework. The findings show the importance of examining patterns of behaviour rather than exclusive focus on the magnitude of differences in discrete behaviours. Gender was the major independent influence on patterns of health maintenance behaviour while social network variables assumed major importance for self-care responses to illness.