RGS-IBG Annual International Conference 2017

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209 Health in the buffer zone of EU
Affiliation Geographies of Health and Wellbeing Research Group
Convenor(s) Izabella Lecka (University of Warsaw, Poland)
Chair(s) Izabella Lecka (University of Warsaw, Poland)
Timetable Thursday 31 August 2017, Session 3 (14:40 - 16:20)
Room Sir Alexander Fleming Building, Room 119
Session abstract East versus West European experience with medical geography and health and wellbeing geography.

In the countries situated to the east of Europe geography of health and wellbeing it is not the focus of many researchers. This is due to many factors, the most important is the lack of colonies in the XIX and XX century's (except Russia) and the lack of research related in eg. to tropical diseases and also the long reign of the socialist system. At that time they inhibited the development of science-threatening and criticizing the achievements of the existing political system. Therefore, the revival of research in the field of medical geography in the countries of the former socialist block occurred only after the collapse of the system. In Poland after World War II there have been some research analyzing health problems to solve, but than in the 60s nobody published on this issue, because the government believed that identifying the problems is a critique of the achievements of socialism. The 90s was a period of political transformation and loss of health profits of the past decades and arising an additional health problems associated with times of intense change. In terms of the research methodology was a long pause in the existence of the geography of health in post-socialist countries. That is not conducive to pluralism of approaches to the problem. However, health researchers have an invaluable contribution to the interpretation of the phenomena of health in the area of their countries, which today is a buffer zone of the European Union. A very important area, because the West is afraid of diseases that can come from the East. However, the greatest threat to the European Union is the migration of disease outside the European Union.

The combination of both perspectives (West and East) can significantly help Europeans in maintaining good health in times of political turbulence. East has significant achievements in solving problems related to health despite economical complication. Mainly due to the some kind of social engineering.
Contact the conference organisers to request a change to session or paper details: AC2017@rgs.org
Medical, health and wellbeing geography in Poland versus West European experience
Izabella Lecka (University of Warsaw, Poland)
In East or Central part of Europe concepts of epidemiological and health transitions quite well describe the processes of changes occurring in the field of health. Sets that this part of Europe, even with the long episode with socialist economy may be described by the classical model of epidemiological transition.
The analysis of historical data shows that the process of passing through the first stages of the transition were similar to those described for western countries, however, the moment of transition may be a little delayed. The level of mortality and life expectancy in Poland in the late XIX century indicate the ending of the first era of epidemics and hunger and entering the second phase of the epidemiological transition. 20s and 30s XX century might be time to leave the second phase of the epidemiological transition, that is the reduction of the incidence of infectious diseases. In the 50s such indicators as total and infant mortality rate and the average duration of life span start characterised the third phase of the epidemiological transition. In the 90s for women, and after 2000 also for men began a new - fourth phase of the epidemiological transition, and the second phase of the health transition, with a very low share of infectious diseases in the structure of causes of death. The tendency of decreasing mortality rates from these causes does not indicate the occurrence of re-emerging of infectious diseases in the Polish population as a cause of mortality. Life expectancy of 70 years or more, characterized by the end of the third phase of the epidemiological transition has been achieved by women in the early 60s while men after 2001.
Degenerative diseases in Poland, which include cardiovascular disease and cancer, for many years are the main causes of death and represent over 70% of male deaths and 80% of women deaths. Favorable changes in mortality due to cardiovascular diseases, for men and women, took place at the beginning of the 90s when the high mortality rates due to diseases of the circulatory system, characteristic for older age groups, it was significantly reduced. This process in recent years resulted in a significant increase in life expectancy, first among women and later among men. To a lesser extent and with a time delay, good changes occur in a mortality due to cancer.
In Poland the rate of population increase slowed during the 1990s and finally stopped in 1999.
Simultaneously, population ageing currently is characterised also by a low fertility rate.
In the 1990s, life expectancy rose and according to epidemiological achievements - significant improvements have taken place in the health status of the population. Mainly due to behavioral changes, such reductions in alcohol consumption and smoking, declines in environmental pollution (except of big cities) and changes to the health care system, with more attention focused on prevention and health promotion. Improvements in the health status of Polish society over the last decade are serving as a counterweight to population ageing.
Between 1998 and 2003, the share of the population who reported that they were in very good health rose by 5%. Simultaneously, the share of the population in very poor and poor health declined, but remained still at a high level of over 10%. Happily, however, the time of economic transformation was not for the health of Poles as devastating as in other neighboring countries.
A major problem in Poland remain migration, on the one hand from the neighboring countries in the East, where the state of public health is much worse. On the other hand - migrations of Poles to Western Europe, where concern about health in this case is very visible in the media.
Medical, health and wellbeing geography in Ukraine versus West European experience
Victoriya Pantyley (University in Lublin, Poland)
Lubov Shevchuk (Lviv Institute for Business and Law, Ukraine)
Medical, health and wellbeing geography in Ukraine is characterized by irregularity of its development. Ukrainian medical, health and wellbeing geography started intensively to develop after collapse of Soviet Union. In 1990-s, a drastic decrease in the standards of living of the population, a rapid growth of unemployment and number of population living below the poverty line, lack of social security, rising social tension caused by the lack of hope for the improvement of the situation – all those side-effects of the transformation period have had a destructive influence on the demographic and health situation, as well as on wellbeing of the society. Military actions in the east of Ukraine harshly sharpened the existed already unfavorable situation and caused a collapse of functioning of many important segments of the society. Ukraine appeared to be a buffer zone between aggressive Russia and internally unstable EU. These determinants compress medical and geographical space of Ukraine and deepened health and demographic crisis in Ukraine. Among urgent issues are the problems of severe depopulation, huge migration outflow of the population, ageing of the population, increasing the incidence and prevalence both social and civilization diseases. Such situation creates the urgent need for developing the new methodological paradigm in medical, health and wellbeing geography in Ukraine, taking into consideration external and internal threats and challenges. Among the challenges one should mentioned the following: the influence of globalization on the spread of social diseases from East to West, transformation of social communication which creates the chances for development of virtual medical geography, telemedicine, conflict and catastrophe medicine, the development of applied medical and health geography based on the estimation of the impact of complex geopolitical, socioeconomic, ecological problems on public health of the population. Such paradigm should take into consideration medical and geographical mentality of the population in the buffer zone. The specific feature for this paradigm is the priority of population survival under prophylactic and medical treatment.
Factors of life expectancy dynamics in Belarus
Liudmila Tsikhanava (Belarusian State University, Belarus)
Liudmila Fakeyeva (Belarusian State University, Belarus)
Life expectancy is one of the main indicators of socio-economic development of the country. This figure is influenced by many different factors, such as:

- the health of the population;
- the level of medical care, number and quality of health clinics and hospitals, cost of medicines, recreation, etc. ;
- the level of social development (quality of housing and nutrition, food security and social protection, etc.);
- culture of the population, promotion of healthy lifestyles, self-preservation behavior of the population and other social factors.
- social protection of the population.

Five specific stages of population life expectancy dynamics in Belarus are outlined in this paper related to main stages of demographic and socio-economic development of the country (since the mid 60-ies of the XX century to the present time). Factors determining the nature of the process dynamics within these stages are the main objective of this research.

- The first stage (from the beginning of the 1960s) is characterized by high life expectancy (about 71.9 - 72.9 years). In this period, such a high level of life expectancy was associated, on the one hand, with the beginning of economic growth of the country, on the other – with great global achievements in medicine (infectious and parasitic diseases control, the emergence of new effective drugs (sulfonamides, antibiotics) led to a decrease in the mortality rate);
- the second stage - the beginning of 1970 – is characterized by a downward trend in life expectancy. This phenomenon can be seen on one hand as a result of changes in the age and sex structure of the population in the direction to its aging, and such industrialization satellites as pollution, the increase of stress due to the growth of labor productivity, leading to increased mortality from circulatory diseases and neoplasms system and accidents (particularly men in relatively young ages);
- the next stage - the 1980s - is characterized by a short-term increase in life expectancy associated with structural and demographic factors, as well as some measures of the state demographic policy (the fight against alcoholism, child mortality decrease, etc.). Great importance in this period plays a structural demographic factor;
- 1990s are characterized by a significant increase in mortality and a decrease in life expectancy. The collapse of the USSR, the restructuring of society, the transition to a market economy, the disaster at the Chernobyl nuclear power plant and other socio-economic and political factors primarily affected the level and nature of morbidity, mortality and life expectancy. Analysis has shown that in 10 years (1991 -2000), the incidence of the population has increased by almost 29% (7.2 thousand cases per 100 thousand people).
- current, the fifth stage is characterized by growth of life expectancy for both sexes - 78.9 years for women, 68.6 - for men and 73.9 for both sexes (2015). Decrease of morbidity and crude mortality rate contributed to the positive dynamics of life expectancy. Many positive results were achieved within realization of state demographic and health programs (for example, infant and maternal mortality significantly reduced, in terms of infant mortality in 2015 – 3,0 ‰.). One of the main problems for the moment is 10 years gap of male and female life expectancy.
Barriers to implementation of the EU HIV/AIDS Action Plan in the EU and neighbouring countries
Eva Pilot (Maastricht University, The Netherlands)
Megan Davis (Maastricht University, The Netherlands)
Thomas Krafft (Maastricht University, The Netherlands)
Aim: Equity in HIV policies in Europe has yet to be achieved. The EU National Action Plan on HIV/AIDS aims to complement national HIV policies in member states and neighbouring countries. Since the introduction in 2009, little is known about individual countries alignment with the plan. Furthermore, potential structural and social barriers to implementation are not addressed.
Method: A mixed-methods approach of a scoping review of EU countries and Eastern Europe summarising current policies and barriers was conducted, along with in-depth interviews with HIV experts in Czech Republic.
Results: The EU Action Plan is not fully supported by both EU member states and neighbouring countries. Whilst individual EU countries have been effective in some initiatives to address HIV-related issues, several barriers still exist due to prevalence of stigma and lack of support from conservative political stances. Eastern Europe is still experiencing increasing rates of HIV particularly among injecting drug users (IDUs), and the current prohibitionist stance threatens prevention efforts and treatment in marginalised groups.
Conclusion: The EU has promoted a progressive plan to tackle HIV/AIDS that addresses all aspects of HIV-related issues, yet faces difficulty in implementation within national policies due to existing structural barriers. Further research is needed to understand how equity in HIV policies can be achieved.