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Improving Health: The Heart of the Matter
BOX 3.1 continued Tuberculosis (TB), a disease strongly linked to poverty, remains a key health risk in ECA, where it is a topic of global importance. While new EU member states have made gains against TB since its peak in the late 1990s, the opposite is true in CIS countries, where progress in TB control during the Soviet era has been reversed. TB incidence has doubled since 1990 in CIS countries, and it is now almost three times higher than among new EU member states and ten times higher than in Western Europe. As a result, attaining the MDG for tuberculosis in these countries is not on track. ECA also has some of the worst TB treatment outcomes in the world, with a success rate of 65 percent, and the spread of drug-resistant tuberculosis is on the rise. The region has the highest rates of multi-drug-resistant TB in the world, with 32 percent of new cases and 76 percent of previously treated cases resistant to at least two of the most potent TB drugs. The number of TB deaths has doubled in ECA during the past 20 years, particularly among working-age men. The policy imperative is to improve case detection rates and treatment outcomes and aggressively address TB-HIV co-infections.
Smoking, Drinking, Men, and Women: More Can Be Done to Address Tobacco and Alcohol Use The starting point for reducing mortality from cardiovascular disease is to address its major risk factors in the general population before individuals need medical care. The focus here is on two of the most important, tobacco and alcohol use. Cigarette smoking damages the blood vessels, impedes the transfer of oxygen from the lungs, and puts the heart under increased strain. Excessive alcohol consumption raises blood pressure, leads to damage of the coronary arteries, and can directly affect the heart muscle. Both raise the risk of heart attack and stroke, among other dangers (which also include cancer). Smokers live about seven years less than nonsmokers. There is also a link between smoking and drinking during pregnancy and the probability of low-birthweight infants, posing a risk to neonatal health, and alcohol contributes to road traffic deaths. Thus, tobacco and alcohol matter for many reasons. Behavior change is one of the most difficult tasks for government policy to accomplish. Who partakes in unhealthy behaviors, and why they do so, can be quite idiosyncratic and strongly influenced by social factors and individual circumstance. At the country level, different nations have both their virtues and vices. Within the Organisation for Economic Co-operation and Development (OECD), the United States has the highest rate of obesity but one of the lowest rates of tobacco use; Greece has
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