Global Health Systems, Factors that Influence Global Health Systems and Health Disparities

Ukraine has survived several challenges over a period of its independence. It has the highest number of death rates in the entire European Union. Its high mortality rates are attributed to several factors such as health care inequalities, weak and the poor political system, environmental injuries and others even resulting from communicable and non communicable diseases. Generally, the entire world has had a positive response in its population growth. Ukraines growth has come as an alarm when compared to fellow European states and to what the entire world is gearing towards. The huge health care disparity in Ukraine has confirmed to have an extensive influence on peoples health status. The section of the population that is not able to access basic health care services in the country are not able to live for many years and are more constrained. Being passed in the country, health care policies also plays an important role, if implemented, in shaping the health system.

According to Frenk (2010), there has been tremendous advancement noted in health and survival rate throughout the entire globe for the past decades. The life expectancy of the entire world, according to the UN world population views revision of 2010, increased from 48 years to 68 years by the year 2010. Despite the increase in the longevity of life in nearly all people of the world, an increase in some region has overshadowed other regions. A boost in the total number of people through the development shown by the demographic information is through the improvement of the ability to conceive and ability to survive as markers. Differential risks of cause-specific mortality thus explain the persistent disparities in the pace of improvements in survival across the worlds populations. Countries that have reduced the risk of childhood death from pneumonia and diarrheal diseases, for example, have achieved more rapid gains in longevity and advanced further through their transitions that are seen in demography and epidemiology.

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The WHO (2008) report consists of two parts that are well organized. First, deals with the overall changes of the mortality patterns associated with age specificity that characterize the transition of the demography. It is described and it has a relationship with a shifting pattern noted in the distribution of death. Secondly, the roles that the specific major causes leading to death play in contributing to disparities are seen in the survival rate globally. The report highlights on how large burden has developed by the communicable disease, including premature mortalities creates a barrier between the demographic and epidemiological transition. This leads to a double burden that ends up causing survival disadvantages in many communities, in many regions worldwide (Hafner & Shiffman, 2013). WHO considers three broad categories of causes of death (WHO, 2008): Group one encompasses communicable diseases, as well as maternal, perinatal and conditions on nutrition: Group two contains all the non-communicable diseases (NCDs) and Group three comprise causes of death resulting from external sources, namely injuries, including both intentional and unintentional injuries. Of the estimated 56.9 million deaths worldwide in 2008, 36.1 million (63.5 percent) were caused by Group two non-communicable diseases, especially diabetes, cardiovascular diseases, chronic cancers and respiratory diseases.

Ukraines High Mortality

OECD (2010) indicates that Non-communicable diseases remain the most significant cause of disease burden in Ukraine. It makes up approximately 77% of the total incidence. Most significant of these diseases are cancer, cardiac and cerebrovascular conditions. In Europe, the most common form of cancer is the breast cancer. It accounts for 14% of all cancer cases reported. It is then followed by prostate cancer (13.2%), colorectal cancer (13%) and finally lung cancer that accounts for 11.6%. However, in terms of mortality incidences reported because of cancer, lung cancer was the most numerous with an estimated 20.2% of the total number of deaths reported. Among the Ukrainian men, prostate cancer was more common. On the other hand, lung cancer became the most common form of cancer. In the womens group, breast cancer took the first pace and it was said to be the main cause of deaths from cancer among Ukrainian women. Diabetes has also been seen as the one causing a significant loss of life and is the fourth leading cause of mortality. Injuries and poisoning incidents from the environmental factors have also been reported among the Ukranian populations and was ranked third. The decrease in population of Ukraine is causing an alarming situation in the country and the European union as a whole. The neighboring countries around Ukraine are showing a positive increase in their population growth as compared to the Ukraine population.

According to Lekhan Rudiy, & Richardson (2010), since its independence, Ukraine has been the center of demographic decline in combination with a health crisis. Its population has been reduced by 12%. If the current trend maintains its momentum, the countrys population will be reduced to the even bigger figure of about 40% by the year 2050. There is a high mortality rate reported among the working age group and a low fertility rate among the age giving birth population. Combining the impact of these two population factors, the age structure of the population ultimately experiences changes, with the highest proportion concentrating on the mid and older groups. In the late 1980s, Ukraine had a similar life expectancy to other countries in Eastern Europe. After that, it started experiencing divergence in its life expectancy and finally declined. There is a worrisome trend noted in the differential figure in the life expectancy of males and females in Ukraine. In other European countries, the female-male differential declined by a year from 1989 to 2005 and stabilized by the year 2005. If Ukraine is compared, its differential increased from 9 to 12 years by the year 2005.

As compared to other central European countries, the probability of a person surviving all the way to old age in Ukraine is low; this has been noted mostly among the males. The adult death rate in Ukraine is at the same level with other countries whose grand national product per capita is lower as compared to that of Ukraine. The non-communicable diseases (NCDs) account for the largest cause of death in Ukraine, which is about 82%. The highest percentage affects the working age males. Moreover, Ukraine experiences the highest mortality in the entire European region that is caused by infectious diseases. In Ukraine, HIV and Aids accounts for about 90% of all the deaths experienced from communicable diseases and it was the leading cause by the year 2005. Death experienced from heart conditions accounts for approximately 50% of all the deaths.

There is an increased rate of dying from cancer in Ukraine as compared to the average European Union index percentage. About half of all the deaths experienced in Ukraine before the age of 75 years could be ommited in case adequate treatment was prescribed and prevention mechanism was applied. The biggest risk factor in Ukraine is high blood pressure. Nearly one third of the countrys population experiences high blood pressure. Unfortunately, the majority of Ukrainians are not aware of their hypertensive status. In addition to that, other risk factors contributing to high blood pressure in the community in which tobacco and alcohol consumption rates are still high. Approximately two thirds of Ukrainian male population over the age of 15 engage themselves in regular smoking habits, which accounts for the highest figure in the entire European region (WHO, UNICEF, UNFPA, & The World Bank, 2012).

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Lekhan, Rudiy, & Richardson (2010), argue that Ukraine health system is inefficient, ill-equipped and of a low quality. The country lacks a comprehensive health reform plan and its implementation strategies in comparison to other European countries. For many years, Ukrainian people have witnessed the proposal and legislation of so many reforms, most of which have not been implemented due to the political instability and frequent changes of government. Moreover, it was influenced by the leadership heading the ministry of health. These factors delay the implementation of these reforms, institution changes in health care and the reorganization anticipated in the primary health care system. The health needs of Ukrainian people that is leaning more towards the non-communicable diseases must be addressed, and in achieving this, the Ukraines health care system has to be changed from the acute care approach into a comprehensive disease management approach that is more effective in tackling and preventing the non-communicable diseases.

Solutions and/or Current Efforts that Are Influencing and/or Advocating for Better Quality Care

The fact is that both main causes of premature death in Ukraine are of preventable or treatable nature and evidence shows that simple and cost effective interventions can work to prevent an increase of mortality. The health system in Ukraine is still directed towards a point in which it was designed for- acute care disease management, and the health system is not fully equipped so that increasing mortality rate has become a crisis in the country. To deliver effective interventions for prevention, the primary care oriented system of service stands to be the ideal means to deal with the Ukrainian problem (Zaiats, 2014). There is a success in reducing the risk factors of the prevalence, therefore, this will significantly help in reducing morbidity and premature deaths incidences. By implementing these simple intervention strategies in Ukraine, many healthy life years can be gained as well as being saved.

The majority of causes leading to death and diseases in Ukraine are mainly attributed to the risk factors that are mainly known to be modifiable and can be prevented. The majority of the risk factors contributing to the high mortality index in Ukraine require behavior changes in lifestyle of individuals, such as smoking, alcohol and diet changes. Many conditions like poisoning and injuries are contributed by the environmental factors and accounts for a small percentage of deaths. The biggest killers experienced in Ukraine are associated with circulatory and heart conditions. Some deaths experienced in Ukraine at the age of under 75 years can be prevented through adequate programs aiming at prevention targeting to change people's behaviors and to improve the conditions of the environment. This, coupled with effective treatment modalities, can help in reducing the mortality rates.

Ukraine has a long way to go. Its health system has to be improved to the standards reached by fellow European countries. Additional capacities in its health care system are mandatory if it has to keep pace with other countries and offer accessibility of basic health care services by its citizens. These additional capacities must be adequate to help the country be able to deal with the preventable and treatable conditions that contributes to the high mortality index in Ukraine. To secure the population growth, the government must aim at reducing the total incidence of non-communicable diseases and the involving risk factors. In doing this, every sector must act and put extra effort that are within their jurisdiction to improve the safety of people. In addition, in achieving these objectives by the government, collaboration among different sectors will be required. This can only prove to be effective when appropriate and substantial reforms are put in place.

Kvasha (2011), states that approximately 80% of the total number of deaths experienced in Ukraine among the working males and about 30 percent of the working female population could have adequately been treated at the primary care level. The non-communicable diseases and morbidity, mainly among the male working population, claim the largest share of the Ukrainian disease burden. This eventually resulted in very significant social and economic consequences of the lives of Ukrainian people. There has been an imbalance in the economic growth that has been triggered by the decline in health and significant inequalities experienced in health status across the Ukrainian people. This has also been exaggerated by political turbulence and weak health care system in the country.

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Multi-sectoral approaches are needed to address the issues of disease prevention and management in bringing changes in the composition of disease burden. Combined strategies in the control and prevention of non-communicable diseases are implemented to foster collaboration among different sectors. There is a need now to identify and prioritize the implementation of cost-effective interventions that should target the major risk factors contributing to the high mortality index (Kruk et al., 2010). Ukraine needs to go through a comprehensive health care system reform to combat its health issues. The reform to be implemented should not take place because of political interest. It may fail because of the weak political system experienced in Ukraine. The offices in the healthcare system need to be changed and new human resources are to take charge.

According to Lekhan, Rudiy, & Richardson (2010), the reforms need to be guided by series of legislation, policies and strategic plans that should be constantly adapted to the changing needs of Ukrainian people. By all means, effective government leadership is vital if the implementation of the reforms is to be successful. The most important element of these reforms first classifies the responsibilities and the roles of the various players taking part in the health care systems. Primary health care system, referral care systems, and provision of performance-based payments should be introduced to spearhead the focus of the reforms in Ukraine. The government needs to develop an integrated structure that will aim at bringing all representatives in the health system and even beyond to coordinate the prevention and control of NCDs. Ukrainian government should aim at tackling and settling the issues that pertain to the inequalities in the health service delivery. Health is a priority and basic need for all, therefore, every individual has the right to access better health services at disposal without any hindrances. The health care professionals as well the influential people in power and government need to advocate for the rights of people to receive better health care. Health care disparities issues should be the key element when implementing reforms. Health care should not only be available to all but should also be utilized by the increased population. If the population is healthy and disease free, the proportion of people dying from the simple and preventable conditions will decrease significantly. If Ukranian government targets this, they will be expecting a considerable improvement in its countrys population. An increase in population translates to the availability of workforce that will ultimately lead to economic improvement in the country.

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