Nestled between Russia, China and other regions of the former Soviet Union, lies the nation of Kazakhstan. As is the case in many other middle-income countries, ischemic heart disease and stroke are the leading causes of death. However, cirrhosis of the liver has overtaken chronic obstructive pulmonary disease (COPD) as one of the top diseases in Kazakhstan. Together, the top diseases in Kazakhstan claim the lives of approximately 85,000 individuals annually.
Ischemic Heart Disease
Often referred to as Coronary Artery Disease (CAD), Ischemic Heart Disease is a condition characterized by insufficient blood flow to the heart. CAD develops when plaque composed of cholesterol and other substances accumulates in blood vessels. As in much of the developed world, the increasing incidence of heart disease in Kazakhstan is correlated with increased body mass index (BMI). More than half the population is overweight. The most common symptom associated with ischemic heart disease is angina or chest pain. Eventually, CAD can lead to heart attacks, heart failure, or arrhythmia.
Cardiovascular Disease is associated with significant direct (e.g. medical) and indirect (e.g. lost productivity) costs. The good news is, there are simple but effective interventions that can reduce the burden of this disease. One study demonstrated a 460% return on investment for community-based initiatives that promoted better lifestyle choices, such as increased physical activity, smoking cessation and healthy eating.
Like ischemic heart disease, stroke is a condition with numerous modifiable risk factors. Most strokes occur when there is insufficient blood flow to the brain. About 20% of strokes are hemorrhagic (due to bleeding). Strokes can result in serious neurological damage and is a leading cause of long-term disability. Community empowerment and education initiatives can help the incidences and severity of strokes. The lifestyle modifications that mitigate the effects of coronary artery disease are also effective in reducing the risk of stroke. In Kazakhstan, sodium intake is one of the most obvious targets for intervention. The average Kazakh consumes over 6,000 mg of sodium daily or three times the maximum recommended by WHO. In addition, limiting alcohol consumption to one drink for women and two for men per day can help lower stroke risk.
Reducing alcoholism in Kazakhstan has proven difficult as evidenced by the increasing prevalence of Cirrhosis. Cirrhosis, or end-stage liver disease, is most commonly caused by hepatitis B or C and alcoholism. According to WHO, the average Kazakh over 15 years of age consumes 10.3 liters of pure alcohol, more than in any other Central Asian country. Since the harmful use of alcohol is also tied to socioeconomic development, organized efforts should be targeted toward this problem. Over time, the incidence of liver Cirrhosis would decrease. There would also be the immediate benefit of reduced motor vehicle accidents, due to intoxication.
In many parts of the world, the leading causes of death have shifted from being acute and communicable to being chronic and noncommunicable. Through medical innovations and effective public policy, those former causes of morbidity and mortality have been dramatically reduced. Sustained passion for social change could also help overcome health problems that now plague the modern world.
– Rebecca Yu