WHO New Regional Director Takes Office

WHO Special Representative of the Director General in Russia Dr. Mikko Vienonen met with Dr. Danzon in the beginning of February, and presented him five questions forwarded by the UN in Russia newsletter.

As you, Dr. Danzon, know well the situation in Russia, what is your opinion about the main health and health sector problems in Russia and how could they be solved?

Russia has experienced an enormous change in social and economic determinants of its population.

Most worrying is that a lot of people now have difficulty in regard to access to the basic health services and medicines they need. Second, the proliferation of several new and old infectious diseases is a big problem. For example, HIV/AIDS, tuberculosis and sexually transmitted diseases have reached epidemic proportions. A third cluster of problems relates to premature deaths of working – age men caused by cardiovascular diseases, cancer and accidents. They have their roots in unhealthy lifestyles such as excess alcohol drinking, tobacco smoking and unhealthy diet. The health of mothers and children is also deteriorating due to increasing poverty and social problems.

What then should be done? There are two areas where the focus in my opinion should be put on. First, change the unhealthy lifestyle to something that will promote health and prevent disease. It can be done, and WHO has a lot of good examples from many countries.

We can help Russia to find its own way, but there is no miracle cure. First, people need scientifically sound independent information and strong public health policies reduce excess in drinking, smoking, fatty diets and dangerous driving.

Second, the main emphasis of health care reforms should be put on the access of care and its quality. So far the financing of health care systems and setting up health insurance schemes has been the focus of main interest.

However, our experience has shown that it is less important how the money is collected for the system. Most important is access of people to care, how health professionals work and how institutions operate.

Dr. Danzon, when do you plan to visit Russia in your new capacity?

It is my wish to visit Russia as soon as possible. Russia is the biggest country in our Region. A healthy Russia is a key to health throughout Europe. Given the present political situation with upcoming presidential elections I believe the most appropriate time to do so could be spring this year. I am looking forward to this trip, and building on the traditionally good links with your country. We have a lot of work ahead. I am very pleased to have an opportunity to learn to know Russia better. I like Moscow and St. Petersburg very much but know that the real Russia is more than these two big cities.

The increase of tuberculosis to epidemic proportions is a new challenge to Russian health authorities and WHO. What is the strategy of WHO to overcome this disease?

The re-emergence of tuberculosis reminds us just how vulnerable public health systems are. We must remember that nothing in health is forever gained. We must be constantly vigilant.

Second it shows how the social situation of people has very concrete health consequences. There are vulnerable groups in our societies, such as homeless, mental health patients and prisoners. Crowded prisons and institutions and sub-standard accommodation have turned into places where tuberculosis spreads effectively. Inadequate treatment, poor access to care and shortage of drugs have increased the number of multi-drug-resistance cases.

WHO has an effective answer to the tuberculosis epidemic, which is called “DOTS”, “Direct Observation Treatment Short-course”. It is a well – documented regime of case finding, treatment and monitoring which we presently are in the process of implementing together with Russian authorities and many other organizations, including the World Bank.

We need to have a very systematic and holistic approach, but I am convinced that by joint efforts the epidemic can be overcome.

Another problem in Russia is the war in Chechnya with a lot of amputees. Has WHO any plans how these people could be helped?

WHO is an organization, which advocates health across battlelines, especially the people in the middle of a crisis. Peace is a prerequisite for health and, therefore, we will always work to enhance peace.

We are part of the guarantee that people in all circumstances will be helped the best way possible and that health facilities can be kept operational. In the past, WHO has supported financially and technically several clinics in the North Caucasus area, where dozens of war victims have been helped to get prostheses.

Presently, our work in the region must focus on more immediate relief operations, but as soon as the situation allows we will once again help to develop rehabilitation services.

HIV/AIDS virus is spreading in Russia. The number of known infected cases is doubled every year. The number of infected people at present is about 25, 000. What kind of joint action with other UN agencies is planned to stop this epidemic?

HIV/AIDS is a difficult problem all over the world. Russia is relatively lucky in that the epidemic has started in the country later than in Western Europe, thus giving it more time to react. Although some patients can be successfully treated now, the cost is so hight that most countries of the Eastern part of the Region cannot afford it. Also vaccine against it still waits to be developed. So prevention remains the only effective way.

Adults can become infected with the HIV virus through unprotected sexual contact, injections, or blood transfusion.

Hence there are very effective ways of protecting oneself from the infection, if you know and want to do it. Together with UNAIDS, UNICEF, UNFPA, UNDP, many other organizations and with Russian authorities we are spreading this message. But we all must strengthen our efforts, as the number of cases is still rising.