L Daniel Holsinger and Dr. Gordon Lindsay, Health Sciences
During the summer of 2001, I traveled for the third time to Ukraine. Unlike my previous longstay residencies in Ukraine (totaling four years), which had focused on language and cultural studies, as well as general humanitarian and missionary service, my third stay was motivated by an explicit agenda to fight big tobacco interests in that country. With strong faculty support, and convinced that the frontal marketing assault to expand tobacco markets in Ukraine was harmful to its citizens, I designed and began to carry out a research effort focused primarily on a tobacco consumption crisis in the former Soviet Union. Although there are currently devastatingly high levels of tobacco related illnesses in the former Soviet Union, this problem does not seem to be a major agenda item for the Ukrainian people.
In America we have made progress in our fight against big tobacco companies. In fact, according to the National Health Interview Survey, cigarette smoking among adults in the US aged 18 and over declined 40% between 1965 and 1990-from 42% to 25%. Cigarette smoking remains the single largest cause of preventable death in the United States, even with smoking prevalence on the decline. Smoking is similarly labeled in Ukraine, and sadly, smoking there is still on the rise. This has now become a top priority for the World Health Organization. An estimated 500 million people a year, living today, will eventually die of tobacco-related mortality.
While in Ukraine, I witnessed the lack of concern for the tobacco problem first-hand. Along with twenty other volunteers, I was advocating an anti-smoking campaign in Ukraine at that time. Despite the health consequences associated with smoking, the percentages of physicians that smoke in Ukraine are extremely high. I began my research effort hoping to probe into their medical education system where initially I could see little formal training focused on smoking related issues. The research effort that was funded through ORCA was designed to answer an important question. What tobacco-related knowledge, if any, is evident among graduating medical students in the former Soviet state Ukraine? In order to carry out this research effort the following steps were accomplished. Initially, we corresponded with a group in Australia that had previously constructed a survey instrument and carried this type of research in Australia. Next, Institutional Review Board (IRB) approval was sought so that our survey instrument could be administered to the medical students in four eastern Ukrainian medical schools where prosocialistic ideals are still a major part of the health care system. After translating the survey into both Russian and Ukrainian we then went to Ukraine and established personal contact with the directors of our target medical schools. The medical schools agreed to administer the surveys to their students under the directives we gave them. Having given them our translated survey instrument we returned to the US and waited until they would administer the survey and send us the completed forms. We only began receiving these surveys in September of 2002. We then began the second phase of our research effort.
During this phase we have been organizing our recovered data into an analytical statistics software program. Although we are not ready to report our data yet, the evidence is mounting that shows a serious deficit in tobacco education in Ukraine. As we are all aware, so called “transition” economies are those moving away from centrally planned socialist economic system and toward integrated free markets or capitalism. This kind of open integration of markets world wide, largely free of import duties and free also of government subsidies to artificially lower costs is what globalization is all about. With the collapse of the Soviet Union markets previously closed to the flow of western capital suddenly were opened. For the most part the subsequent investments in places like Ukraine have been responsible for the creation of jobs and the ability of that country to export something other than outdated tractors and raw agricultural products. The bad side, however, is that several U.S. based tobacco companies, whose profits have fallen in domestic markets, have taken this opening as a cue to aggressively market their tobacco products in Ukraine. Unsuspecting Ukrainians, especially youth, have become addicted to cigarettes smoking. Initial prices were kept very low and were also largely free of Ukrainian imposed taxes. The irony here is that the ill health effects of smoking will with absolutely certainty follow the massive, unfettered introduction of tobacco addiction. In the absence of government policy to discourage tobacco use, the public health consequences will be enormous as will be the health care cost of dealing with tobacco-related diseases. It is ironic to say the least that on the one hand American insistence on open access to markets will prove to be at least a partial solution to the poverty provoked by socialist governments in the past while, on the other hand, big American tobacco interests availed themselves of this opportunity to enrich themselves at such a horrible personal health cost to hundreds of thousands unsuspecting Ukrainian citizens. The only remedy we can think of is to educate Ukrainian consumers of the duplicity inherent in the aggressive tobacco marketing and the purchased silence of their own government officials.
This research would obtain key information helpful in painting a picture of the attitudes and comprehension levels on tobacco issues of tomorrows Ukrainian physicians. Beyond the initial question we set out to answer, other aspects of this problem we feel our surveys will help us understand include, data comparison analysis to similar projects done in the USA and Australia. We also want to look at what our results produce relating to the measurement of tobacco use and treatment as well as gender specific issues in tobacco knowledge and use.
Time and money invested into this project are required to finish this effort. Conclusions will be written up in a comparative report to be published in the United States and in Ukraine hopefully by the end of the academic year 2002. The publications will potentially be read by thousands of individuals. This is one of the key steps in motivating the health care professionals in that country to take action and begin to implement the changes necessary to keep big tobacco from it’s almost totally uninhibited assault on the new market economy of Ukraine.