LLH project Living Conditions, Lifestyles and Health (LLH)The project lasted for three years (2000-2003) and was implemented within the framework of Copernicus-2 program, funded by the European Union. The project compares 8 former Soviet countries with considerable variations in life-expectancy, culture, religion and lifestyle. It includes some more European, some more Asiatic countries and Christian as well as Muslim populations. While the evidence of poor and deteriorating health in the population of the Russian Federation with 250 million people is incontrovertible, aggregate evidence cannot answer the question: Why are some former Soviet citizens healthier than others? The project would enable us to address the issue: why are there variations of this kind between countries and within countries between regions? What factors have lead health in some countries to improve since independence, whilst it has declined dramatically in others?
The objectives of the project were:
to explore the relation of living conditions, lifestyles and health of the eight former Soviet republics: Russia, Belarus, Ukraine, Moldova, Kazakhstan, Kyrgyzstan, Armenia and Georgia. These countries represent a large portion of the former Soviet Union, but also demonstrate important ethnic, cultural and religious differences;
to study how tobacco and alcohol usage, including their social and cultural context, correlate with the cardiovascular diseases in these 8 countries;
to examine how the socioeconomic conditions, including employment, unemployment, housing, income and social group influence the health;
to examine how the social environment and social connections, including a comparison of formal and informal access to medical care, the means used to seek for medical care affect health;
to examine how the psycho-social factors, such as a sense of control over life, can affect health;
to explore how culture and way of life, including ethnic and regional differences may affect health;
to study the influence of environmental factors on health, regarding the regional differences;
to obtain new empirical data and to correlate it with the existing data of medical statistics about the lifestyle, living conditions and health of adults in eight CIS countries;
to analyze which of the above factors are the most important. Using the full range of data collected to understand what circumstances and what differences in the individual choice of lifestyle, socio-economic status, ethnic behavior, national health system and a set of national resources lead to the differences in a health status;
to support the development of a pluralistic research system by working with the national teams in 8 different countries of the CIS;
to create a multilevel database, including the collection of all the statistics on health, environment and data collected during our own quantitative (18,500 respondents) and qualitative researches;
to use the results to determine the causes of health decline;
to extend in the CIS countries (in the ones being surveyed) via the Internet and press the results and recommendations in the national languages. The results of the survey will also be available for the EU leadership and researchers of the international level;
to develop the concrete measures of improving the level of health and to inform the stakeholders about needed action in the organization of public health service;
to issue technical guidance on methods of quantitative comparative study, methods of qualitative comparative study and methods of comparison of the statistics on health to support the project upon its completion.
Methods used in the project:
Collection of the national statistics on health and socioeconomic indicators in each of the 8 countries. Quantification of a representative study. Conducting of in-depth focused group interviews in two regions in Ukraine, Russia and Kazakhstan. The regions with the best and regions with the worst socioeconomic and health indicators (based on the collection of medical statistics). Carrying out of interviews with the health professionals in 6 selected regions. A detailed study of the environment in 6 selected regions. Conducting in-depth and focus-group interviews in the Chernobyl region (including the most affected regions of Ukraine, Belarus and Russia).
The project combines a number of different data sources for each country. In the first stage of the project, aggregate statistics was collected at a national and regional level in order to calculate standardized mortality, infant mortality and other trends over time. In the first stage of the project, surveys were conducted using standardized formats of 2000 individuals in each country, but 4000 in Russia and 2500 in Ukraine to reflect the size and diversity of those countries. The survey enabled the collection of information about living conditions (housing, health, education, income), about alcohol and tobacco use, about psycho-social attitudes including locus of control and optimism/ pessimism, use of health services both formally and informally, social capital and religion along with a range of lifestyle variables which would enable the identification and differentiation of lifestyle groups. In Stage 2 of the project, a series of intensive regional studies were carried out. These studies took place in only three of the selected countries - the largest three exhibiting some of the worst health problems: Russia, Ukraine and Kazakhstan. Three regions were chosen in each country based upon the analysis of the aggregate health statistics carried out in Stage 1: a region with good health, one with poor health and one with average health. In each of these sub-regions there were in-depth interviews with 50 respondents about their health and lifestyle behavior.
There were also 3 focus groups carried out in each region with targeted population groups such as men aged 40-59, women responsible for family health care and so on. In these regions there were also expert interviews with health professionals at different levels of the health system including practitioners at the interface with the public. The results of the surveys and the statistical data were discussed with these local level experts in order to take into account their responses. These regional studies incorporated local information about the nature of the labour market, pollution levels and other environmental factor that could contribute to health outcomes. In addition, during Stage 2, there was a special study of the Chernobyl region, replicating a study undertaken there in 1990 by the Belarusian partner. The Chernobyl study spaned three of the countries under investigation: Ukraine, Belarus and Russia.
In Stage 3 of the project the data from the regional studies as well as the statistical data was brought together in multi-national data sets enabling comparisons between countries as well as within countries. At this stage, a series of reports was produced with the help of the three Western European partners which addressed in a comparative and comprehensive way the main objectives of the study. Hence, there was one report on tobacco and alcohol consumption, one about the consequences of socioeconomic changes (employment, unemployment, income differences), one report concentrating upon social capital and use of the health services, one report about psycho-social factors affecting health and one report about the consequences of culture and lifestyle for health in different settings. The final outcome of the research program was eight national reports and a final comparative report. The results of the project were presented at both national and international levels with advice from the international Advisory Board.