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Zaiga Krisjane Introduction Political changes in Latvia and in other post-socialist countries have led to a transition to market economy which in turn has caused several crises. One of them is that transition is characterized by considerable economical crises, as well as, by some socio-economical changes. Moreover these changes are reflected in demographical situation of Latvia. Naturally demographical processes are closely connected with the development of the state. The structure of population increase has changed since 1989. This could be explained by the fact that the growth of population was based on migration from other republics of the USSR until 1989. And only, approximately 1/3 of the whole population increase was caused by natural growth. At present emigration has been dominating in migration processes. Other tendency, that took place after 1991 was depopulation. Depopulation is affected by both factors: decrease of birth rate and increase of mortality. Since 1992 the natural growth has decreased in aggregate in the state both in cities and rural areas. Besides, the birth rate is low and continues to fall, whereas the death rate is high and continues to rise. Over the period 1989- 1994 we observe trends of changing birth rate more rapidly than mortality rate. (Krisjane, Eglite 1994). It is of importance to note that the state of environment has also changed along with political and economical changes of Latvia. ( see table 1.) Special attention is paid to period from 1989 to 1994 in that report, because in that time the social- demographic date were changed more rapidly and there has been the biggest changes in the guality of life.
The occurring trends in demographical situation of
Latvia have to become the concern of the whole society. Thus,
the aim of the paper is to characterize and to assess human health
and the conditions of environment in transition period. It is
also important to analyze the factors which could affect human
health. The main emphasis is based on social and environmental
aspects of the problem. Published materials on the problem have indicated the possible environmental impact on human health, however, there still is a lack of clear understanding how to assess this impact in Latvia (for example, Eglite 1994). The article is an attempt to clarify the occurring processes. Thus, one of the tasks was to clarify how inhabitants evaluate the impact of environment on their health. As human health is closely linked with changes in demographical situation, many demographical features can be used to characterize human health and it changes, for example, birth rate, mortality and, especially, infant mortality, the average life expectancy. Although there are some traditional demographical indicators, there has been an attempt to use the concept of health self evaluation as one of indicators along with traditional ones. This approach has been used to assess the situation of human health in the country. The data consisted of self-evaluation done by inhabitants and results have been obtained from special survey.
The aim of the survey was to find out the attitude of the population
to the environment and their health. When carrying out the assessment
of the environment and health, the following aspects have been
considered:
Both demographical and environmental indicators obtained in the
course of the research have been compared to the obtained result
from the survey. Official statistical data published by Central Statistical Bureau of Latvia have been used to verify the real situation concerning demographical and environmental situation. The emphasis in the research was put on the period between 1989-1994. Out of demographical indicators, infant mortality indices are being used to characterize the territorial differences of human health on district level. These data are available for every year in observed period. The average level of life expectancy for current years in the country is obtainable only for urban and rural areas on the whole, consequently, that does not allow us to obtain information concerning regional differences. The average life expectancy by place of residence has been calculated based on 1989 population census. ( Krumins, 1994) This was plausible because the results of the census provide complete information on the structure of population. Thus, these results could be used to analyze territorial differences of life expectancy. To assess the state of the environment both indicators characterizing the level of pollution and the opinion of inhabitants on pollution issues has been taken into account. Furthermore, other data have been used to reveal the inhabitant's views on their health and the environment. In 1994 the Faculty of Geography, University of Latvia together with the Institute of Economics, the Latvian Academy of Sciences carried out an opinion poll, where respondents were asked to assess the state of environment and its influence on their health. The survey was carried out by occasional selection and it included 1108 respondents. This is the following distribution 51 % from capital- Riga, 11 % from other urban areas, 13,7 % from small urban towns, and 24,35 % from rural areas. Among respondents there are 65 % women, 35 % men, 74 % Latvians and 26 % other nationalities. The respondents comprised all age groups, however, the number of young people was larger than other groups. The age of respondents was a bit younger than the average in the whole country, however, it does not much differ in towns and rural areas of different size. It allows to compare the replies provided by respondents not dividing them into definite age groups.
It is of importance to mention that when comparing
data on human health and their environment, many types of statistical
accounts are being improved since 1991 so that they correspond
to international standards and are comparable with other countries,
for example , infant mortality rate.(Usackis 1995, 8p.) Human health has been affected by sharp changes of socio- economical system in Latvia which in turn caused important problems of demographical situation and processes. Human health could be characterized by average life expectancy. In Latvia in comparison with other countries the situation is very unfavorable, and, contrary to all general world trends, life expectancy over the last years has decreased again both in relation to men and women. Especially, life expectancy of men dramatically decreased. In 1989 the indicator was 65,25 years, but in 1994 the life expectancy of men decreased to 60,72 years. As it is known, average life expectancy mostly is influenced by mortality causes that affect young people, especially children. Accidents and trauma, have led to 39.7 %. It affected mostly those of the age, and capable of work. When describing the structure of mortality causes, coronary diseases and trombones dominate over other reasons, although, there is a very sharp increase of mortality caused by unnatural causes reaching the increase from 11 % in 1989 to 14.0 % in 1994. (Latvijas demografijas gada gramata 1995) (see fig.1 and fig.2)
As to other mortality causes (that is mortality caused
by various diseases) there is only a slight increase over the
average one. Mental illness, addiction to alcohol changes in the
frequency and structure of mortality causes show that mortality
rate increase and life expectancy decrease has been caused by
victims themselves and as well as due to their unhealthy life
style which aggravates the possibility of falling ill and the
determination of human health condition.(Eglite 1993) Analysing dynamic trends of infant mortality, we came to the conclusion that from 1971 - 1989 the rate of infant mortality had a tendency to decrease less both in urban and rural areas. In rural areas the phenomenon of decrease takes place even faster. After 1989 infant mortality rate has increased both in rural and urban areas. ( Krisjane, Eglite 1994) The highest infant mortality rate was observed in 1992 (17.4 ). In the following years it gradually decreased reaching 15.5 in 1994, however, in comparison with other European countries, this indicator is still rather high. It is advisable to observe the infant mortality cases over large period, because the number of cases is not big and besides they fluctuate over some years, for example, in 1994 infant mortality indicator in rural areas of Latvia was 13.8 , but in urban areas it was 16.6 . In 1993, in rural areas the indicator was 16.2, but in urban areas it was 15.7. (Latvijas demografijas gadagramata 1993,1994,1995) Infant mortality indicators like in previous years, in 1993 and in 1994 have territorial differences, in comparison with 1980 s, the high rate of infant mortality still remains in eastern part of Latvia. In some regions infant mortality indicators are lower than it was in 1970 s, 1980 s, however, the given indicators exceed the average level in the country. The highest indicator is at present in Balvu district which is located in North East part of Latvia. The high mortality indicators observed in eastern part of Latvia partly might be explained by comparatively bad socio-economical situation of the area. Higher mortality rates are also observed in such big cities as Daugavpils, Rezekne, Jelgava, Liepaja, where medical health service is comparatively much better, and where there is a better economical situation. Infant mortality is being affected by urban life style and stress due to high anaemic cases among pregnant women for example in Liepaja. In western part of Latvia like in 1980-s over the last 2 years high rate of mortality is in Liepajas district. (see map)
In Riga and Riga region as well as in some other
central regions of Latvia, there are comparatively low infant
mortality indicators. In Riga infant mortality rate is lower than
on average in the country, however, in comparison with the end
of 1980-s, like it is in other cities, a neonatal indicator in
Riga reached 11.33 in 1994 (Latvijas demografijas gada gramata
1995, 115p.). Possibly, that the favorable situation observed
in Riga is due to a comparatively high level of health service
and due to a comparatively high income rate, considering that
the ecological situation of Riga has not considerably changed,
on the contrary, the pollution caused by cars even has increased.
In order to characterize human health let's move on to the subjective health assessment. The results of the self-evaluation done by inhabitants show the following: beneath the socio-economical changes there are no important differences of health self evaluation. The majority of respondents evaluate their health as good and satisfactory. Only 6,4 % of them think, that it is bad or very bad. There are differences between male and female points of view like us other studies in Latvia. 7,7% of women clarify their health as bad, where as only 5% of men call it bad. Comparing the results of self-evaluation and official demographical indexes we come to the conclusion, that assessment given by inhabitants is more exact than statistical data. Norbalt study shows that self evaluation of Riga's inhabitants done 1994 in comparison with 1992 has declined. ( Vasaraudze,1996) This is connected with a lack of financing of the Health care. First of all it affects people with low income. Decrease of solvency (the purchasing power) has influence on expenses for health care. Many people have simply been unable to pay for medicine. The number of visits falls down. Because of that many cases of illnesses are not included in official statistics. ( Krumina, 1996) At the same time self-assessment is rather high. It suggests that health care is just only one factor affecting human health. Apart from it we should also consider socio-economical and environmental factors affecting their health.
Further on we would analyze the assessment of the state of health
among different types of settlements. (s. table 2) The population
of the capital Riga is 850 thousand, that is 1/3 of population
live there. That is why the obtained results have been grouped
separately. When comparing their health the negative assessment ( above the average in Latvia) could be observed in two areas. Inhabitants of Riga (7,9 %) assess their state of health mostly as bad, especially women (10 %) as well as rural inhabitants, especially men (10 % from answers). The assessment in Riga differs in various parts, particularly, in its central parts. High negative response could be explained by the impact of urbanization, dense level of pollution which naturally cannot be compensated with better health care service. The respondents had to assess the impact of environment on health. Only 30 % admit that environment to some extent has affected their health or health of their family members. Out of them only 8 % point out that the impact of environment was unfavorable, others admit saying it was favorable. More indicators of unfavorable impact of environment have mentioned people of Riga (10 %). 24 % of residents who live in the center of Riga point out that while living in a town, their health has deteriorated because of impact of environment. Respondents from small towns of Latvia practically do not indicate the negative impact of environment (3,3 %), on the contrary 29,4 % of respondents indicate the favorable impact of environment. This assessment is almost twice higher than in Riga.
Possibly that many inhabitants are not aware of negative impact
of environment on their health or the possible impact is very
tiny and thus, does not cause any danger to peoples' health. The aggravation of economical situation should be pointed out as one of the reasons affecting the above mentioned processes. The economical situation could be characterized by the fact that GDP per capita decreased by more than twice from 1990 to 1994. Income per capita on average from 100 points in 1990 to 50,5 points in 1994. At the same time there are territorial differences in income, and these differences relate also to income differences in rural and urban areas, and there is a tendency for these differences to grow. In 1993 income of a family in rural areas per capita was 74,6 % from that of increase received by urban population, but in 1994 it constituted only 66,4 %. (The income shown does not include income from subsistence economy used for their own consumption.) 70 % of people in Latvia lived below subsistence minimum in 1994, 10 % lived on subsistence minimum, but 20 % of population lived on larger income than subsistence minimum.( Latvia Human development report 1995, 53p.) There are large unemployment differences in Latvia. The lowest level of unemployment was in Riga and other port cities Ventspils, Liepaja and in adjacent areas in 1994. The highest rate of unemployment is in Eastern part of Latvia. In some areas its indicators are 3 times higher than on average in the country. (Latvia Human development report 1995, 60 p.) As one of the most important factors one has to point out the state of environment. As to the level of environmental pollution, Latvia differs from other Baltic countries, as well as Russia and Poland. It is largely determined by specific production and underdeveloped production of energy. The total discharge of pollutants into the atmosphere from all air pollution sources in Latvia, per capita, is approximately one-half of that registered in Estonia and one third of that registered in Lithuania. The deposition of sulfur oxides and nitrogen compounds is caused by long range transport, but local contributions are more important here than those in Nordic countries (The Baltic and the Nordic Countries, 1996). Transport sources are among the most important pollution sources. The output from factories to the total pollution level is appreciable in the largest cities of Latvia - Riga, Venstpils, Liepaja, Daugavpils. 95% of emissions form stationary sources in Latvia in 1993 were created by sulfur dioxide (50.1%), nitrogen oxides (10%), carbon oxide (24%) and particle matter (10.8%). (Statistical Yearbook, 1995, 184p.) However, the pollution load from industrial production within the last two years has decreased, mostly due to the reduction of production. On the other hand, the relative role of pollutant loads from transport is steadily increasing (per ~ 11% per year). This is evident when analysing the trends in amount of emissions of main pollutants: sulfur and nitrogen oxides. The amount of emitted pollutants over the last two years increased. Greatly this can be explained by a wider use of heavier fuels with a higher sulfur content. Air pollution problem in Latvia is important in the largest cities and in the direct vicinity of large enterprises, as well as, indoors. In some biggest cities, but, especially, in Riga, concentrations of pollutants have increased. The atmospheric air of the towns is still badly polluted by formaldehyde, ammonia. (Klavins, Cimdins 1994) Some of the most crucial problems of environmental protection are associated with pollution of inner waters. Most common is the pollution with nutrients, however, in several places also the presence of other pollutants has been found in high concentrations (e.g. heavy metals, detergents, phenols, pesticides and other priority pollutants,). The most polluted areas are river segments located below biggest cities (Riga, Daugavpils, Ventspils) as well as some lakes with direct introduction of wastewater discharge (Lake Liepajas, Kisezers and other). (Klavins et al. 1995) On the average 95% of the population in cities of Latvia consume their tap water from a centralized supply system. However, in rural areas the most common source of tap water still are wells from which up to 20% are polluted. At the same time in biggest cities (Riga, Daugavpils, Liepaja, Ventspils, Jelgava) qualitative tap water sources have become exhausted: depression funnels have formed in Riga, Liepaja, Ogre and other cities as a result of intensive use of groundwater.(Klavins et al. 1996) Let's move on to the evaluation of environment components. When assessing impact of environment on health it is important to know how inhabitants characterize and evaluate components of environment in their own place of residence.
On the whole, 3/4 of respondents assess the state
of environment as being good or satisfactory, and only 1/4 of
respondents admit it being poor. Among respondents in their replies:
31,3 % rural and 29,1 % of small towns assess the state of environment
as being good. On the contrary, only 15 % in Riga assess the state
of environment as being good, however, this assessment differs
from one area to other. (Eglite 1996, 22p.) Only 2 % of respondents
living in the center of Riga, assess the state of environment
as being good. In other city districts, where there are more green
areas the assessment reaches even 25 %.
In the opinion poll respondents were asked to assess separate
elements of environment which are close to their place of residence:
The respondents had to name one of the features that upset them most of all. The highest dissatisfaction is being caused by low quality of tap water, whereas the second one is being mentioned the cleanliness of open water bodies. The opinion of respondents is that environmental indicators in urban and rural areas are of different character. People are mostly worried about the problems connected with the quality of tap water. This element is being mentioned as the first one both by Riga and other large city inhabitants. In Liepaja, Ventspils, Daugavpils tap water worries even 1/4 of respondents. Another complaint is air pollution. When analysing the replies of Riga respondents it should be stressed that most people are worried about it. (More than 25% are not satisfied). It is influenced by fast increase of cars causing pollution from exhaust fumes, industrial enterprises, heating appliances and their exhausts. More then 60% respondents of central part are not satisfied with the above mentioned causes. Cleanliness of open waterbodies worries inhabitants because it create problems for their relaxation, that is they are worried to go swimming in Jurmala or other recreation areas. About 1/4 of people are dissatisfied with high noise level. Many people complain about dirty streets and littered yards. In small towns about 10 % of respondents complain about low quality of tap water, as well as, air pollution. Inhabitants of rural areas are not satisfied with the cleanliness of open waterbodies and the collection of litter. So according to survey results respondents are mostly worried about problems linked with their every day life. When analysing the most worried cases we can conclude that the above mentioned phenomena is linked with people's everyday life causing health problems. When comparing self assessment of population with pollution indicators one can conclude that level of pollution is higher in cities, especially in Riga because there is the highest concentration of air and water polluters. Discussion Judging from the survey and environment quality indicators we see that the state of environment is not favorable to health , although inhabitants themselves do not consider them as causing danger. Therefore, when working on environmental and health care strategy, we should take in account the ways of improving definite environmental aspects and their possible impact. The quality of water could improve with more effective water purification technology systems. Thus, the risk factors for people's health might decrease. The situation of human health can be improved by a radical revision of the whole system of measures aimed at providing normal functions in activities in all spheres of life. A radical change in the system of health care and social security in the country could be very valuable. As the health care system in Latvia is now radically transformed, more attention has to be paid to factors that contribute to high mortality and factors lead to differences between population groups and regions. Reform in health care envisages that the old concepts centralization and emphasis on treatment should be replaced by principles of decentralization, quality of care, better education of professionals, prevention and attention to wider range environmental issues in health protection. (Zvidrins, 1996) As health is influenced not only by medicine, it is important to improve the environment and society's attitude where the people lives. Economic development, social welfare and security may play much better role in health than medicine ever does. In future it is advisable to pay more attention to education of inhabitants and to inform them about environmental impact on their health. Promotion of healthy life style is of special importance increasing preventive measure in health care. References Eglite, P.: Vide ap jums. Sociologijas un Politologijas Zurnals 7 19-22 ( 1996) Eglite, P.: Iedzivotaju veselibas stavoklis Latvija un ta teritorialas atskiribas 90. gadu sakuma. Darba petnieciska atskaite. LZA Ekonomikas instituts, Riga. 1994. Eglite, P.: Age Specific characteristics of the population's health in Latvia (early 1990's) (in Latvian). Latvijas Zinatnu Akademijas Vestis 1 1-8 (1993) Iedzivotaju dabiska kustiba un migracija Latvijas republika 1989.gada. Stat.bil. LR VSK, Riga. 1990. Klavins, M.; Rodinovs, V.; Briede, A.; Cimdins, P.; Klavina, I.; Purite, M.; Cinis,U.; Dzene, M.; Blanka, L.: Waters in Latvia's Wells. LU, Riga. 1996. Klavins, M.; Briede, A.; Klavina, I.; Rodinovs, V.: Metals in sediments of lakes in Latvia Environ. Internat. 4( vol. 21) 451-458 (1995) Klavins, M.; Cimdins, P.: Economy and environment in societies in transition: case study in Latvia. LU, Riga. 1994. Krisjane, Z.; Eglite, P.: Infant Mortality as a Characterizing Indicator of the Quality of Life in Latvia. In: Environment and Quality of Life in Central Europe: Problems of Transition. CD-ROM Conference Proceedings. IGU, Prague. 1994. Krumina, I.: Iedzivotaju veselibas stavoklis. In.: Zvidrins, P.(ed.) Latvijas iedzivotaju paaudzu nomaina (Population replacement in Latvia), pp. 50-60. Riga , 1996. Krumins, J.: Iedzivotaju muza ilgums - tendences un palielinasanas problemas. Latvijas Universitate.1993. Latvia Human development report 1995. UNDP, Riga. 1995. Latvijas demografijas gada gramata 1995. Stat.bil. LR VSK, Riga. 1995. Latvijas demografijas gada gramata 1993. Stat.bil. LR VSK, Riga. 1994. Latvijas demografijas gadagramata 1992. LR VSK, Riga. 1993. Statistical Yearbook of Latvia 1995. LR VSK, Riga. 1995. The Baltic and the Nordic Countries. LR VSK, Riga. 1996 Usackis, U.: The Demographical situation in Latvia: a statistical view. Humanities and Social Sciences. Latvia 2 (7) 4-16 (1995) Vasaraudze I.: Veselibas stavoklis. In: Oslands, O. (ed), Dzives apstakli Latvija, pp. 107-144. Central Statistical Bureau of Latvia,1996. Zvidrins, P. Summary. In.: Zvidrins, P.(ed.) Latvijas iedzivotaju paaudzu nomaina (Population replacement in Latvia), pp. 7-15. Riga , 1996. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
