SIHLWA Northwest Russia Stakeholder Analysis by Dmitry Titkov, International Affairs Unit at National Institute for Health and Welfare (Finland)
Northern Dimension Partnership in Public Health and Social Well-being
SIHLWA Northwest Russia Stakeholder Analysis
REPORT
Report prepared by:
Mr. Dmitry Titkov, STAKES/THL, Finland
Ms. Marja Tuomi, STAKES/THL, Finland
Ms. Anna Orlova, St-Petersburg
Ms. Natalia Gurina, St-Petersburg
Ms. Irina Krutikova, Karelia
Ms. Olga Fetisova, Murmansk
Table of contents
Executive summary 5
1 Introduction 7
1.1 Background 9
1.1.1. The Northern Dimension Partnership in Public Health and Social Wellbeing (NDPHS) 9
1.1.2. Neighbouring area, Barents Euro-Arctic region and NDPHS co-operation 9
1.1.3. Social Inclusion, Healthy lifestyles and Work Ability (SIHLWA) background 10
1.2 Objectives 11
1.3 Methodology 11
2 Realisation 13
2.1. Personnel 13
2.2 Desk study 13
2.1.1. Review of international policies and strategies 13
2.1.2. Review of international projects 19
2.2 Field visits 21
3 Results 23
3.1. Federal legislation (policies, strategies, laws) related to health promotion 23
3.2. Federal legislation (policies, strategies, laws) related to alcohol 24
3.3. Conclusions for the legislative basis 26
3.4. Organisation of healthy and socially rewarding lifestyles promotion at governmental level 26
3.5. Organisation of risky behavior and alcohol prevention and alcoholism treatment/rehabilitation at governmental level 28
3.6. Conclusions for governmental arrangements in promotion healthy lifestyles and alcohol prevention 31
4 Overview of the situation in the regions 36
4.1 Leningradskaya oblast 36
4.1.1.General situation 36
4.1.2. Stakeholders 37
4.1.3. Programmes 40
4.1.4. Projects 41
4.2 St Petersburg 43
4.2.1. General situation 43
4.2.2. Stakeholders 43
4.2.3. Programmes 49
4.2.4. Projects 52
4.3 Karelia 55
4.3.1. General information 55
4.3.2. Stakeholders 55
4.3.3. Programmes 58
4.3.4. Projects 59
4.4 Murmansk oblast 61
4.4.1. General Information 61
4.4.2. Stakeholders 61
4.4.3. Programmes 64
4.4.4. Projects 66
5. Conclusions 68
6. Recommendations 70
6.1. Implications about project-based activity 70
6.2. Implications about stakeholder analyses 71
Annexes:
Annex 1. Stakeholder questionnaire template
Annexes 2a and 2b. List of Stakeholders
Annex 3. List of Projects
Annex 4. Health behavior questionnaire (translation) used by Murmansk Centre of Medical Prevention
ABBREVIATIONS
AIDS – Acquired Immune Deficiency Syndrome
CINDI –Country-wide Integrated Non-communicable Diseases Intervention
CSR – Committee of Senior Representatives
ECATOD - European Community Actions supporting primary health care action against Tobacco consumption and hazardous Drinking
EIBI – Early Identification and Brief Intervention
EU – European Union
HIV – Human immunodeficiency virus
ICD-10 – International Classification of Diseases, ver.10
MAPS – Medical Academy of Post-Graduate Studies (St-Petersburg)
NGO – non-governmental organisation
NDPHS – Northern Dimension Partnership for Public Health and Social Wellbeing
PAC – Partnership Annual Conference
RUR – rouble
SIHLWA – Social Inclusion, Healthy Lifestyle and Work Ability
STAKES/IDC – International Development Collaboration at Finnish National Research and Development Centre for Welfare and Health
STI – sexually transmitted diseases
THL – National Institute for Health and Welfare (Finland)
UN – United Nations
UNICEF – United Nations Children’s Fund
WHO – World Health Organisation
Executive summary
The given Stakeholder Analysis Project is based on the discussions held during the Northern Dimension Partnership for Public Health and Social Wellbeing (NDPHS) Expert Group Meeting "Social inclusion, Healthy Lifestyles Work Ability" SHLWA, Helsinki, 16-17 May 2006.
The SIHLWA, Expert Group under NDPHS agreed that there was a need to have a better picture and understanding of different actors and stakeholders in the sector addressed by SIHLWA. In particular, this means actors and their activities aiming on prevention of negative effects of alcohol use and on promotion of healthy lifestyles among young people. Many institutions, incl. research organizations and NGOs, (military and religious/faith-based organizations included) work towards these goals, but we do not always know who they are and what exactly they have done or are doing.
The present project-based work in the neighbouring regions of Finland does not enhance a possibility to survey the field of stakeholders to an adequate extent i.e. the work tends to be limited to the partners who know each other and by the priorities defined in the 1990s. Elaborating a list of most important key stakeholders and their activities in the thematic areas covered by SIHLWA would be an indispensable starting point to enhance and support existing national and international activities. The scope of SIHLWA, non-communicable lifestyle related diseases, is partly new as compared to the priorities set previously in the Finnish-Russian cooperation in the areas of health and social well-being. The proposed work may also for its part prepare some grounds for new international cooperation with Russia in the area of health and social wellbeing.
The present report constitutes an outcome of efforts undertaken by Finnish and Russian experts. The working methods employed in making the present report were desk-studies to review available databases, documents and mass media, interviewing both personally and by phone or email, and field visits. The project progressed quite smoothly, partly due to good communications established between the Finnish and Russian experts.
The present report includes overviews of strategies and policies internationally, followed by deeper insight into the situation in Russia, and particularly in the studied regions of the Northwest Russia. The overall picture of the state-led health promotion activity guided regionally by Centres of Medical Prevention is presented. The key elements and structures of the existing alcohol prevention and treatment system presented by state-funded Addictions Clinics are depicted. Information about recent projects on the issues concerned and stakeholders has been compiled. While the report’s text bears just few examples of project activity and stakeholders, the attached annexes include wider lists (Annex 2 List of Stakeholders, Annex 3 List of Projects). Yet, it should be borne in mind that there are definitely projects and stakeholders which so far are missing from the lists. The same concerns the most recent developments and changes in the Russian policies with relation to lifestyles among young people in general and alcohol in particular. Such were happening at the moment of the report writing but were not included as this report is not a telephone directory but should be considered as a tool. It is expected that later, in the revised version of the report, amendments will appear in terms of projects, programmes, stakeholders, and, most expected, positive changes in the Russian healthy lifestyles promotion strategies and alcohol policies.
It may seem that the theme of alcohol is prioritised in the present report, and this impression will be in a way correct. The fact is that alcohol issues have recently been high on the agenda of WHO, European Commission, Northern Dimension Partnership on Public Health and Social Wellbeing, Baltic Sea States Council, and other international structures. Besides, alcohol and healthy lifestyles are closely interconnected. Promoting healthy lifestyles implies, among others, non-acceptance of or withdrawal from health risks, and alcohol abuse is one of such risks. At the same time, the question of socially rewarding lifestyles remains open for further discussion. It is not yet clear whether socially rewarding lifestyles are necessarily healthy, and whether healthy lifestyles can be led socially unrewarding.
The last chapters carry impressions and conclusions from the work done, as well as recommendations which followed the data and experiences obtained in the course of the project. It should be reinforced that at the moment of reading of this report some of the recommendations may sound out of place due to the rapidly changing situation in Russia, hopefully changing for the better.
The idea in the background of the stakeholder analysis is to create a flexible model or approach to analysing stakeholders and programmes/projects in other regions. This report is the first attempt to gather information about and analyse lifestyle-related stakeholders and programmes/projects, and therefore certain omissions can be detected. It is also obvious that the use of the proposed approach in other regions may require modifications or alterations.
1 Introduction
Every normal person wants to live a long and happy life. And everyone realizes that a precondition for the dream to come true is good health. No normal person in this world wants to be sick, everyone wants to be healthy, but in most cases people act on the contrary: deliberately or involuntarily they waste their health and think it never ends. At young age a rare person cares about own health; it seems that the whole life is still ahead and the organism is full of energy and will cope with any stress. The price of health becomes known only when it is ruined. And there are thousands of ways to ruin own health.
According to various surveys[1], most young people are sure that health is mainly determined by lifestyles, and many people know that their health depends primarily on them themselves. Yet, knowing this, they bend practically no effort to care about their health, which is paradoxical. Health is not considered as a value, into which investments should be made, but health itself is looked upon as an investment, which could be put into achieving other goals.
Childhood and adolescence are the age when consequences of actions are rarely thought about. This is the age for making experiments and rioting against standards and rules. This is the age when peer pressure dominates over the words of parents and teachers. This is the age when demonstration of authority from adults will meet opposition, no matter how reasonable the adults are. The complex development stage at teen age is very sensitive and fragile and may be easily jeopardised by risks in the individual’s environment. The modern time poses a variety of such, which were unknown or not spread so widely before: drugs, tobacco, alcohol, gambling, environmental pollution, junk food, PC games, HIV and sexually transmitted diseases, etc.
The global community has well recognised the threats that have arisen before the young generations and certain steps have been undertaken to ensure their good health and wellbeing. Yet, those steps are not enough to build barriers between the younger generations and the health-related risks, as the practice shows. Therefore, even more resources should be identified to be invested into child and youth health and development to ensure tomorrow’s prosperity and stability.
Such global actors as the United Nations and World Health Organisation have acted as leaders of worldwide initiatives aimed at health promotion among children and young people. The WHO realizes that the young people now are adults tomorrow, and the behavioral patterns they set now in terms of their health will affect how long they will live and how fully they will be able to display their potential as members of society and how meaningfully they will be able to contribute into the economies of their countries. While developing comprehensive strategies for health development, WHO, UN and other institutes also focus on certain risks related to health and wellbeing of children and young people, and one of the risks is alcohol.
High-level recognition of the dangerous alcohol consumption, particularly among young people, came long ago. The world’s largest alcohol consumption is recorded in Europe[2] - 11 litres of pure alcohol/adult/year. Such high level leads to frequent occurrence of health disorders, diseases and mortality caused by harmful use of alcohol. According to the Public Health Portal of the European Union[3], “Europe has the highest proportion of drinkers in the world, the highest levels of alcohol consumption per capita and a high level of alcohol-related harm. Harmful and hazardous alcohol consumption is a net cause of 7.4% of all ill-health and early death in the EU”.
Thus, no wonder that most initiatives in reduction of harmful consumption of alcohol were developed in Europe. When looking back at recent times, one can mention the initiative of the WHO EURO to launch a region-wide action plan on alcohol in 1992. This was followed by numerous positive steps to counteract the problem - the year 1995 saw the European Charter on Alcohol, which was adopted at the WHO European Conference on Health, Society and Alcohol. Six years later, in 2001, the WHO EURO held a European Ministerial Conference on Young People and Alcohol. The Conference addressed the issues and possible measures to prevent alcohol abuse by young people. In the following year the WHO EURO put into effect the European Alcohol Information System, which provides country-based data sets on policies and strategies related to alcohol. At the moment the Europe’s guiding policy is the European Alcohol Policy Framework of 2005.
At the same time it is obvious that alcohol abuse prevention cannot be done through alcohol-related measures. The approach should be taken comprehensively and embrace all unhealthy behavioral risks, like tobacco smoking, drug use, nutrition, physical activity, etc. Although alcohol is a big contributor to mortality amongst young people, especially males, this, unfortunately, is not the only cause for premature mortality among working-age people.
Therefore, activities of global (UN, WHO, etc.) and regional institutes (in our case, Barents Euro-Arctic Council, Baltic Sea States Council, Northern Dimension Partnership in Public Health and Social Wellbeing, Baltic Sea Network, etc.) emphasize a variety of problems specific of the region’s youth, yet provide space for holistic, multi-sectoral and comprehensive approaches as most effective in dealing with today’s concerns.
In this respect it would be important to see what legal and organizational infrastructure is available in Russia and Russian Northwest, keeping in mind that former Soviet time’s institutes, which were responsible for ideological development of children and young people, have been dissolved (Octoberist organisation, pioneer organisation and Komsomol, i.e. young communist organisation) but new institutes to replace them in taking care of adolescents’ and youth’s lifestyles and behaviour models have not been built. For 20 years children and adolescents have been in vacuum with no one to take care of their healthy and social behaviours. The state has been overwhelmed with economic and financial problems, and consequently schools, health and social institutions, parents have been concerned with the problems of pure survival. As a result, generations with dominating indifferent, uncaring and selfish traits have come up. The generations who witnessed the poverty and poverty-driven problems care now in the first place about careers and income, while the traditional systems of values, like family values, are shattered.