Health Promotion, Politics and Public Health Policy in post-Soviet Kazakhstan

In the post-Soviet period, Kazakhstan inherited a centralized, government health delivery system fraught with inefficiency , inequity, lacking health promotion policies and health education programs. Between 1991-2001, per capita GDP decreased by 40%, social inequities, poverty and poor health outcomes escalated. Kazakhstan's male life expectancy at birth fell from 63.8 in 1990 to 59 in 1996-1998, 15 years below EU levels. Mortality rates for children <5years old increased from 63/1000 in 1990 to 73/1000 in 2004. After a new Constitution was passed in 1995, significant changes in health policy followed. In 1997, a 30-year welfare strategy was initiated which emphasized the priority of health promotion as central to long-term targets: disease prevention; promotion of healthy lifestyles; combating drug abuse; reducing tobacco and alcohol consumption; improvements in nutrition, environment and ecology. In 2004, the “National Health Reform and Development Program for 2005-2010” was established. Although annual public health expenditures remained flat at 2% of the GDP between 1998-2004, the health promotion initiative successfully created the Kazakhstan National Centre for Healthy Lifestyles and the first School of Public Health in Central Asia, accredited by the ASPHER in 2006. There followed over 30 regulations from the Ministry of Health which addressed progress in the county's health profile with health promotion policies. Currently, a National Coordinating Council of the Ministry of Health improves government policy guidelines for public health protection by maintaining intersectoral communication between central and local health bodies, international and non-governmental organizations, and evaluating advances in public health status.