Important Determinant Of Population Health Research Articles

Gender inequality and utilization of ART: an international cross-sectional and longitudinal analysis.

What is the association between a country's level of gender equality and access to ART, as measured through ART utilization? ART utilization is associated with a country's level of gender equality even after controlling for the level of development. Although gender equality is recognized as an important determinant of population health, its association with fertility care, a highly gendered condition, has not been explored. A longitudinal cross-national analysis of ART utilization in 69 countries during 2002-2014 was carried out. The Gender Inequality Index (GII), Human Development Index (HDI), and their component indicators were modelled against ART utilization using univariate regression models as well as mixed-effects regression methods (adjusted for country, time, and economic/human development) with multiple imputation to account for missing data. ART utilization is associated with the GII. In an HDI-adjusted analysis, a one standard deviation decrease in the GII (towards greater equality) is associated with a 59% increase in ART utilization. Gross national income per capita, the maternal mortality ratio, and female parliamentary representation were the index components most predictive of ART utilization. Only ART was used rather than all infertility treatments (including less costly and non-invasive treatments such as ovulation induction). This was a country-level analysis and the results cannot be generalized to smaller groups. Not all modelled variables were available for each country across 2002-2014. Access to fertility care is central to women's sexual and reproductive health, to women's rights, and to human rights. As gender equality improves, so does access to ART. This relation is likely to be reinforcing and bi-directional, with progress towards global, equitable access to fertility care also improving women's status and participation in societies. External funding was not provided for this study. G.D.A. declares consulting fees from Labcorp and CooperSurgical. G.D.A. is the founder and CEO of Advanced Reproductive Care, Inc., as well as the Chair of the International Committee for Monitoring Assisted Reproductive Technologies (ICMART) and the World Endometriosis Research Foundation, both of which are unpaid roles. G.M.C. is an ICMART Board Representative, which is an unpaid role, and no payments are received from ICMART to UNSW, Sydney, or to G.M.C. to undertake this study. O.F., S.D., F.Z.-H., and E.K. report no conflicts of interest. N/A.

Identifying and Prioritizing Social Determinants of Population Health in Iran: A Mixed Method Research

Background and Purpose: In recent decades, research has shown that social determinants of health (SDH) affect population health more than medical care. Therefore, identifying the SDH has become a top priority. Materials and Methods: It is an explanatory-sequential mixed-method study. We used the meta-synthesis method in the first step to identify and prioritize social determinants of population health in Iran. Then, the identified factors were shown in a semantic map. Afterward, we used fuzzy Delphi to screen and determine each factor’s importance in Iran. Results: A total of 172 factors were identified and classified into 4 levels: individual, local, national, and global. After screening items, parental competence, hope, addiction, types of pollution, inflation, and unemployment rate (the crisp value of defuzzification 9-10) are generally the most important determinants of population health at the individual and national levels in Iran. Conclusion: The resulting semantic map of SDH demonstrates the substantial effect of non-health policies on the health of Iran’s population. This finding proposes health as a complex and comprehensive system needing an interdisciplinary approach to address its multiple determinants. Specifically, the comparative analysis of this research shows that among the determinants of health in Iran, parental competence, individual behaviors such as addiction, and spiritual and mental health, including depression, suicide, and stress, are the most important SDH in Iran.

Heterogeneous treatment effects in social policy studies: An assessment of contemporary articles in the health and social sciences

Social policies are important determinants of population health but may have varying effects on subgroups of people. Evaluating heterogeneous treatment effects (HTEs) of social policies is critical to determine how social policies will affect health inequities. Methods for evaluating HTEs are not standardized. Little is known about how often and by what methods HTEs are assessed in social policy and health research. A sample of 55 articles from 2019 on the health effects of social policies were evaluated for frequency of reporting HTEs; for what subgroupings HTEs were reported; frequency of a priori specification of intent to assess HTEs; and methods used for assessing HTEs. A total of 24 (44%) studies described some form of HTE assessment, including by age, gender, education, race/ethnicity, and/or geography. Among studies assessing HTEs, 63% specified HTE assessment a priori, and most (71%) used descriptive methods such as stratification; 21% used statistical tests (e.g., interaction terms in a regression); and no studies used data-driven algorithms. Although understanding HTEs could enhance policy and practice-based efforts to reduce inequities, it is not routine research practice. Increased evaluation of HTEs across relevant subgroups is needed.

Accessing primary care and the importance of 'human fit': a qualitative participatory case study.

Good access to primary care is an important determinant of population health. While the academic literature on access to care emphasises its complexity, policies aimed at improving access to general practice in the UK have tended to focus on measurable aspects, such as timeliness or number of appointments. To fill the gap between the complex understanding of primary care access in the literature and the narrow definition of access assumed in UK policies. Qualitative, community-based participatory case study within the geographic footprint of a clinical commissioning group in the north west of England. Data collection took place from October 2015 to October 2016. Purposive sampling and snowball approaches were used to achieve maximum variation among service users and providers across general practice settings. Levesque et al's conceptual framework of patient-centred access was applied and the study used multiple qualitative methods (interviews, focus groups, and observation). Analysis was ongoing, iterative, inductive, and abductive with the theory. The comprehensiveness of Levesque et al's access theory resonated with diverse participant experiences. However, while its strength was to highlight the importance of people's abilities to access care, this study's data suggest equal importance of healthcare workforce abilities to make care accessible. Thus, the authors present a definition of access as the 'human fit' between the needs and abilities of people in the population and the abilities and capacity of people in the healthcare workforce, and provide a modified conceptual framework reflecting these insights. An understanding of access as 'human fit' has the potential to address longstanding problems of access within general practice, focusing attention on the need for staff training and support, and emphasising the importance of continuity of care.

Associations between high temperatures in pregnancy and risk of preterm birth, low birth weight, and stillbirths: systematic review and meta-analysis

ObjectiveTo assess whether exposure to high temperatures in pregnancy is associated with increased risk for preterm birth, low birth weight, and stillbirth.DesignSystematic review and random effects meta-analysis.Data sourcesMedline and Web...

Changes in physiology and microbial diversity in larval ornate chorus frogs are associated with habitat quality.

Environmental change associated with anthropogenic disturbance can lower habitat quality, especially for sensitive species such as many amphibians. Variation in environmental quality may affect an organism's physiological health and, ultimately, survival and fitness. Using multiple health measures can aid in identifying populations at increased risk of declines. Our objective was to measure environmental variables at multiple spatial scales and their effect on three indicators of health in ornate chorus frog (Pseudacris ornata) tadpoles to identify potential correlates of population declines. To accomplish this, we measured a glucocorticoid hormone (corticosterone; CORT) profile associated with the stress response, as well as the skin mucosal immune function (combined function of skin secretions and skin bacterial community) and bacterial communities of tadpoles from multiple ponds. We found that water quality characteristics associated with environmental variation, including higher water temperature, conductivity and total dissolved solids, as well as percent developed land nearby, were associated with elevated CORT release rates. However, mucosal immune function, although highly variable, was not significantly associated with water quality or environmental factors. Finally, we examined skin bacterial diversity as it aids in immunity and is affected by environmental variation. We found that skin bacterial diversity differed between ponds and was affected by land cover type, canopy cover and pond proximity. Our results indicate that both local water quality and land cover characteristics are important determinants of population health for ornate chorus frogs. Moreover, using these proactive measures of health over time may aid in early identification of at-risk populations that could prevent further declines and aid in management decisions.

Neighbourhood community life and health: A systematic review of reviews.

Neighbourhood community life has been widely recognized as an important determinant of population health. This systematic review of reviews provides an overview of the evidence for the ecological correlation between neighbourhood community life and population health. Nine databases were searched from 2008 to 2018 in order to identify systematic reviews of studies examining the association between neighbourhood community life and population health in urban neighbourhoods within the Organisation for Economic Co-operation and Development countries. Two reviewers completed selection and data extraction, then assessed the methodological quality of reviews using the Measurement Tool to Assess Systematic Reviews. We identified three high quality reviews and five of moderate quality. The reviews vary in quality of methodology, concepts, and measures. Most of the reviews examined the influence of social cohesion, social capital, and social interactions on health. Reviews found evidence supporting a consistently favourable correlation between social cohesion and physical activity, as well as a favourable trend in the relationship between social cohesion and healthy weight. They also found evidence of a favourable trend in the correlation between social capital and healthy weight. Reviews identified studies supporting a consistently favourable correlation between social interaction and depression. We identify evidence of a positive association between neighbourhood community life and several population health outcomes. Future research should define and conceptualize neighbourhood community life factors and health indicators to improve the comparison between studies and the process of evidence synthesis. This will also enable policy makers to take appropriate decisions.

Impact of Political Economy on Population Health: A Systematic Review of Reviews.

Background. Although there is a large literature examining the relationship between a wide range of political economy exposures and health outcomes, the extent to which the different aspects of political economy influence health, and through which mechanisms and in what contexts, is only partially understood. The areas in which there are few high-quality studies are also unclear. Objectives. To systematically review the literature describing the impact of political economy on population health. Search Methods. We undertook a systematic review of reviews, searching MEDLINE, Embase, International Bibliography of the Social Sciences, ProQuest Public Health, Sociological Abstracts, Applied Social Sciences Index and Abstracts, EconLit, SocINDEX, Web of Science, and the gray literature via Google Scholar. Selection Criteria. We included studies that were a review of the literature. Relevant exposures were differences or changes in policy, law, or rules; economic conditions; institutions or social structures; or politics, power, or conflict. Relevant outcomes were any overall measure of population health such as self-assessed health, mortality, life expectancy, survival, morbidity, well-being, illness, ill health, and life span. Two authors independently reviewed all citations for relevance. Data Collection and Analysis. We undertook critical appraisal of all included reviews by using modified Assessing the Methodological Quality of Systematic Reviews (AMSTAR) criteria and then synthesized narratively giving greater weight to the higher-quality reviews. Main Results. From 4912 citations, we included 58 reviews. Both the quality of the reviews and the underlying studies within the reviews were variable. Social democratic welfare states, higher public spending, fair trade policies, extensions to compulsory education provision, microfinance initiatives in low-income countries, health and safety policy, improved access to health care, and high-quality affordable housing have positive impacts on population health. Neoliberal restructuring seems to be associated with increased health inequalities and higher income inequality with lower self-rated health and higher mortality. Authors' Conclusions. Politics, economics, and public policy are important determinants of population health. Countries with social democratic regimes, higher public spending, and lower income inequalities have populations with better health. There are substantial gaps in the synthesized evidence on the relationship between political economy and health, and there is a need for higher-quality reviews and empirical studies in this area. However, there is sufficient evidence in this review, if applied through policy and practice, to have marked beneficial health impacts. Public Health Implications. Policymakers should be aware that social democratic welfare state types, countries that spend more on public services, and countries with lower income inequalities have better self-rated health and lower mortality. Research funders and researchers should be aware that there remain substantial gaps in the available evidence base. One such area concerns the interrelationship between governance, polities, power, macroeconomic policy, public policy, and population health, including how these aspects of political economy generate social class processes and forms of discrimination that have a differential impact across social groups. This includes the influence of patterns of ownership (of land and capital) and tax policies. For some areas, there are many lower-quality reviews, which leave uncertainties in the relationship between political economy and population health, and a high-quality review is needed. There are also areas in which the available reviews have identified primary research gaps such as the impact of changes to housing policy, availability, and tenure.

The inequality of nutrition intake among adults in China

ABSTRACT This paper constructs a multidimensional Theil Index to estimate and decompose the inequality of nutrition intake among the adult population in China. Using 1991–2009 China Health and Nutrition Surveys (CHNS), this paper features two major findings. First, we show that the nutrition inequality has remained small in contrast to the large and increasing inequality in population income. Second, using Theil decompositions and Oaxaca–Blinder (O-B) decompositions, we find that, unlike income inequality, nature factors (such as age and gender) and regional factors play a more important role than socioeconomic factors in nutrition inequality. This finding provides a plausible explanation to the different time trends of nutrition inequality and income inequality. Moreover, it suggests that policies that aim to reduce the socioeconomic disparities may not automatically transfer to closing the gap in nutrition intake, which in turn is a potentially important determinant of population health and the long-term economic development.

The Health Impacts of Changes in Individual or Household Income: A Systematic Review

Background: Income is a centrally important determinant of population health, yet the health impacts of changes to income are unknown. This study aimed to systematically review the available literature to clarify the health impact of changes to individual or household income. Methods: We undertook a systematic review, critical appraisal and narrative synthesis. We searched seven databases and the grey literature. The exposure of interest was any change in individual or household income and we included studies with any general health or mortality outcome. We limited the review to longitudinal studies with a non-unexposed comparison group and excluded studies considering only specific health outcomes. There were no restrictions to the time period or populations of interest. Findings: We screened 7,283 citations and identified 19 high quality studies for inclusion. Fourteen examined the impact of secular changes in income and generally found that increased income led to increased self-assessed health. The impact of inheritances or lottery wins was uncertain but generally positive. Changes in income in the context of social security changes had mixed impacts on health. Interpretation: Increased income over time is associated with increased self-assessed health but there is an absence of evidence of the impact on mortality. There is a need for studies of the impacts of changes in individual income on mortality and for evaluations of changes in policy that affect incomes. Funding Statement: Anmol Yagnik was granted a Global Health Travel Award by York University to the amount of $4,000 (CAD) to travel to Scotland and work on this project. No other funding was received for this work. Declaration of Interests: The authors declare no competing interests.

Adventures in nannydom: reclaiming collective action for the public's health.

Each of us has written about the importance of reframing the debate over public health paternalism. Our individual explorations of the many and varied paths forward from libertarian “nanny state” objections to the “new public health” have been intimately informed by collaboration. This article represents a summary of our current thinking — reflecting the ground gained through many fruitful exchanges and charting future collaborative efforts.Our starting point is that law is a vitally important determinant of population health, and the interplay among law, social norms, cultural beliefs, health behaviors, and healthy living conditions is complex. Anti-paternalists’ efforts to limit the scope of public health law to controlling only the proximal determinants of infectious diseases are utterly unjustifiable in the face of so much preventable death, disability, and disparity. Equally important, the anti-paternalism push is deeply counter-majoritarian and undemocratic, threatening to disable communities from undertaking measures to improve their own well-being.

Income inequality and population health: An analysis of panel data for 21 developed countries, 1975–2006

The relative income–health hypothesis postulates that income distribution is an important determinant of population health, but the age and sex patterns of this association are not well known. We tested the relative income–health hypothesis using panel data collected for 21 developed countries over 30 years. Net of trends in gross domestic product per head and unobserved period and country factors, income inequality measured by the Gini index is positively associated with the mortality of males and females at ages 1–14 and 15–49, and with the mortality of females at ages 65–89 albeit less strongly than for the younger age groups. These findings suggest that policies to decrease income inequality may improve health, especially that of children and young-to-middle-aged men and women. The mechanisms behind the income inequality–mortality association remain unknown and should be the focus of future research.

Socio-professional status as a major determinant of disparities in cardiovascular outcomes: contemporary data on the prognosis inof manual workersmen after an acute myocardial infarction

Introduction: Over the last decade in France, the early prognosis after acute myocardial infarction (AMI) has markedly improved. However, recent work suggests persistent socioeconomic disparities in outcomes after AMI. From a regional population-based study, we analyzed the prognosis in manual workers after AMI. Patients: Patients recorded in the ObservatoiRe des Infarctus du myocarde de Cote d'Or (RICO) between 2001 and 2011, < 65 y, with a current professional activity and follow-up at one year. Socio-professional categories (SPC) were collected according to INSEE definition. The primary endpoint was combined mortality and hospitalization for heart failure. Results: Among the 1671 patients included during the study period, 403 (24%) were manual workers. Mean age was 50.8 years, 85% were male and 50% had ST-segment elevation MI (STEMI). Although manual workers have a more favorable pattern of risk factors, the combined endpoint in manual workers was 3 times that in other SPC (7.9% vs. 2.6%). Multivariate analysis showed that manual work remained strongly associated with a worse prognosis, even after adjustment for confounders (OR (95% CI): 3.22 (1.44-7.17)). Conclusion: This large contemporary study showed that the medium-term prognosis in manual workers after AMI was still worse than in other SPC in France. Socio-professional status is an important determinant of population health and cardiovascular outcomes and may account for some of the heterogeneity in outcomes in patients hospitalized for AMI.

002: Socio-professional status as a major determinant of disparities in cardiovascular outcomes: contemporary data on the prognosis of workmen after an acute myocardial infarction

Over the last decade in France, early prognosis after acute myocardial infarction (AMI) markedly improved. However, recent works suggest persistent socioeconomic disparities in outcomes after AMI. From a regional population-based study, we aimed to analyze the prognosis of workmen after AMI. Patients enrolled in the Observatoire des Infarctus du myocarde de Côte d’Or (RICO) between 2001 and 2011, <65 y, with current occupational activity and follow-up at one year. Socio-professional categories (SPC) were collected according to INSEE definition. The primary endpoint combined mortality and hospitalization for heart failure. Among the 1671 patients included during the study period, 403 (24%) were workmen. Mean age was 50.8 years, 85% were male and 50% had ST segment elevation MI (STEMI). Although workmen have more favorable pattern of risk factors, the rate of combined endpoint was 3 fold higher among workmen vs other SPC (7.9% vs 2.6%). Multivariate analysis showed that workmen remain strongly associated with worse prognosis, even after adjustment for confounding (OR (95%CI): 3.22(1.44–7.17)). This large contemporary study showed that the medium-term prognosis of workmen after an AMI is still worse than other SPC in France. Socio-professional status is an important determinant of population health and cardiovascular outcomes and may account for some of the heterogeneity in outcomes for patients hospitalized with AMI.

The mediating effect of social relationships on the association between socioeconomic status and subjective health – results from the Heinz Nixdorf Recall cohort study

BackgroundSocioeconomic status (SES) is an important determinant of population health. Explanatory approaches on how SES determines health have so far included numerous factors, amongst them psychosocial factors such as social relationships. However, it is unclear whether social relationships can help explain socioeconomic differences in general subjective health. Do different aspects of social relationships contribute differently to the explanation? Based on a cohort study of middle and older aged residents (45 to 75 years) from the Ruhr Area in Germany our study tries to clarify the matter.MethodsFor the analyses data from the population-based prospective Heinz Nixdorf Recall (HNR) Study is used. As indicators of SES education, equivalent household income and occupational status were employed. Social relations were assessed by including structural as well as functional aspects. Structural aspects were estimated by the Social Integration Index (SII) and functional aspects were measured by availability of emotional and instrumental support. Data on general subjective health status was available for both baseline examination (2000–2003) and a 5-year follow-up (2006–2008). The sample consists of 4,146 men and women. Four logistic regression models were calculated: in the first model we controlled for age and subjective health at baseline, while in models 2 and 3, either functional or structural aspects of social relationships were introduced separately. Model 4 then included all variables. As former studies indicated different health effects of SES and social relations in men and women, analyses were conducted with the overall sample as well as for each gender alone.ResultsProspective associations of SES and subjective health were reduced after introducing social relationships into the regression models. Percentage reductions between 2% and 30% were observed in the overall sample when all aspects of social relations were included. The percentage reductions were strongest in the lowest SES group. Gender specific analyses revealed mediating effects of social relationships in women and men. The magnitude of mediating effects varied depending on the indicators of SES and social relations.ConclusionsSocial relationships substantially contribute to the explanation of SES differences in subjective health. Interventions for improving social relations which especially focus on socially deprived groups are likely to help reducing socioeconomic disparities in health.

YEARS OF LIFE LOST DUE TO COLD AND HOT TEMPERATURES IN BRISBANE, AUSTRALIA

Background and Aims: Temperature is an important determinant of population health. Most previous studies were formulated in terms of temperature-related mortality risk, but it is also useful to consider years of life lost. Information on years of life lost is of great concern for policy makers, as evidenced by the issue of mortality displacement. This study aims to estimate the years of life lost associated with changes in season and temperature in Brisbane, Australia. Methods: We used daily time series data on climate and mortality collected for Brisbane city between 1996 and 2004. The years of life lost were estimated by matching each death by age and sex to Australian life tables for the years 2002–2004. Regression was used to estimate the association between daily total years of life lost and daily maximum temperature, with adjustment for day of week, trend and season. To examine the non-linear and lagged effects of temperature, we used the distributed lag non-linear model. Results: There was no effect of season on years of life lost. The association between daily maximum temperature and daily total years of life lost was V-shaped with increased years of life lost for cold and hot temperatures. The lowest years of life lost were at 30 °C for men and 27 °C for women. The greater heat-related years of life lost were most associated with a shorter lag (same day exposure), and the largest cold-related years of life lost were most associated with a multiple days lag. Conclusions: This study provides evidence of increased years of life lost due to cold and hot temperatures. Extreme temperatures are known to cause increases in the number of deaths, our study demonstrates that temperature extremes also cause significant increases in years of life lost.

Editorial: The Public Health Needs for an Ageing Society

Population ageing is the sought-for outcome of improved public health, education and medical care over the last century. Worldwide, life expectancy is increasing. The health with which people age, given longer lives, has become a critically important determinant of population health and of development agendas as well as the economic well-being of nations. This issue of Public Health Reviews is devoted to the description and the analysis of how increased life expectancy and ageing affect population needs and compel us to modify public health science and leadership. It lays out the transitions in population science and the multilevel public health and policy agenda for the future necessary to support longer lives that are healthy and engaged. The public health consequences of longevity and population ageing do not come as a surprise. The emergence of ageing as a public health issue dates back to the mid-20 century. The demographic transition (as originally expressed in the 1920’s by Warren Thompson) predicted an increase in the proportion of aged people in the post-transitional period, i.e., as a result of the combination of low mortality and low birth rate. The link between the demographic transition and population health was further characterized by Omran in the 1970’s. The so-called epidemiologic transition characterizes the secular change between two epidemiological stages, i.e., from high fertility and a high, unstable frequency of rapidly lethal infectious diseases to a new situation of low fertility and health issues dominated by slowly progressing chronic and degenerative diseases. Cardiometabolic disease, cancer, neuropsychiatric diseases and musculo-skeletal conditions are now predominant (or will be soon) in most parts of the world. Several current observations were, however, unexpected. One is the ever-increasing longevity in most high income countries. Mortality is low,

ALCOHOL CONSUMPTION AND ALL-CAUSE MORTALITY IN BELARUS

The aims of the present study were: to estimate the effect of per capita alcohol consumption on all-cause mortality in Belarus and to compare the alcohol effect for Belarus with that found for other countries. Annual data on male all-cause mortality and alcohol sale per capita for the period 1970-2005 were analysed using the Box-Jenkins technique. Female mortality was included as a control variable and regarded as a proxy for other causal factors. The outcomes suggest that a 1-litre increase in consumption was associated with an increase in male all-cause mortality of about 2,3 %. The present study strengthens the notion of alcohol consumption as an important determinant of population health , and thus the notion that alcohol control must be a key priority for Belorussian public health policy.

Politics and health in eight European countries: A comparative study of mortality decline under social democracies and right-wing governments

Recent publications have argued that the welfare state is an important determinant of population health, and that social democracy in office and higher levels of health expenditure promote health progress. In the period 1950-2000, Greece, Portugal, and Spain were the poorest market economies in Europe, with a fragmented system of welfare provision, and many years of military or authoritarian right-wing regimes. In contrast, the five Nordic countries were the richest market economies in Europe, governed mostly by center or center-left coalitions often including the social democratic parties, and having a generous and universal welfare state. In spite of the socioeconomic and political differences, and a large gap between the five Nordic and the three southern nations in levels of health in 1950, population health indicators converged among these eight countries. Mean decadal gains in longevity of Portugal and Spain between 1950 and 2000 were almost three times greater than gains in Denmark, and about twice as great as those in Iceland, Norway and Sweden during the same period. All this raises serious doubts regarding the hypothesis that the political regime, the political party in office, the level of health care spending, and the type of welfare state exert major influences on population health. Either these factors are not major determinants of mortality decline, or their impact on population health in Nordic countries was more than offset by other health-promoting factors present in Southern Europe.

Per capita alcohol consumption and alcohol-related harm in Belarus, 1970-2005

Although alcohol seems to be an important determinant of the mortality crisis in the former Soviet Republic of Belarus, little systematic research has been done on the relationship between alcohol consumption and harm at the aggregate level. The aims of the present study were to estimate the effect of per capita alcohol consumption on all-cause mortality, mortality from alcohol poisoning and hospital admissions for alcohol psychosis in Belarus. Annual data on the three outcomes and alcohol sale per capita for the period 1970-2005 were analysed using the Box-Jenkins technique. Female mortality was included as a control variable and regarded as a proxy for other causal factors. To incorporate the lag structure, a weighted input was used in which a geometrical lag-scheme was applied. The outcomes suggest that a 1 l increase in consumption was associated with an increase in male all-cause mortality of ∼2.3%. The corresponding figures for alcohol poisoning mortality and alcohol psychosis admissions are 12 and 25%. The present study strengthens the notion of alcohol consumption as an important determinant of population health in this part of the world, and thus the notion that alcohol control must be a key priority for Belorussian public health policy.