Second Environmental Performance Review of Albania

Chapter 10: Human health and environment137average (Table 10.2). Thus, considerable effort isneeded if MDG 5, which aims to reduce the maternalmortality rate by three quarters between 1990 and2015, is to be attained.Mortality by main causes of deathBoth the regular reporting of mortality by cause andthe latest WHO estimates show that noncommunicablediseases continue to represent themajor proportion of deaths and of years of life lost ofAlbanians. Similarly to the situation in the rest ofEurope, cardiovascular diseases constitute the leadingcause of death, followed by cancer. Ill-defined causes– when the main cause of death is classified undersymptoms, signs, abnormal findings, etc. – persistedas a cause of 13-14 per cent of deaths in Albania,indicating the need to strengthen health informationcapacities for diagnosis and death registration.Overall mortality in Albania has decreased over time,in particular in the second half of the 1990s. Sincethen, progress in all-causes mortality and that of theleading underlying causes has been inconsistent andrather slow as compared with the steady decrease inEU averages. In 2005, diseases of the circulatorysystem caused more than half of all deaths in Albaniaand air pollution both, ambient and indoor, contributeto it. Cancer caused only every seventh death inAlbania, which may be at least partly explained bydifferences in the classification and registration ofcauses of death. External causes and respiratorydiseases each accounted for about 5 per cent, andcommunicable diseases only 0.5 per cent, of alldeaths (Table 10.3). Other country groups showedsimilar distribution of cause-specific mortality in2005, with the exception of the EU countries, inwhich diseases of the circulatory system accountedfor about 40 per cent of total deaths, most likely dueto more effective health care and prevention of healthrisks, including environmental risks.Selected trends in morbidityAccording to the regularly reported hospital-basedmorbidity data, respiratory and gastrointestinaldiseases continue to be the main causes and the ratesare high – in 2007, they were 1,527 and 1,358 per100,000 respectively. This important toll ofmorbidity is largely preventable through anintegrated approach addressing risk factors that spanmany different policy sectors beyond health. Forexample, reducing the main risk factors of respiratorydisease morbidity such as indoor air pollution relatedto tobacco smoke and solid fuel used for cooking andheating, outdoor air pollution, and occupational dustsand chemicals, implies the involvement oftransportation, industry, housing, and occupationalhealth and safety institutions.Morbidity due to infectious and parasitic diseases isalso high. The rates of hospital discharges are greaterthan those of the EU: in 2007, they were 649 and 408per 100,000 respectively. Infectious diseases relatedto water and food contamination, and poor hygieneand sanitation, though decreasing, are a significantpublic health issue. The same is true of epizoonoticdiseases such as brucellosis transmitted throughunpasteurised milk or meat. Figure 10.1 displays thesignificantly higher incidence rates of brucellosis,shigellosis and typhoid fever in Albania as comparedwith the CEEC and the EU averages. It indicates thatinfectious diseases are not a major cause of mortality,but remain a significant morbidity burden.Viral hepatitis, especially the most common HepatitisA which is particularly frequent under poor sanitaryand hygiene conditions, is still an important publichealth problem in Albania. A new hepatitis casebasedsurveillance system is underway. As regardstuberculosis, incidence rates have decreased since2000 and are similar to those of the EU, which can berelated to the improvement of living standards andhealth care.Health risks related to environmental factorsAir qualityDue to the lack of coordination of actions in the past,consistent data from air quality monitoring onparticulate matter (PM 10 , PM 2.5 ) relevant forpopulation exposure is currently limited to onemonitoring station in the centre of Tirana, which hasbeen operational since the summer of 2010. IPHoperates air quality monitoring under contract toMoEFWA, which has responsibility for air quality.Extension of the comprehensive monitoring networkis underway but overall progress with those positivedevelopments has been slow.Ambient air pollution is now recognised as a serioushealth problem in the main cities of Albania, in partas a result of information from WHO stating thatpollution levels in Tirana are reducing lifeexpectancy by 1.5 years. The rapid urbanisation andassociated major increase in residential andcommercial building construction contributesignificantly to air pollution, together with the currentbad condition of streets and roads within the urbanareas. With the dramatic increase in the number ofcars, and the number of old vehicles in use, traffic inurban areas is now a major cause of air pollution.