‘One Decision, Millions Of Lives:’ Nanushyan On Cutting Smoking And Out-Of-Pocket Costs – Health Policy Watch

Report on Armenia’s Health Reforms and Alignment with Sustainable Development Goals

Introduction: Integrating Public Health and Universal Health Coverage for SDG 3

Armenia is implementing a dual-pronged health reform strategy focused on strengthening tobacco control and introducing universal health insurance. According to First Deputy Health Minister Lena Nanushyan, these initiatives are designed to be mutually reinforcing, directly contributing to the achievement of Sustainable Development Goal 3 (Good Health and Well-being). The core principle of this approach is that “Public health and universal health coverage are inseparable,” aiming to reduce the national disease burden while simultaneously protecting citizens from financial hardship.

Advancing SDG Target 3.a through National Tobacco Control

In alignment with SDG Target 3.a (Strengthen the implementation of the WHO Framework Convention on Tobacco Control), Armenia has prioritized tobacco control as a key public health intervention. This decision was informed by a UN/WHO investment case demonstrating its potential for significant health gains, which also supports SDG Target 3.4 (Reduce premature mortality from non-communicable diseases).

• Prevalence: The initiative addresses a critical health issue, with over half of Armenian men smoking and a rising use of e-cigarettes among adolescents.
• Legislation: A comprehensive law was passed despite industry opposition, with a phased implementation approach introducing new provisions annually.

Implementation and Monitoring Strategy

Effective enforcement and behavioral change are central to the long-term success of the tobacco control policy. The Ministry of Health has outlined a multi-faceted strategy:

1. Continuous Enforcement: Recognizing that legislation alone is insufficient, daily efforts are required to ensure compliance.
2. Support Systems: The government is providing cessation support for individuals wishing to quit smoking.
3. Public Education: School-based educational programs are being implemented to prevent tobacco uptake among youth.
4. Data-Driven Assessment: A new national survey is planned to assess behavioral changes by comparing data with a baseline from seven years prior.

Achieving SDG Target 3.8 via Universal Health Insurance

Shaped by lessons from the COVID-19 pandemic and a recent conflict, Armenia is advancing universal health insurance to achieve SDG Target 3.8 (Achieve universal health coverage, including financial risk protection). The reform aims to institutionalize resilience within the health system and protect households from financial distress, thereby also contributing to SDG 1 (No Poverty).

• Primary Objective: The system, funded by small monthly contributions, is designed to curb high out-of-pocket spending and prevent “catastrophic expenses” for families.
• System Strengthening: The reform is coupled with efforts to build a more robust healthcare infrastructure, including:
  • Stronger primary care services.
  • Improved quality of laboratories and medicines.
  • Enhanced preparedness of the health workforce.

Leveraging SDG 17: Partnerships and Advocacy for Sustainable Reform

The progress of Armenia’s health reforms highlights the importance of collaboration, as emphasized in SDG 17 (Partnerships for the Goals). Success has been attributed to a combination of national efforts and international cooperation.

• Enabling Factors: Key drivers include effective cross-government negotiation, data-driven advocacy, and leveraging expertise from Armenia’s global diaspora.
• Call for Global Solidarity: A call was made for a “stronger public health voice” on the international stage, advocating for increased solidarity and unified action to support national health initiatives worldwide.

Analysis of SDGs in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The article’s primary focus is on public health initiatives in Armenia. It discusses measures to improve population health, such as tobacco control to “cut disease” and the implementation of universal health insurance to ensure access to healthcare. These actions directly contribute to ensuring healthy lives and promoting well-being for all at all ages.
2. SDG 17: Partnerships for the Goals
   • The article highlights the importance of collaboration. It mentions “cross-government negotiation” and leveraging expertise from “Armenia’s global diaspora” as key factors in advancing health reforms. Furthermore, the call for a “louder international chorus” and “more solidarity” emphasizes the need for global partnerships to strengthen public health systems, which aligns with the spirit of SDG 17.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • The article’s emphasis on “tougher tobacco controls” is a direct strategy to prevent non-communicable diseases (NCDs) like cancer, cardiovascular disease, and chronic respiratory diseases, for which tobacco is a primary risk factor. The goal to “cut disease” through these measures directly supports the reduction of premature mortality from NCDs.
2. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
   • This target is explicitly addressed through Armenia’s “coming universal health insurance reform.” The article states the reform is designed to protect “households from catastrophic medical bills” and “curb out-of-pocket spending,” which are core components of financial risk protection under universal health coverage.
3. Target 3.a: Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate.
   • The article details Armenia’s efforts to implement “tougher tobacco controls,” making it a “number one priority.” This includes passing new laws, enforcing them, providing cessation support, and conducting school-based education, all of which are key actions for implementing the WHO FCTC.
4. Target 17.17: Encourage and promote effective public, public-private and civil society partnerships, building on the experience and resourcing strategies of partnerships.
   • The success of the reforms is credited to “cross-government negotiation” and input from the “global diaspora.” This demonstrates the use of multi-stakeholder partnerships (public and civil society) to achieve health goals.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Implied Indicator for Target 3.a (Prevalence of tobacco use):
   • The article provides baseline data by stating that “More than half of Armenian men smoke, while vaping and e-cigarettes are rising among adolescents.” Progress can be measured against this. Furthermore, it mentions a plan to “compare a new national survey with data from seven years ago to assess behaviour change,” which directly refers to the methodology for tracking the prevalence of tobacco use (Indicator 3.a.1: Age-standardized prevalence of current tobacco use among persons aged 15 years and older).
2. Implied Indicator for Target 3.8 (Financial hardship due to health spending):
   • The article’s stated goal is to “protecting households from catastrophic medical bills” and “curb out-of-pocket spending.” This directly relates to Indicator 3.8.2 (Proportion of population with large household expenditures on health as a share of total household expenditure or income). The success of the universal health insurance reform would be measured by a reduction in this proportion.

4. Summary Table of SDGs, Targets, and Indicators

Source: healthpolicy-watch.news