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Life Expectancy: 74.36 years F / 65.16 years M

Top Ten Causes of Death: Ischemic heart disease, stroke, cirrhosis, lung cancer, Alzheimer's disease, cardiomyopathy, colorectal cancer, self-harm, chronic obstructive pulmonary disease (COPD), and stomach cancer

Ukraine has among the highest burdens of HIV/AIDS in Eastern Europe and close to the highest rate of multi-drug resistant tuberculosis (MDR-TB) in the world

Gender and class differences in health lifestyle practices appear to be key variables

Working-class males show the most negative practices in the results for frequent drinking, smoking, and diet

Females confront increased sexual and gender-based violence and perilous health conditions while being forced to make life-and-death survival decisions for their families

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Healthcare Values and Beliefs:

Ukrainians prefer a lot of at-home remedies rather than conventional medicine

Traditional remedies are believed to be more effective and less expensive than prescription medication

Many Ukrainians deny vaccines to all ages

General Values and Beliefs:

Ukrainians value their education and professionalism

Religion and family values are top tier for Ukrainians

Ukrainians are very friendly and welcoming, eye contact is a way to show respect for the Ukrainian culture

Ukrainians will always offer food and hospitality to any guest

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Common Languages:

The language that is most widely spoken in Ukraine is Ukrainian

Ukrainian is closely related to Russian but also has distinct similarities to the Polish language

- 67% of the population of Ukraine speaks Ukrainian

-30% of the population of Ukraine speaks Russian

-19% of the population of Ukraine speaks both languages

Ukrainian was not officially considered a language until the end of the 18th century

Common Religions:

Ukraine is characterized by a mix of religions that consist of Easter Orthodox Christianity, Catholicism, Protestantism, Judaism, and Islam

Eastern Orthodoxy: The majority of Ukrainians identify with Eastern Orthodoxy. The Ukrainian Orthodox Church is the largest religious body in the country

Catholicism: Catholicism, particularly the Roman Catholic Church, has a significant presence in western Ukraine

Protestantism: Various Protestant denominations have followers in Ukraine, including Baptists, Evangelicals, and Pentecostals

Judaism: Ukraine has a historical Jewish community

Islam: There is a Muslim minority in Ukraine, with followers of Islam, primarily Sunni, residing in different regions

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The Ukrainian Greek Catholic Church is the largest Eastern Catholic Church in the country

Third-Most Beautiful Language In The World

Ukraine is the largest country in Europe

Ukraine is home to seven world heritage sites

Inhabitation Dates Back To The Fifth Century BC

Ukraine's most popular sport is football (soccer)

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When caring for Ukrainians, recognize that they tend to have high rates of cardiovascular disease and the associated risk factors (diabetes, high cholesterol, and hypertension)

Ukrainians' use of herbal and alternative remedies may complicate management of chronic diseases

Culturally, rates of excessive alcohol consumption as well as infectious diseases such as HIV and TB are prevalent due to intravenous drug use

Stigma surrounding mental health is present in Ukrainian culture and may prevent clients from speaking up about mental health challenges

Vaccine hesitancy

Unplanned migration that comes from conflict in Ukraine has serious implications on people's health

Be sure to consider language barriers and have a translator on hand when treating Ukrainians

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https://translatorswithoutborders.org/language-data-for-ukraine

https://www.cdc.gov/globalhealth/countries/ukraine/default.htm

https://www.who.int/europe/news/item/24-10-2022-accessing-health-care-in-ukraine-after-8-months-of-war--the-health-system-remains-resilient--but-key-health-services-and-medicine-are-increasingly-unaffordable

https://www.usaid.gov/ukraine/health#:~:text=Ukraine%20has%20among%20the%20highest,%2DTB)%20in%20the%20world.

https://www.statista.com/statistics/974733/life-expectancy-at-birth-in-ukraine-by-gender/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260664/

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BACKGROUND

The conflict in Ukraine has displaced millions of people, creating a new refugee crisis. A formal route exists for Ukrainians to reside and access health care in the UK, including primary care. In this article we explore the health of refugees from Ukraine before, during, and after their migration to the UK, with a particular lens focusing on how UK primary care can seek to meet these needs.

BEFORE TRANSIT

Ukraine is a lower middle-income country in Eastern Europe. It is predominantly Slavic in culture (Ukrainian/Russian-speaking) with a number of ethnic minority groups. Culturally, a comparatively high proportion of Ukrainians identify with a religion, particularly Christianity. Over the past three decades, community health care in Ukraine has expanded to include GP-led primary care services alongside district physicians within multidisciplinary Semashko polyclinics.1 The private healthcare sector is robust, with direct access to specialists, diagnostics, and treatment for those who can afford it.

Rates of cardiovascular disease and associated risk factors, including diabetes, cholesterol, and hypertension are high. Prevalence of thyroid disease and malignancy are high in some parts of Ukraine, a legacy of the Chernobyl nuclear disaster of 1986. Lifestyle choices, limited health literacy, and frequent use of herbal and alternative remedies complicate chronic disease management.2

Rates of excess alcohol consumption and certain infectious diseases are higher than in the UK, particularly tuberculosis and HIV due to intravenous drug use. Individuals may choose not to openly disclose these conditions to a doctor. Mental health stigma exists, in part a legacy of questionable management of many mental health conditions within large residential care centres ('internats'). The prolonged conflict in Eastern Ukraine has led to an increased prevalence of post-traumatic stress disorder.3 COVID-19 vaccination rates in Ukraine are currently around 35%, in part due to significant vaccine hesitancy.4

DURING CONFLICT AND TRANSIT

The conflict has disrupted supply chains, meaning many individuals have had difficulty accessing essential medications, including thyroxine and insulin. Medical facilities have been damaged, with personnel killed, injured, or redeployed. The rapid and potentially unplanned migration stemming from the conflict has put individuals' health at risk, with specific vulnerabilities according to an individual's sex, ethnicity, and age. The majority of refugees from Ukraine are women and children. Individuals may have undergone long journeys under precarious conditions, with limited access to medication, health care, translation, finances, and social support. Criminal, physical, and sexual exploitation of Ukrainians is already being reported.5

IN THE HOST COUNTRY

Universal health coverage does not necessarily ensure equality of care. Health capacity and capabilities in some European transit countries are becoming overstretched. Lessons for the NHS can be learned from other Central and Eastern Europeans' experiences of migration to the UK, including the social and environmental factors that have compromised their physical and mental health.6,7 Prevalence of mental health conditions and alcohol overuse are concerningly high.7,8 Delayed primary care registration and presentation is common. Unfamiliarity with UK clinician communication approaches including telephone consultations, short consultation durations, and shared and self-care has led to disengagement. Refugees from Ukraine are likely to share many of these characteristics. Their engagement with primary care may be complicated by a limited number of Ukrainian healthcare staff/translators and the impact of trauma. Furthermore, Ukrainians are not familiar with waiting lists for specialist review - expectations and needs will need to be sensitively managed.

THE RESPONSE OF PRIMARY CARE

Providing effective primary care for refugees from Ukraine will require a culturally-informed and medically sound approach. Suggestions include:

1. Review access to primary care services, including registration, appointment booking, and translator access. Printable resources are available in Ukrainian and Russian on how the NHS works.9 Feedback and input from Central/Eastern European and refugee patients could inform this process.

2. Implement structured health and social screening within practice registration including immunisation status, infectious (TB, hepatitis C, and HIV [when indicated]), nutritional, metabolic, and mental health disorders. Creating a patient record template will ease this process.10

3. Assess for 'red flags' within consultations, including psychological trauma and exploitation (modern slavery, sexual trafficking, and child exploitation). E-learning resources are available to support post-war mental health care for Ukrainian adults and children.11,12

4. Considering culturally tailored strategies to meet complex health and social needs. This will require ongoing compassion, patience, and recognition of a shared humanity. Management options may include liaising with local and national support organisations for Ukrainians and refugees (see below).

RESOURCES

Local and national organisations supporting Ukrainians in the UK include:

SOCIAL, CULTURAL, AND RELIGIOUS

ADVOCACY, COUNSELLING, AND DOMESTIC VIOLENCE

REFERENCES

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

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Providing responsive primary care for Ukrainian refugees

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The conflict in Ukraine has displaced millions of people, creating a new refugee crisis. A formal route exists for Ukrainians to reside and access health care in the UK, including primary care. In this article we explore the health of refugees from Ukraine before, during, and after their migration to the UK, with a particular lens focusing on how UK primary care can seek to meet these needs.

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1. Name 3 causes of death in Ukraine

2. What is the most widely spoken language in Ukraine?

3. Ukraine has among the highest burdens of ________ in Eastern Europe