168: The system will explode. air pollution and cancer. why is there a state?

In the “Pressing” program Satik Seyranyan the guest hLusine Yaghjian, epidemiologist, doctor, professor, lecturer at the University of Florida, USA is.

Lusine Yaghjian learned Yerevan State Medical Universityto whom, Master of Public Healthin: (MPH) degree American University of Armeniato whom, then continued his education A:Faculty of Health Sciencesto whom (in collaboration with the Johns Hopkins University Bloomberg School of Public Health), pDoctor of Philosophy (Ph.D.) is in epidemiology (USA:, ohio University of Cincinnati, Department of Environmental Health, Department of Epidemiology), Ohio, USA (Director: Dr. Susan Pinney): 2009–2013: Postdoctoral Researcher, Cancer Prevention and Control (University of Washington, St. Louis and Siteman Cancer Center, led by Dr Graham Cold). Since 2013, he has been working as a lecturer at the University of Florida, USA. Has 23 years of experience in healthcare and canceryhas a degree in epidemiology.

The main theses of the interview are below.

• The image of healthcare in Armenia is very worrying, the situation is very sad. All the efforts of the health care system are aimed at the last stage, when the patient is already in the hospital, while the stages of primary and secondary prevention are very important. Unfortunately, I don’t see it being done in Armenia. At most, secondary prevention is done, which, if not done correctly, will lead to system collapse.

• Until recently, there was no specific registry in Armenia in the field of oncology. Recently, some steps are being taken in that direction, but my attempts to get in touch with those responsible have not yielded any results. It takes years for that registry to be validated. It is necessary to actively monitor these patients, to be in constant contact with them. Without it, it is impossible to have clear, accurate data about oncological diseases.

• Screening programs are being added in Armenia, which brings with it new problems. Medical facilities performing testing or treatment must be prepared to serve large numbers of patients, because if large numbers of new patients are detected and not treated, the entire purpose of screening will be lost.:

• Any survey conducted in official reports should have a specific purpose, so that you can say this is the specific reason, and based on this, we can take the following steps. Queries aren’t just for drawing pretty charts. What’s more important, whether a person living in a village has an outdoor toilet or not, or that you’re bringing in labor from a country where hygiene is very poor and there are lots of viruses:

• One of the questions in those reports was about depression. The survey asked: Who is more depressed, those who lost in the 44-day war or those who did not? It’s clear, isn’t it, that the haves are more? So what’s the point of wasting a public resource on this survey? There are absurd questions in those surveys, and their purpose is not clear. 

• It was announced that the Ministry of Health of Armenia has started creating a cancer registry that will receive and collect data on cancer patients. However, I see a lack of accurate data collection. This not only affects the accuracy of health statistics and planning, but also creates obstacles. Furthermore, it is not possible to evaluate any implemented program if its data are inaccurate, the tools used for evaluation are inadequate, and the methods are not clearly defined.

• Sustainable and effective development of healthcare systems is possible only when the processes of management decision-making and resource allocation are based on reliable statistical data. With such information, it is possible to obtain a complete picture of population morbidity, mortality trends, workload of medical facilities, quality of services, geographic and social access, as well as provision of human resources. This is not done in Armenia, an unprofessional approach is shown. 

• Inconsistent accountability over the years, missing documentation that does not include data on deaths from COVID and the 44-day war. Instead, the official reports are full of useless graphs and useless information (toilet location, etc.). 

• In the United States, age-adjusted premature death rates from cancer have decreased by about 20% over the past two decades. Moreover, this happened thanks to the implementation of very aggressive prevention measures. And this is when the treatment methods in the US are even more innovative, the screening programs are even more aggressive. Meanwhile, in Armenia, according to the indicators given by the Ministry of Health, there is a 23% decrease in morbidity in 7 years.

• Statistics published by Anahit Avanesyan included premature deaths from cardiovascular disease per 100,000 population (decrease from 100.9 in 2018 to 85.7 in 2025 or a 15% decrease in 7 years) and cancer (decrease from 75.6 in 2018 to 58.4 or about 23% in 7 in the year). How so? In recent years, people have had the opportunity to go abroad, to be treated, to come, therefore, these positive indicators are not the achievement of Armenia, but of those countries.: People are being misled by providing false information.

• Proper cancer statistics require full coverage and proper accountability for standard data elements. Even if the registry is established, it will take time to verify its operation and use the data correctly.

• Are cases of cancer diagnosed abroad being properly accounted for? Positive cases of cancer patients treated in other countries outside of Armenia cannot reflect the quality of Armenia’s healthcare system. 

• Drinking, smoking and air pollution are some of the causes of cancer. If everyone stopped smoking, 70-80% of lung tumors would not occur. 30% of cancer cases can be reduced if air pollution levels are reduced. These are huge wings! Screening, of course, can change the situation if there is an understanding that the goal of screening is to treat a person quickly after an early diagnosis. If it depends on a person to stop drinking or smoking, then the issue of air pollution should be solved by the state, it is the government’s job. 

The problem of air pollution is given a large role in the development of cancer, because air is something that the state must deal with. It does not depend on a person’s will, people have to breathe that air whether they like it or not. Air pollution has been proven to have a huge impact, so why isn’t it being addressed as well as drinking water quality?

• Let the Minister of Health, Anahit Avanesyan, explain what is the reason that in the last 3 years, the incidence of prostate disease has increased by 60%, and that of the breast by 20%, and nothing is being done about it. I would like to hear his answer.

• Along with the spread of drug addiction, the number of hepatitis and AIDS patients is increasing. Available figures show that the picture is getting worse. Medical centers should keep this in mind.

Those who come from other countries must undergo a check-up so that they do not have an infection and do not bring infections from their countries to Armenia. The same goes for tuberculosis. India, China and Pakistan are in the first place in the number of tuberculosis carriers. Why do we endanger the health of our citizens, especially since those who come do not know that they are sick and will infect others… And these diseases require long-term and expensive treatment for life. Who will pay for it if our population becomes infected?

If the state doesn’t do it, at least employers should try to prevent it. The solution is that no employer should be allowed to hire workers from those countries unless they have tested positive for the specified diseases.:

Those leaving for long-term work in the United States and other countries must submit the answers to these tests.

• In the US, both sperm and blood donors receive a certain amount of money. And if we take this into account, it is not excluded that drug addicts also want to donate sperm and be a danger to the women who will be its recipients. It is a matter of national security and there should be strict control.

• If there is no registry of sperm donors in Armenia, and the number of donors is also small, then after some time there will be a generation where the probability of being siblings is high, increasing, with all the resulting genetic consequences: diseases, mortality, health problems, genetic defects, etc. I repeat, it is a matter of national security. 

• About the universal health insurance system implemented in Armenia. Sooner or later, the system will explode if steps are not taken, especially since the flow of patients will increase and the workload of doctors will increase. This problem also exists in the USA. knowing that the patient is insured, many tests are ordered, but there is a specialist who says what is needed and what is not. Is there such a specialist in Armenia? I’m not sure. It turns out that patients who really need treatment will have to wait. And I feel sorry for the doctors who have to admit patients with such a large flow, explain, talk about the condition. It’s tough both physically and psychologically.

• I would advise your colleagues to ask questions to Anahit Avanesyan again: morbidity is increasing, how do you explain it, how do you evaluate it as an improvement of the situation, when the numbers show a completely opposite picture?

Details in the video.

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