BIRMINGHAM, Alabama — The Republic of Bulgaria, located in Southeast Europe, has the highest mortality rate in the world. The leading cause of death is cardiovascular disease. Lack of access for people who cannot afford to pay for the compulsory health insurance program remains persistent. This further links poverty, high mortality rates and health care in Bulgaria, particularly for social and ethnic minorities, rural citizens, disabled citizens and unemployed citizens. However, the country’s government continues to work to improve its health care system, recognizing the impact of poverty in Bulgaria. Here are critical aspects of the link between the mortality rate and poverty in Bulgaria.
How Poverty Impacts Bulgaria’s Mortality Rate
- Bulgaria has a shrinking population. Collective farming and factory work became a primary part of the nation throughout the twentieth century. Once communism fell in 1989, many citizens began to leave Bulgaria in search of new jobs and prospects. Since the 1990s, the country has lost one-fifth of its population. Furthermore, a low rate of births and a high mortality rate contribute to the issue of a shrinking population. Of note: As the working-age population shrinks, the financial foundation of the social health care system weakens as well.
- Cardiovascular disease is the leading cause of death. In 2013, 60% of all deaths in Bulgaria were caused by cardiovascular diseases. Many factors, such as smoking, physical inactivity, unhealthy diets and alcohol abuse can contribute to cardiovascular disease. The country joined Joint Action on Chronic Diseases (JA-CHRODIS), an international effort between more than 60 partners from 26 E.U. member states that aimed to reduce instances of chronic diseases. Bulgaria employed the National Program for Prevention of Chronic Non-Communicable Diseases 2014-2020 in order to improve health and mortality rates, as well as risk factors for certain diseases. Addressing public health safety, notably with a focus on cardiovascular and other diseases, stood as a primary target of the organization’s goals.
- Health insurance is not accessible to all citizens. There are two types of health insurance in the country: compulsory insurance and voluntary or complementary insurance. The compulsory insurance, aimed to be accessible for all citizens, requires 8% of a citizen’s monthly income. However, this bar remains out of reach for citizens without jobs. The unemployment rate in Bulgaria is currently 5.7% even as the system remains less accessible to unemployed or impoverished citizens. Trends indicate that health care revenue by taxation has decreased as well, indicating that individuals have had to increasingly pay out of pocket. This rising burden disproportionately hurts the nation’s poor, sometimes forcing the choice between destitution or treatment. Decreasing poverty and increasing health care access will minimize the link between high mortality rates and poverty in Bulgaria.
- Bulgaria has made progress in reducing poverty rates. The country had a national poverty rate of 24% in 2006. Varied improvements, such as increasing wages for unskilled laborers and increasing purchasing power in low-income households, have continued to help reduce poverty levels. As of 2017, Bulgaria’s poverty rate stands at 7.5%. The National Strategy for Poverty Reduction and Social Inclusion Promotion 2020 was also created to develop target areas for government policies centered on poverty and social inclusion. Due to its high at-risk-of-poverty percentage, Bulgaria still works to reduce poverty rates even further.
- Altruistic organizations aim to help Bulgaria alleviate poverty. The European Anti-Poverty Network (EAPN) works to fight poverty and social exclusion. Formed by anti-poverty nonprofit organizations and European organizations, this network works with different countries to develop projects and policies to eradicate poverty. EAPN has helped Bulgaria improve its Strategy Against Poverty and Social Exclusion by primarily focusing on labor market policies and social assistance policies. The network recommends a “comprehensive and long-term vision, based on inclusive growth and aimed at internal cohesion” for the sake of Bulgarians across the country.
Many unemployed citizens in Bulgaria do not have access to health insurance, and a weakening health care system decreases access for the most vulnerable citizens. However, direct work to improve public health care shows progress. Moreover, understanding the connection between high mortality rates and poverty in Bulgaria opens new avenues of action. The stakes remain high, but poverty-reduction efforts are more meaningful as a result.
– Mia Banuelos