The city of Astana, the capital of the former Soviet republic of Kazakhstan, is well known to U.S. professional cycling fans as the team sponsor for Lance Armstrong and his rival Alberto Contador, who won this year's Tour de France. Earlier today I met two earnest physicians from Astana who are in the United States to learn about public health and prevention in order to inform their country's effort to reduce death rates from preventable diseases. Despite obvious differences in size, history, and demographics, the similarities between Kazakhstan and the U.S. in health policy are striking. Like us, they have concluded that promoting healthy behaviors such as smoking cessation, alcohol moderation, diet, and regular physical activity are the keys to improving the long-term health of their population. Like us, they are moving to enact health reforms to ensure that all of their citizens have access to screening tests and other preventive services. And they told us a story that could teach U.S. health care reformers a thing or two.
Several years ago, the government of Kazakhstan decided to made a major investment in modern health care facilities - primarily by expanding specialty clinics and hospitals. They focused on acquiring the most advanced diagnostic and treatment technologies and training specialist physicians in the use of those technologies. The result? Mortality and disease rates remained the same, or rose. Astana's health officials belatedly realized that their neglect of their country's primary care infrastructure made it difficult for people to access care, or have their care coordinated by primary care physicians. To their credit, they have diagnosed the problem and are moving aggressively toward a solution - including reforming their system of medical education to produce greater numbers of primary care physicians. In my opinion, Washington, DC would do well to learn from Astana's example.