Genetic Counseling and Preventive Medicine in Post-War Bosnia

Philip C. Aka

• Publisher: Palgrave Macmillan
• Year: 2020
• Print ISBN:
  9789811579868
• eBook ISBN:
  9789811579875
• Topic: Social Sciences
• Subtopic: Medical Theory, Practice & Reference
• Index: Social Sciences

Genetic Counseling and Preventive Medicine in Post-War Bosnia offers a unique new perspective to longstanding debates on healthcare reforms in Bosnia. In this penetrating analysis, Philip C. Aka argues that twenty-five years after the ethnic war that shook Bosnia and Herzegovina to its foundations, healthcare reforms are a function of preventive medicine, defined as genetic counselling, backed by tobacco and alcohol control. At its core, the book offers a fresh examination of healthcare reforms in Bosnia set in the multidisciplinary field of bioethics, supplemented by comparative health studies, and comparative human rights. By offering an extensive list of electronically accessible literature on healthcare accessible in the public domain, Aka delivers an exemplar of research possibilities in the Information Age.

© The Author(s) 2020

P. C. AkaGenetic Counseling and Preventive Medicine in Post-War Bosniahttps://doi.org/10.1007/978-981-15-7987-5_1

Begin Abstract

1. Introduction

Philip C. Aka¹

(1)

International University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Abstract

This chapter provides a statement relating to the debate on healthcare reforms in Bosnia, including a primer on the country, the argument of the study, and the book’s organization.

Keywords

Healthcare in Bosnia’s Reform AgendaGenetic counselingPreventive medicineBioethicsComparative healthcare studiesComparative human right studies

End Abstract

Primer on Bosnia and Herzegovina

Bosnia and Herzegovina (BiH)¹ is a state of two entities, plus a self-governing unit, a federation of sorts, dominated by three ethnic communities.² Geographically speaking, BiH is located in south-eastern Europe, west of the Balkan Peninsula.³ With a landmass of 51,197 square kilometers, BiH is comparable in size to the State of West Virginia in the United States (62,758 square kilometers), Croatia (56,594 square kilometers), and Slovakia (49,035 square kilometers).⁴ The country is bordered by Croatia to the north, Serbia and Montenegro to the east, and the Adriatic Sea to the south, with a total boundary length of 1389 kilometers.⁵

BiH has a population of 3.5 million people.⁶ The figure is 1 million people less than 4.5 million persons from the prewar census in 1991.⁷ The significant drop in population is due to various factors, including a negative perception of their socioeconomic futures by many Bosnians and a fertility rate below replacement numbers.⁸ Bosnia is a post-socialist state with a service-based economy.⁹ It is one of six components of former Socialist Federal Republic of Yugoslavia (SFRY).¹⁰ SFRY existed from 1945 to 1992, although its roots date back to the Kingdom of Serbs, Croats, and Slovens, formed in December of 1918.¹¹ Bosnians’ self-awareness of their separate statehood goes back in time to the tenth century.¹² One recent expression of this self-image was in 1943 when BiH’s present boundaries were determined as part of a boundary-making exercise for the whole of Yugoslavia.¹³

Healthcare in Bosnia’s Reform Agenda

In September of 2015, fourteen governments which make up Bosnia and Herzegovina drew up a set of proposals for reform in several fields of national development that included healthcare.¹⁴ The fourteen governments were the Council of Ministers of Bosnia and Herzegovina, the Government of the Federation of Bosnia and Herzegovina (FBiH),¹⁵ the Government of Republika Srpska (RS), the Government of Brčko District, and the governments of the ten Cantons in FBiH—Una-Sana, Posavina, Tuzla, Zenica-Doboj, Bosnia-Podrinje, Central Bosnia, Herzegovina-Neretva, West Herzegovina, Sarajevo, and Canton 10 (West Bosnia Canton).¹⁶ The fourteen governmental units, minus the Council of Ministers of Bosnia and Herzegovina, constitute the BiH healthcare system, itself alternatively organized around two entities, plus a self-governing unit—FBiH and its ten Cantons, RS, and Brčko District.¹⁷

Broadly, the fourteen governments “recognize[d] an urgent need to initiate a process of rehabilitating and modernizing the economy with a view to” realizing certain cherished values, such as “fostering sustainable, efficient, socially[-]just and steady economic growth; [and] creating new jobs[.]”¹⁸ With specific reference to healthcare, the fourteen governments pledged to curtail “the burden on labor needs” “by reducing contributions for health insurance, coupled at the same time with the need to ensure additional revenues for extra-budgetary funds to cover the losses generated as a result of the reduced contribution rate.”¹⁹ The team of fourteen governments also pledged to “seek financial and technical assistance [from] the World Bank to implement” several aspects of healthcare reform, “includ[ing] a solution for outstanding debts,” and defining “new models and sources of funding, with a more precise regulation of the network of health care institutions.”²⁰ Finally, the fourteen governments proposed to “support an increase in excise duties on tobacco and alcohol which will be the direct income of the health insurance fund of the RS and health insurance funds in the FBiH, Cantons[,] and Brčko District by the end of 2015.”²¹ These pledges of healthcare reform culminated “an increased demand from many sectors for improved and comprehensive information on the workings and quality of the health care system in Bosnia and Herzegovina,” the Office of the United Nations High Commissioner for Refugees (UNHCR) in Sarajevo commented upon in a study that the office published in 2001.²²

Argument

This book contributes to the long-standing debate on healthcare reforms that reached a high point in the Reform Agenda for BiH discussed in the previous section. Bosnia is a nation forged in war.²³ Twenty-five years after the bloody fighting, Bosnians have yet to recover fully from the war that shook the country to its very foundation on the verge of its nationhood.²⁴ The contribution to the debate on healthcare reforms this book embodies revolves around the concept of preventive medicine—quality medical attention short of complex examination and treatment, that is actuated by the need to remove the causes of ill-health.²⁵ The book portrays preventive medicine as a function of progress in genetic counseling,²⁶ plus alcohol and tobacco controls.²⁷ More elaborately, the book’s argument is that twenty-five years after the ethnic war that shook Bosnia and Herzegovina to its foundations at the dawn of its independent nationhood, healthcare reforms in the land is a function of preventive medicine, defined as genetic counseling, backed by alcohol and tobacco controls.²⁸

BiH maintains an abiding commitment to socioeconomic human rights, including healthcare, that dates back to its socialist incarnation in Yugoslavia.²⁹ However, enjoyment of these rights by citizens, particularly the healthcare rights at the focus of this book, lacks depth.³⁰ This is due to multiple forces which individually and collectively took a decided toll on these guarantees. Predictions are hazardous and this book takes no cause-and-effect position on the matter, but a foundational factor was the destruction of health and other infrastructure by the internecine war from 1992 to 1995 that convulsed BiH.³¹ About 200,000 people died during the war with another 240,000 wounded, many of them seriously, some to the point of permanent disability.³² Many of these were healthcare workers.³³ The war also devastated much of the country’s already-modest healthcare infrastructure.³⁴ Problems after the war with negative ramifications for healthcare, including genetic testing and counseling at the heart of this study, revolved around deficiencies in the various hallmarks of a good healthcare system,³⁵ that this book pulls together in Chap. 4.

In the light of the foregoing, it may be argued that the quantity and quality of healthcare services produced today in BiH fall below “the facilities available in Western Europe” and the level achieved before the war.³⁶ First, the level of healthcare services provided to insured persons falls below the level guaranteed by law.³⁷ Second, despite the promise of an unalienable right to healthcare, a large number of the populace lack acc...

Table of contents

• Cover
• Front Matter
• 1. Introduction
• Part I. Starting Point
• Part II. Healthcare Reforms as Human Rights in Bosnia
• Part III. Toward Preventive Medicine in Bosnia
• Back Matter