The effects of dictatorship on health: the case of Turkmenistan.
BACKGROUND
There is a health crisis in Turkmenistan similar to, but more severe than, in other Central Asian countries. This paper asks whether the health crisis in Turkmenistan is attributable to the consequences of the dictatorship under president Niyazov, who died in 2006.


METHODS
The basis for this paper was a series of semi-structured in-depth interviews with key informants complemented by an iterative search of internet sites, initially published as a report in April 2005, and subsequently updated with feedback on the report as well as a comprehensive search of secondary information sources and databases.


RESULTS
This paper describes in depth three areas in which the dictatorship in Turkmenistan had a negative impact on population health: the regime's policy of secrecy and denial, which sees the "solution" to health care problems in concealment rather than prevention; its complicity in the trafficking of drugs from Afghanistan; and the neglect of its health care system.


CONCLUSIONS
The paper concludes that dictatorship has contributed to the health crisis facing Turkmenistan. One of the first tests of the new regime will be whether it can address this crisis.
European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK. bernd.rechel@lshtm.ac.uk
Bernd
B
Rechel
Martin
M
McKee
D000818:Animals; D001717:Birds; D003695:Delivery of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data; D015658:HIV Infections / Q000453:epidemiology; D006291:Health Policy; D006304:Health Status; D006305:Health Status Indicators; D006280:Health Workforce; D006806:Human Rights; D006801:Humans; D005585:Influenza in Birds / Q000453:epidemiology; D033181:Information Dissemination; D020407:Internet; D010930:Plague / Q000453:epidemiology; D011056:Political Systems; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D014342:Truth Disclosure; D014376:Tuberculosis / Q000453:epidemiology; D014423:Turkmenistan / Q000453:epidemiology