According to research findings and statistics on morbidity, the incidence of diseases and other health problems among children has increased 13 percent since 1965, and the trend is consistently rising. To a large extent, this is an outcome of a deteriorating environment and spreading infection in overcrowded preschool facilities and school classrooms. The proportion of adolescents in need of regular health care is constantly growing. Psychological burdens in school are a major factor.

The extent among children of major health problems which tend eventually to be irremediable is often underestimated. Such are problems with eyesight, orthopedic deformities and psychoneurological problems. Problems with the locomotor system lead to a high incidence of orthopedic defects, as well as to neuroses which are exhibited by children once they begin going to school.

The problems are further aggravated by an unwillingness on the part of some teachers to abandon the grading of performance in gymnastics and calisthenics. Among people with less efficient locomotor systems, grading is stressful and contributes to greater aversion toward sports. Sporting activities outside school have long been geared toward the achievement of better performance at the expense of recreation. Financial difficulties have exacerbated the situation in sporting clubs that used to be subsidized by the government. Organized sporting activities are beginning to be accessible only to either extremely talented children, or those who can afford them. As children grow to adulthood, a stress-inducing environment at school and a lack of physical activity can result in the greater incidence of those diseases which rank among the most significant causes of mortality in Slovakia.

1. Nutrition. Unhealthy eating habits are a major cause of an excessively high rate of cardiovascular diseases. Slovakia, as in the case of Czechoslovakia, is among the countries with the lowest per capita consumption of fruit and vegetables and the highest rate of obesity in Europe. Although educated young people and city dwellers have been showing significantly greater interest in good nutrition during the past three or four years, in overall quantitative terms those who show such an interest still represent a relatively small group. Physicians are also concerned by the fact that, because of the decline in living standards, the consumption of fruit has fallen by 19 percent since 1991, while that of vegetables has dropped by 22 percent. This has been a cause of a rise, since 1991, in the percentage of school-age children exhibiting high blood cholestrol levels from 15-17 percent to 22-29 percent, and an increase in the rate of obesity among children from 2 to 6 percent. Malnutrition among Gypsy children is a particular problem.

2. Drugs. Recently, the percentage of smokers among the youngest age groups has been increasing. This has been attributed to a massive advertising campaign which followed the influx of foreign capital into the tobacco industries in the Czech Republic and Slovakia. A ban on cigarette advertising has been in place since autumn 1993, and since April 1994 a regulation requiring all cigarette packages to bear an official stamp has been enforced in order to thwart the massive inflow of cheap smuggled cigarettes.

Even more important have been the changes in behavior patterns. In contrast to the recent past, a more negative attitude toward smoking is evident among more well educated young people. The example set by developed Western countries has played an important role in this. However, an opposite and more powerful trend prevails in vocational schools and, especially, in boarding schools.

In Slovakia the consumption of alcohol is broadly accepted. The latest statistics rank Slovakia among the top countries worldwide in the use of alcohol, with a per capita annual consumption of 12.8 liters of alcoholic beverages (Statistical Yearbook of the Slovak Republic 1994, p. 345, Statistical Office of the Slovak Republic).

More than one-half of all children are first exposed to alcohol before they reach eight years of age. Seventy-six percent of all 12-year-olds have tasted alcohol, and 28 percent have smoked cigarettes. Alcohol abuse has been found among over nine percent of secondary school students.

The most widespread forms of drug addiction before 1990 were addiction to medicines and to commercially available volatile substances which were inhaled by abusers. Probably due to less extensive urban development, Slovakia did not have the same "tradition" in the production of homemade narcotics as did Bohemia (in the Czech Republic). However, since 1990 there has been a rapid change in drug addiction involving more hard drugs and younger age groups.

Slovakia is a crossroads of two routes for the transport of drugs to Western Europe from the Balkans and East Asia. After the borders were opened in 1989, the flow of drugs across Slovakia became more intense. Although Slovakia is primarily a country of transit, drug distributors have tried to expand the domestic market and are attempting to entice young clients.

A heroine "epidemic" has broken out, with 208 new addicts recorded in 1993. A vast majority of new addicts are young people aged 10 to 19 years. The use of crack has appeared in Eastern Slovakia (Ko&##154;ice). Antidrug professionals estimate the actual incidence of drug addiction at almost ten times the levels found by findings and reported in statistics.

Secondary vocational boarding schools and places where young unemployed people meet are among the environments where drug consumption is most common and where young drug consumers are most likely to develop an addiction. However, statistics for 1994 show that secondary and university students, especially art students, tend to be even more in danger. Surveys indicate a dramatic rise in the number of primary school pupils who have tried marijuana. In Bratislava 13 percent of 13 and 14-year-olds have tried it. Large urban areas are the most affected. According to experts, the spread of drug abuse to smaller towns and to the countryside is only a question of time.

Prevention is the most efficient and cheapest solution to the drug problem, be it in schools or families. However, bewilderment seems to be the most usual reaction. In Slovakia the drug problem itself is generally considered a taboo subject. For instance, the notion of establishing "drop-in" centers is condemned out of hand much more frequently in Slovakia than it is in Bohemia. In Slovakia the fight against drugs cannot be compared to the antidrug effort in Bohemia, where foundations have emerged, antidrug music concerts have been organized and popular personalities have become personally involved.

Early in 1994, the former administration established a special advisory group on the drug problem. The present government has continued these efforts. New, more severe laws have been passed which no longer permit the possession of drugs even for "personal consumption."

However, a nationwide antidrug campaign is needed. The acceptance of new methods of treatment is also important. The most recent legislation, very similar to laws in the Czech Republic, makes pharmacological treatments even more difficult because it has imposed a ban on the use of methadon, the most effective such treatment.

3. Gambling. Gambling machines were virtually unknown in Slovakia before 1989. However, the number of gambling parlors has skyrocketed since 1990. Gambling machines are now seen in coffeehouses and pubs. "Addiction" to gambling is now viewed on a par with drug addiction. A special department for the treatment of gambling "addicts" has been opened at Predna Hora, the largest therapeutic facility in Slovakia for drug addicts. Boys and unemployed young men aged 16 to 26 are among the prime victims.

4. AIDS. Though official statistics do not suggest that an HIV pandemic is spreading in Slovakia (30 HIV carriers and ten cases of AIDS have been identified), experts estimate that the actual number of cases is five to ten times higher. The number of people engaging in "high-risk" forms of sexual intercourse is in relative terms (as a percentage of total population) the same as in the rest of the developed world. According to the World Health Organization, in the immediate future Slovakia will become one of the most at-risk countries in Europe, especially because of the anticipated explosion in "sex tourism."

In 1994, a multimedia campaign was initiated with the support of the Swiss Government. This, as well as attempts on the part of schools and nongovernment organizations (NGOs) to promote safe sex, has encountered opposition from teachers and the Church, particularly in the countryside.

The government provides free and anonymous testing. However, public awareness and incentives are lacking. Unlike the Czech Republic, Slovakia is strongly influenced by the Catholic tradition, and people thus tend to be far more reserved with regard to discussions about sexuality, contraceptives and "safe sex." People's attitudes are rather prejudiced vis-à-vis both AIDS victims and homosexuals.

Sixty-five percent of the respondents to a survey said that they would object to having a person with AIDS as a neighbor, and 57 percent would not like to have a homosexual person as a neighbor (FOCUS, October 1993). Sex education is generally too inhibited.

5. The disabled. A striking experience for a Slovak traveling abroad is the seemingly far greater number of disabled people. This is true in Western countries, but also in former East Germany or Hungary. This is certainly not because there are fewer disabled people in Slovakia. Rather it is evidence of the tragic status of the disabled in Slovakia, who are segregated and receive little assistance. The totalitarian regime thought fit to keep the disabled hidden away as if they embodied the failure of the system. People unaccustomed to seeing the disabled perceive any encounter with them as a strange occurrence. In the best of cases they may be willing to help, but do not know how. In the worst of cases they turn away, as if the disabled were inferior. Only in recent years have attempts been made to integrate physically disabled and mentally disabled children into society. This is the only possible solution. However, the parents of nondisabled children must be made aware of the problems of the disabled, and funds must be raised to remove the physical barriers the disabled encounter on a daily basis.

Providing assistance to the disabled is the aim of most of the foundations, self-help groups, and NGOs involved in this issue. A vast majority of these organizations (150) operate under the umbrella of and are subsidized by the Slovak Humanitarian Council. Changes in attitudes are facilitated by many widely publicized charitable events, the sort of effort that was never undertaken before 1989. Despite the undeniable effect of these activities, many people criticize the fact that they are typically conducted like campaigns, particularly around the Christmas holidays, so that people have the impression they are being asked to give gifts to compensate for their inaction and inattention throughout the rest of the year.

In addition to insufficient funds, problems also include the lack of occupational training, the lack of training for specialist teachers, and regional disparities. For example, Eastern Slovakia has the largest number of disabled and the fewest number of specialized education facilities. A high-quality information system and database are also needed.

6. The state and health. In the 1960s the public health care system in Czechoslovakia was among the most developed in Europe. This was reflected in indicators such as the neonatal mortality rate and average life expectancy. The 1970s witnessed stagnation in the sector, and the 80s saw significant deterioration. The current situation in public health can be described without exaggeration as disastrous. Since 1993 the level of subsidies has been declining markedly. This is particularly evident given the opposite trend in the Czech Republic. Hospitals are becoming burdened with millions of dollars in debt and often lack funds for essentials. Minimum services are offered to most patients.

For decades the public health sector was financed through allocations from the state budget. In 1993 the National Insurance Company was established, bringing together three insurance schemes: health care, the welfare system, and pensions. In 1994 the National Insurance Company became independent of the state budget. At the beginning of 1995 it was divided into three companies, one each for health care, welfare, and pensions. The public health sector is covered by The General Health Insurance Company. In January 1995 legislation came into force permitting the establishment of alternative health insurance schemes, but the criteria for this have not been adequately defined and are still not sufficiently clear. The General Health Insurance Company has, therefore, been able to maintain a monopolistic position in the sector. These and other unresolved problems in health insurance have hindered efforts to privatize health care services. These efforts seem especially slow in Slovakia when compared to those in the Czech Republic.

Even more harmful to the health status of children and young people is the lack of preventive care. Though the importance of preventive care for all aspects of health is emphasized in statements issued to the public, in practice preventive care programs fail to produce improvements commensurate with the funds spent on them.

7. Where should the focus be? Comprehensive education in health care may represent a solution, as might education designed to enhance social, interpersonal and emotional development, the elimination of psychological barriers in addressing issues such as sex and drugs, barriers to the proper care of the physically and mentally disabled, and the provision of more opportunities for locomotor development among young people of all social backgrounds. Respondents have particularly appreciated attempts to transfer foreign experiences and pilot programs for sex education and AIDS prevention, as well as the prevention and treatment of drug addiction.

Note: This section is based on the observations of and information provided by Miroslav Bronis, Jarmila Horecna, Iva Kucekova, Alojz Nociar, Maria Orgonasova, Ludmila Sevcikova, Blazej Slaby, and Zuzana Vranova.