Illustrations by Armine Shahbazyan.
Health Is the Cornerstone of a Country’s Development
For a nation to thrive and progress, its population must be healthy.
Armenia needs to adopt a better system of health care: one, in which every citizen of the republics of Armenia and Artsakh—including those in the most remote areas—has coverage for and access to the care they need, and a system that values quality care across the board, in all specializations and aspects of health care.
These things, of course, take time, and Armenia is at the beginning stages. But with more initiatives geared toward developing and strengthening the quality of care, better health education, a focus on primary health care, and wide-scale reforms in the health sector, we have the ability to make strides toward a healthier population.
Health is the cornerstone of a country’s development and success, and quality is the cornerstone of healthcare. Without delivering quality healthcare, Armenia can only go so far in ensuring a healthy population.
A healthier population will positively impact the future of Armenia by increasing economic growth. A healthier workforce will contribute to a stronger national economy, and a stronger economy will contribute to a healthier population. Workers are more likely to show up for work, and be more productive when at work, when they are physically and mentally healthy. And a healthy, more productive workforce will lead to a stronger, more robust economy with more jobs, higher salaries and better benefits.
Armenia is currently working toward universal health coverage (UHC) with the goal of implementation by 2023. The intent is for all citizens to have access to affordable, quality and timely care. Access to affordable healthcare is important, but access to quality healthcare is vital for a universal system to take root and be considered successful.
A study published in The Lancet journal in 2018 concluded that UHC could avert millions of deaths a year in low-income and middle-income countries, but only if there were significant investments into high quality systems. Evidence in the article noted that “expanding healthcare does not necessarily result in better outcomes” and in some cases, care that is unnecessary or inappropriate not only creates more problems than it solves, but can be dangerous and detrimental to a patient’s health. Of all preventable deaths in Armenia, 53 percent of them are due to poor quality rather than lack of access. This is still an underestimate when we take into consideration the deaths excluded that could have been prevented by population-level public health or intersectoral policies that prevent a disease in the first place.
Currently, 44 hospitals and medical centers operate in the capital city of Yerevan, excluding polyclinics, which account for approximately another 30 facilities. To put things into perspective, the city of Boston, which many consider to be the healthcare capital of the United States, is home to about 30 hospitals. While the population of Boston is slightly smaller than Yerevan’s, it (unlike Yerevan) provides care for hundreds of thousands of international patients a year. Why is it then, that there are many more hospitals in Yerevan than in Boston?
Unfortunately, a greater focus has been placed on infrastructure than on quality here in Armenia. And while access to healthcare continues to be an issue in Armenia, especially outside the capital, access to quality healthcare is the real crux of Armenia’s health crisis.
We also cannot ignore the immense influence education has on the overall health of a nation. Educating the population and having them engaged in their own health and care can significantly improve health outcomes. Healthy lifestyle classes were introduced in Armenia between 2008 and 2010 for grades eight to twelve and were reviewed and revised a few years back. The guides cover topics related to puberty, maintaining physical and mental health, and the importance of nutrition. Continuous collaboration between the Ministry of Education and Ministry of Health has the potential to yield positive outcomes for developing the concept of preventative health at an early age and set the groundwork for building on more healthcare concepts in the future.
My vision is for Armenia to have what my birthplace has: a high level of quality of care. With high quality of care, we will be able to excel on many fronts in our healthcare system. This will allow us to build a strong primary healthcare system, further develop the concept of preventative healthcare, create a standardized practice of care, be able to successfully implement UHC, and most importantly strive for a healthier population.
So how can Armenia get there? With the collective effort of not only the Ministry of Health and its relevant bodies (e.g. NCDC, NIH, etc.), but that of the entire government and most importantly the citizens of our country.
It is important to note that, although health plays a large component in any country’s development, it is just as important for all sectors to be collaborating and complementing the work of other sectors in order for the country to move forward in the most efficient way possible.
The Working Mother’s Dilemma
As a mother raising three children, I also juggle a career and involvement in several civic initiatives. The woman-mother-employee triad brings with it a number of challenges, all of which can be mitigated through individual or systemic solutions.
When I became a working parent, I started reading literature on parenting and took part in discussions and classes. My intuitive skills were enhanced by fact-based knowledge and I became more convinced of the importance of informed parenting, of taking children’s upbringing seriously and responsibly.
There is a common thread that runs through most parenting literature: you have to be present in your child’s life, everyday. Beyond simply being in the same physical space, spending quality time together—having fun, engaging with them, sharing their joys and sorrows, being responsive— is vital to their development. Playing with your children, reading books with them, drawing, playing with modeling clay, kneading dough, taking a walk, are simple, useful and pleasant pursuits, but they can be time-consuming if it all falls on the shoulders of only one person.
The mother is always considered to be the primary nurturer and caregiver and surely women do bear the lion’s share of caring for and raising children. In Armenia, the widespread misperception is that the privilege and responsibility of raising children belongs solely to the mother; and that the father is primarily responsible for being the breadwinner and usually blaming the mother for any shortcomings in a child’s behavior.
Research has shown that children whose fathers are actively engaged in their care and upbringing have better cognitive-linguistic skills, are more confident and have less difficulty establishing personal relationships. By being involved in a child’s care and upbringing, as well as sharing the burdens of housework, fathers not only contribute to their children’s development and strengthen their relationships with them, but also help to make sure their wives aren’t overburdened. With a little free time once in a while, women can pursue their personal interests as well, or simply take a well-deserved break and take care of their own health. When a child is born to a family, the extra stress can burden the marital relationship. By helping his wife and sharing the load of childcare and domestic work, a husband helps to keep the whole family on a solid footing.
When my own children were growing up, I made sure to continue pursuing my personal interests. It contributed to my ongoing personal growth, skills development and self-affirmation. This was possible only with the support of my husband and family, which in turn kept me in the right shape to take care of them also. As traditional restrictions on women in society are cast aside, in parallel with taking care of her home and her family, more women are putting additional focus on their careers. Sometimes, these women are treated with an attitude of “if you want to be independent and free, then figure it out yourself.” Around me, there are many families where the man encourages and supports his wife’s self-expression in every way possible. In such families, children see and learn respect and how to care for and support each other. Such families showcase that the active, working, self-sufficient woman and the caring mother are not mutually exclusive; they are complementary and set the guidelines for the development of our children and society.
After my first maternity leave, I was one of the lucky few who had the opportunity to return to work on a part-time basis. Working full-time with young children can be challenging. Many of my acquaintances who were not able to find part-time work either had to return to working full-time, and feel guilty about not being able to spend as much time with their children as they would like, or stayed home for several years to take care of their young children, resulting in their professional career taking a hit. In this sense, I believe that both the public and private sector have work to do to increase the number of part-time positions, to give women with children greater flexibility in finding their footing in the labor market and providing affordable, accessible daycare.
Armenia’s Labor Code extends certain privileges in terms of reduced working hours for breastfeeding mothers, but only until their children are 18 months old.
Since March 2020, due to the pandemic, many of us started working online and later in a hybrid online/offline model. This exercise demonstrated that it’s possible to be productive without being in the office from 9 a.m. to 6 p.m. five days a week. The modern economy allows many of us to veer off from the industrial age synchronized eight-hour work day. Different organizations and even countries are reviewing the logic behind set working hours. This seemingly small change can have a significant impact for women in terms of work-family balance, quality parenting, career motivation and efficiency.
Another important change that could help increase working opportunities for women with children is adjusting the teaching hours of kindergartens and elementary schools to align with typical working hours. Private schools seem to have already been able to resolve this issue. Even though public schools currently have the right to provide after-school programs for children, in practice, few actually have such programs available. As a result, a parent—often the mother—is forced to either ask to leave work early to pick up their children, or arrange for them to get to their workplace. Organizing substantive after-school programs will allow parents to finish their work, and then pick up their children afterward.
When I used to occasionally take my newborn to work at Yerevan City Hall, we began discussing the benefits of having a designated room for children at the workplace, where they can spend their time while their parents worked. It is common in Armenia for children to go to their mothers’ workplace after school and sit quietly until she is finished with her work. A room for children would give them the opportunity to do their homework without disturbing their parents and their colleagues. This might seem like a dream in our reality today, but it’s only by dreaming that we can move forward and bring positive change.
Today, we often talk about women’s rights, including the right to continue their education, build careers; we encourage their involvement in social issues and political processes, while asking them to become mothers to maintain healthy demographic growth, etc. In reality, each of us has a role to play—the individual, the family, the workplace, the state—to develop the full potential of women. The richest countries are the ones that have tapped into the potential of women to benefit society. Through constructive dialogue and supporting each other, we can get there, too.
Pilgrimage to the Future
A copy of my book “Pilgrimage to the Brain” was delivered to the school in the border village of Taghavard in Artsakh. Of course, I was thrilled that the book reached the village school. But I was also told that Azerbaijani military positions can be seen from the windows of the school… And now I’m constantly thinking about how our children will read this book, learn and simply be at peace, when there is the constant accumulation of fear and threats right outside those windows.
Lately, I feel that I have a silently escalating conflict with the phrase “the future of Armenia.” It is not that Armenia has no future. I simply refuse to sign under such a dramatic statement. Armenia, with or without us, will appear in the future.
The question is whether we will finally want to do something about that future. Unfortunately, today I have the impression that I have been deprived of the right to be motivated or to think about that future.
It seems that I am living at the mercy of inertia. My associations with the word “future” are very contradictory. The word evokes the taste of the smoke of current wars on my tongue. When talking about the future, I exhale the smoke that rises from my lungs. The pain of our distorted present is so illuminated and staggering that I cannot think of the future.
The future is always a consequence of the present, insofar as all our futures have eventually become our pasts. Today we are reaping the fruits of the future that was decapitated in the past.
We were taught to dream about the future, to write essays, to recite poems, but we were not taught to take responsibility or be responsible for the future. These imply very different behaviors.
I often have the impression that the reason for the dulling of this pervasive humanism is that subconsciously, our “Plan B” is to simply move to Mars. It seems as if we, as a nation, have become paralyzed from watching scenarios of war.
We have become slaves to the predatory race to the future. Sometimes I get the impression that I am watching a movie with 3D glasses, where we are soaring towards the black hole of the universe, fastened in VIP seats in the front row of a convertible rocket and the only thing ringing in my ear is my own voice saying: This is not a dream Kristine… this is not a dream…
I think we must now be extremely clear-headed about our defeat. We must learn to lose with honor and learn lessons so that we consolidate and not lose our future completely. Here is where we need experts well-versed in the formula of learning from mistakes that guarantee success in the technological world. It’s not only in the world of technology that we must learn from our mistakes. It is time to learn from the danger of losing our future…
We all deserve one another… each of us deserve the one we precisely hate without exception. Today there are no winners among us… We have all been defeated.
Unfortunately, science and technology, which promised us “salvation,” are thus far only creating wars. There is no end to them. Our corporations have enslaved the education system and science; the economy seems to be serving “higher” forces and the leaders of humanity have forgotten that people are important.
It’s necessary to sober up. The only hope left for becoming self-aware is to become self – aware. But who will take the first step? Who is that powerful one who will finally bring everyone together… finally bring them to their senses… unite them…
The only question that concerns me today is this: Who will unite this divided nation? How much longer do we have to “stone” one another, criticize and take revenge on each other? We are already disappointed in everyone, even ourselves. Now we have to unite…now, or we will never heal. Now we have to forgive, accept what we have, and pave the way to the future together. I am not saying that we need to draw the future, just set-off together.
Setting-off together is already a good start. We must go on a pilgrimage, together, a pilgrimage to a self-awareness of unity.
Continuum as a Strategy
The arts have been an essential part of my life. I remember myself as a three-year-old sitting on the balcony of the Aram Khatchaturian Concert Hall and listening to a performance by the Philharmonic Orchestra of Armenia with my grandfather playing among the musicians (he was a member of the orchestra for 40 years). I still recall the sense of pride I felt. Later, I remember my mother organizing our Sundays and taking my sister and me to the newly opened Museum of Contemporary Arts. This was quite an experience. By that time I knew that my life would be fully absorbed by the arts and it would be the essence of my existence.
During the last decade, I have been in charge of different local and international organizations and programs, and have founded my own non-profit. My experience of these undertakings has fully assured me that the most direct way of lobbying to transform what is largely considered the “poor cousin” (i.e. culture), is shifting the thinking about arts and culture and positioning them as not “beautiful things” which come after everything but a serious industry which can produce economic, social, and financial outcomes resulting in the well-being of society. However, this is easier said than done.
Where do we start?
It seems logical to state that when one mentions “a cousin”, even if it is “poor”, they mean a big family stands behind it, right? It means we speak about a conglomeration; a cluster of members being involved. Who are those family members, and what family do we talk about? I suggest the family is called a STATE, and the parts of its engine include the economy, finance, justice and more.
What do we do when we have issues in our families? We map the problem, envision the situation, consider new and alternative approaches to the problems, draw up an action plan and go for it.
We start with strategic planning. But that is never enough for an entire sphere of social life. So, what can be the trigger for change, for setting the mission and vision, and objectives to reach? I would say, putting on paper a strategic business case study as its very core as a new way of thinking.
Nowadays, we are used to seeing the government putting its best foot forward and saying, “We’re amazing, we have these ambitions and a strategy to match, and these are going to be the positive outcomes.” But the case study forces us to rework that kind of thinking.
Let’s imagine we have a building for developing the arts, but it does not have the main characteristics or necessary facilities. We have to start from the position where we state upfront that the building is not fit-for-purpose and that it’s negatively impacting our capacity to deliver our vision and strategy, and with this comes diminished outcomes. We should stress that, yes, it’s our greatest asset, and yet we’re basically saying this building is inadequate. It’s impacting our capacity to fundraise, impacting our audiences’ numbers and their experience, impacting artists and our programs.
So, where do we start? Map the assets we have, conduct comprehensive research, a feasibility study to find out what we have and what we don’t, and what exactly should be done to reach our goals. Then we will have everything armed and ready to go, constantly lobbying the government to keep the vision alive. Simultaneous to this, I see the steps to go forward in the sector which would help us pave the path toward big changes. One of those is collaboration between different creative industries.
Governments do have a role in the process of nurturing creativity but the real driver of the creative economy is creative people and they, in turn, are shaped by the culture in which they live and organizations they establish.
One of the most salient features of creative industries is that they collaborate almost as much as they compete. Whether online or offline, professional networks create a climate in which social exchange and professional support become indistinguishable. When technologies, creative insights and consumer behaviors are evolving at an accelerating pace, these networks provide peer-to-peer teaching and support that are at least as valuable as more traditional skills and training opportunities. This underpins some of the thinking about this next phase. We’re going to embed placemaking from strategizing to development. And it appears to me to be a very collaborative process.
We need to create an umbrella organization, let’s call it the Armenia Arts Council, which could consolidate all the essential creative industries of the country where these organizations could provide critical career pathways and skills development between them. The sector’s leading organizations could act as incubators of talent. They would invest in innovation and experimentation, connecting with audiences and diversifying arts practice, from our largest cities to our most remote communities without overlooking the essential role of our independent artists or smaller projects.
The Council would also be responsible for delivering on its legislated functions, which involves a longer-term view of what is needed to sustain and strengthen Armenian arts and culture.
Here we have approached the next step, which I find essential and that is the establishment of the endowment policy and an endowment foundation for the cultural sector.
The Endowment Fund shall be organized and operated as a publicly-funded organization delivering support measures to our arts and culture sector, to support jobs and creative skills which are the foundations of a vibrant and diverse arts and cultural sector, sustain and expand the industry.
There will always be more that can and should be done to support Armenian creativity. It’s about sector growth – managing it and getting it right. We all know this is not something that’s happening overnight. And arts and cultural industries are always in constant change. New cultural industries raise new questions: what and who drives the creative economy? Who will benefit from it as it grows in global significance? We know for sure that the time to scatter stones is an ongoing process in the arts, and the time to gather them never comes. But as recent scientific research argues, long-term plans and a positive attitude help overcome crises and turbulent times more efficiently. Isn’t this our case?
