Sevak Lalayan

Project Name: Armenia: Tobacco Control Measures in the Context of High Poverty/New approaches for tobacco control advocacy

This paper is an output of a joint project with 2003 IPF Fellow Mr. Paruyr Amirjanyan (www.policy.hu/amirjanyan). His research paper which is developed under the same topic focuses on the economic aspects of the problem.

Simultaneously in this paper we focused on advocacy issues of the poor population oriented tobacco control policy.

Almost every second adult in Armenia is a smoker in spite of sex: experts of the Ministry of Health came to this conclusion through their research conducted within the framework of National Tobacco Program (NTP). The research showed that every 6th adult has never smoked while 50% of men and 39.6% of women smoke. However, these figures varied among different researches: according to report of the National Statistical Service (NSS) only 29% of men and 1.24% of women are considered as smokers. Still, the rate of tobacco-related mortality in Armenia ‘confirms’ the results of the NTP research.

High rates of mortality and disability problems result from smoking. (According to reports of the Natural Remedy Center 40-70% of the registered mortality cases in Armenia are due to tobacco use). At the same time smokers and surrounding people are equally exposed to tobacco. Statistics in this sphere is not encouraging: some USD 80 mln.[1] is spent in Armenia annually on cigarettes and more than half of healthcare expenses is also spent on illnesses related to smoking.

So, Armenia is amongst the countries where the tobacco use and tobacco induced mortality and morbidity have reached enormous proportions.

Regrettably, tobacco-control or anti-smoking issues are not properly introduced in Armenia. There is not any attempt by any party to raise these problems to the level of discussions even within Primary Health Care system. There are some kinds of objective causes for such ignorance towards smoking in Armenia. The problem is, that the obstacles on the way of creation of completely new economic system caused drastic decline in economy, thus cutting down the employment and making the creation of additional workplaces a top priority for the policy making. Under the highlight of the recent positive changes in investment climate and economy at whole, the recovery of tobacco industry was perceived by the policy makers and the population as an important step towards economic stabilization and a possibility for a boost in employment. That is why the Tobacco Control policy has never been interpreted as is - it has always been considered as a measure to ease smoking impact on health but never under the highlight of its economic consequences.

The issue becomes more crucial taking into consideration the high poverty level in Armenia. Poverty in Armenia is widespread, deep, and severe. More than half of the population is poor and about a third of those are extremely poor, failing to meet their minimum food consumption needs. The consumption of the average poor household is less than three quarters of the value of the minimum consumption basket; and among the extremely poor, average consumption is less than 80 per cent of the poverty line (Griffin, 2002).

Along with poor understanding that tobacco is a major cause of death and disease, many people have not yet recognized that tobacco contributes to poverty. Governments of most developing countries are unprepared to deal with increases in tobacco deaths, including the impact on health systems and health costs. Policy makers are likely to be aware on what may happen in their own country when the tobacco control measures take place. This especially refers to the poor population of Armenia, as their reactions to the tobacco control measures implemented by the government are not expected to be similar with those of wealthier ones. So, tobacco control measures have to contain special procedures, adjusted to involve the poor population in the countries, where the share of poor is high.

Yet, smoking is not only considered to be the problem of the government and health services but also a pending issue raised within the whole society.

Consequently, there is an urgent need to mobilize all necessary forces of the society for productive combating against smoking in Armenia. The present situation becomes impossible to change merely by the means of the Government. We perfectly realize inability to generate a change lacking to involve NGOs, media and other public institutions to cooperate in unison and raise public demand for healthy generation.

The purpose of this paper is to estimate the effectiveness of tobacco control policy in the context of the poor segments of the population, taking into consideration economic and administrative aspect of the tobacco control. The main goal here is endeavouring to find effective levers for reduction of smoking among poor population. It is also formulating the outlines of the “policy first” - a complex of measures which different NGOs can implement easily without substantial funding.

Armenia still belongs to the group of countries with low (below 765 USD) per capita GDP (which in 2001 was 706 USD), falling behind the countries with below average (766-3035 USD), above average (3036-9385) and high (from 9386 and up) GDP [2].

1996	1997	1998	1999	2000	2001
423.0	432.3	498.2	485.2	503.7	706.3

With the assistance of the World Bank, the Government of Armenia carried out nationally representative household income and expenditure surveys in 1996, 1998/99, and 2001. Those surveys allowed assessing the level of income poverty within the country.

	1996	1998/1999	2001
Poor population (%)	54.73	55.05	50.9
Extremely poors (%)	27.67	22.91	16.0

According to the data the share of poor population (poverty level) hasn’t been considerably changed throughout 1996-1999. Despite the poverty level reduction in 1999-2001 it proceeds “step” in the scope of 50 percent.

Moreover, almost two-third of households of Armenia is below the poverty line and one-third of households with three or more children are in extreme poverty. The average size of extremely poor households is comparatively the biggest and these very households have the highest number of children [5].

Poverty in Armenia is summarized in the drab quality of the family and the social lives of the poor. Family and social events, such as wedding ceremonies, birthdays, and housewarmings, have been cut down to a minimum. January 1st - the New Year holiday- is basically the only one celebrated at present among a variety of Armenian holidays [6]. The frequency of family visits and gatherings has declined, traditional fashion has changed, and people organize outdoor activity seldom enough than they used to do previously. All segments of the poor are alarmed by the prospects of providing their children with education and maintaining their proper health.

A subculture of poor has been developed. In the most of cases the instinct of self-preservation is stipulating the behaviour of this larger group of population. Due to the general picture of great number of discussions within the poor families (most of which has highest number of children) their living style is substantially different from usual perceptions. In most cases the parents’ personal needs are of less importance in this type of families and mostly are not even being planned in the structure of family expenditures.

Traditionally family and children are perhaps the core values for the Armenian people - be they poor or rich. This is especially true for the poor people, who in most cases highly prioritize children’s nutrition, education and health as compared to any other issue. So there is a traditionally rooted special attitude towards children lifestyle. Thus, we believe that any policy comprising persuasion component should be well formulated through messages which commit possibilities of better lifestyle for their children.

This can be precisely stated also for effective tobacco control policy. The message “Do not smoke to be healthier” appears to be less effective for the poor population when comparing with the “Do not smoke and in two months you will be able to buy a school bag for your child”.

In corollary, the nature of poverty in Armenia is transforming from the state of living conditions into more psychological one. Hence such sensitive matter should find its key place in any policy devoted to the poor population.

Since 1999 the poverty reduction has been declared as the top priority for the coming years for the Government of Armenia. Currently, the Government has undertaken the preparation of a comprehensive poverty reduction strategy paper. A Steering Committee for the Poverty Reduction Strategy Paper (PRSP) has been established with broad participation from representatives of the social and economic policy implementing agencies, parliamentary committees and political parties represented in the Parliament, NGOs, and the donor community, with the purpose of organizing the preparation and implementation of Poverty Reduction Strategy. The draft paper already is in circulation.

Public debates for the possible effective ways of overcoming poverty still continue in Armenia. Hence, any proposed change for different spheres of the public life, if it has a direct connection with poverty issue (improving living or health conditions), should become a part of public agenda. We strongly believe an effective tobacco control could have also a direct poverty reduction effect; therefore it should be introduced in the PRSP in a considerable and broader manner.

From the PRSP which is totalling more than 250 pages we excerpted all paragraphs somehow relating to tobacco control (see Box 1). Obviously, they are few and mostly of abstract character.

The Ministry of Public Health should directly control the whole scope of issues regarding diseases’ prevention and treatment, organizational and financial reform within the system of medical aid, as well as realization of actions directed to the perfection and additional development of the health care system’s legal basis and management. It should also lead and coordinate the cooperation with other domains by the following directions:

… 9/ work with NGOs and mass media in order to promote healthy lifestyle, including developing and carrying out of campaigns on anti-smoking, drug and alcohol abuse, increase of information possession on health issues of society….

…For the long-term perspectives of essential improvement of the health conditions of the population is of utmost importance to root healthy lifestyle and in particular to take measures against smoking as a part of national action plan. The program should foresee and carry out sharp measures directed to restriction of tobacco advertising and regulation of tobacco trade.

Many times the Government of Armenia announced about its openness to accept any proposal devoted to poverty reduction. That means that well argued and correctly presented observations of tobacco control should be comprised in the PRSP and become a part of Government’s priorities for the coming years.

A well designed and balanced tobacco control policy doesn’t yet exist in Armenia. The Soviet-time ‘approaches’ are still working, but they are extremely inefficient as they are dealing only with the health problems resulted from smoking – the economic aspect of the issue is completely ignored.

In modern Armenia anti- smoking campaign is also being considered in a similar manner. The economy, overcoming exogenous and endogenous obstacles, sets more utilitarian goals which do not consider public healthcare principles as top priority. Given these circumstances the global anti-smoking campaign can hardly overwhelm in policy-making process if opposed to economic gains of tobacco production development.

Nevertheless several anti-smoking campaigns, mostly using propagandistic tools and advertising, are from time to time being implemented in Armenia, mostly in Yerevan. Also some permanent measures are carried out by many state institutions, such as cigarette banning or limitations, however, these can hardly be perceived as a serious restriction.

The legislative basis also sets several restrictions on smoking. The tobacco products’ advertising is partly restricted. The Law on Advertising sets several prohibitions to restrict children and youth access to tobacco advertising, such as tobacco advertising by TV, radio and printed media for youth; advertisement of tobacco products to have curing, stimulating or relaxing features; tobacco advertising without a warning statement about the harm of smoking is forbidden; demonstrating the process of use of tobacco during its advertising; advertising through electronic mass media during the hours from 7.00 a.m. to 9 p.m. However, there are several cases of the violations of law requirements by some TV companies in Armenia.

Article 14. Defense of the Under-aged during Advertisement Production, Placing and Spreading

1. Advertising of alcoholic drinks and tobacco by radio and TV programs for children and youth, in printed publications concerning the under-aged, as well as in children’s, educational, medical, cultural, sport organizations and institutions and their areas is forbidden.

a) to suggest that alcoholic drinks and tobacco have curing, stimulating, relaxing features;

b) to induce the consumers to widely use alcohol and tobacco, negatively assess their non-use or moderate use;

c) to present as a positive feature the high content of alcohol in drinks and of nicotine in tobacco.

2. Tobacco advertising not including warning statement about harmfulness of smoking is forbidden.

3. In alcoholic drinks and tobacco advertising it is forbidden to address directly to the under-aged.

4. It is forbidden to demonstrate the process of use of alcoholic drinks and tobacco during their advertising.

A draft Law is now being prepared to strengthen the control over tobacco use. It has several strict prohibitions over tobacco advertisement and its use in public buildings and places. For example, it sets a complete banning on tobacco advertising on radio or TV. During last four years there were few attempts to pass the low in the Parliament but they have always failed. In any way the draft still is in the circulation and we hope that the newly elected Parliament would pass it.

The advertisement campaign of local tobacco producers is visually aggressive and broad. Although there are no data on how much money these companies do spend on their advertising (these data are not disclosed to the public), it is obvious for an observer, that both the quality and the efficiency of local brands’ advertising is high. This refers to advertisement by TV and radio and also to the poster ads. Besides, the local producers stress on peculiarities of Armenian lifestyle, thus remaining closer to the consumer.

An interesting practice of anti-smoking campaign was during last 2-3 years being implemented by the major cigarette producer in Armenia. Instead of advertising its production the mentioned company does its best to propaganda non-smoking style of life. As a matter of fact, the advertising campaign really included statistical data on tobacco-related mortality and in fact is expected to affect the smoking population. The phenomenon can only be explained by internal marketing policy of the company, aimed to impress more educated groups of population, which are normally outside of the share of market of local brands.

The danger of smoking is not a popular theme in Armenian Society. One can smoke in any place or almost in any place here in Armenia. Indeed, the estbalishement of many representations of international organizations as well as an inflow of international experts into Armenia in the last 8-10 years brought about changes in the general working standards. “American offices” - a term used by general public- are smoking free areas. And this phenomena is step by step spread to local offices as well. But still the share of non-smoking workplaces is rather small.

In such circumstances an important role has to be given to organizing large-scale discussions about the harmful nature of tobacco within the society aimed at raising public awareness. Initially the problem needs to be discussed. The difference between unspoken problem and non-existent problem is not seen in the eyes of the people. The problem exists and it should become a topic of discussion within the public. And this is an imperative.

There is also another aspect of this issue. The raise of public awareness could tend to coincide with culture change. Currently the personality of “a smoking man” is considered to be so classical and acceptable that it becomes quite complicated to even argue with the naturalness of that public perception. The picture of frequently smoking father and uncle is an every-day-scene in most of the Armenian families, and the cigarette smoke is subconsciously accepted as the part of latter’s character. This is already rooted perception, a separate culture; hence the changes should also be cultural ones.

The link between the reforms in socio-economic, educational, health and other spheres and the public perception of those reforms is initially carried out via public institutions and the government. In fact, any change oriented public demand formulation in most cases appears to be more complicated than even making that very change. This presumes everyday follow-up activity firstly by the state institutions, yet the relevant public institutions also assumes to play a key role.

The issue becomes more complicated since Armenia is in the transition period therefore the majority of the institutions are still in the phase of formation. While all the sectors of economic reforms, on the one hand, and effective tobacco control policy implementation, on the other, require meticulous attention on society strengthening.

More than one-third of 3000 NGOs currently operating in Armenia is devoted to economic issues. Those organizations and the sector in general that is used to call “non-governmental”, are mainly funded by donor organizations’ grant programs.

Nowadays various state agencies of Armenia perform different functions that are less coinciding to the “state role”. Such functions can also be found in tobacco control sphere. Here, among other measures we can specify those designed to force people-talk on the harm of smoking. In other words – measures tend not only to be propagating theory, but also reinforcing effective practices to help society openly discuss, debate and cultivate their demand for living in a healthy environment and prosperous generation. These measures predominantly ought to be implemented by public sector and to a lesser extent comprised in strategy elaboration and control functions vastly specific to the government.

Consequently, in the context of the government structure optimizing policy implemented in Armenia, certain sectors of tobacco control policy today could be assuredly particularized and granted to NGO sector via tender. We won’t come up with a new invention if state that the separation of certain functions and handing to NGO sector via tender could be considered as the state’s vital support to develop this sector. Moreover, we are confident that the functions implementation productivity won’t suffer from the aforementioned, right vice versa, the completion would lead to efficiency amplification.

Thus, in the context of the currently implemented policy for optimization of the governance system in Armenia, certain parts of tobacco control policy presently can be separated and transferred to NGO sector on competitive bases.

We would not be reinventing the wheel if we state that separation of certain functions and their transfer to the civil sector through competitive processes can truly act as a government contribution towards the development of the civil sector in a given country. Furthermore, we believe that not only the efficiency of these functions will be adequate but also that the competition will lead to an increase in the efficiency.

Therefore, in Armenia the implementation of the efficient tobacco control, especially when aimed at poor groups of population, should take into account number of realities. First, it is necessary to develop a comprehensive, large-scale and long-term strategy taking into account the need to form public attitude against the smoking. In order to put anti-smoking campaign on an institutional basis it is necessary to ensure larger involvement of the NGOs in the process.

At the same time, one can achieve substantial results in combating smoking amongst poors with concrete and low-cost measures. For this part of population, development of anti-smoking measures and their advocacy is particularly actual since it can coincide with the development of poverty reduction strategy in Armenia and therefore many doors may be opened easier for the anti-smoking advocates.

Further in the text (topic “Options of policy first”) we will summarize our observations on the factors contributing to the prevalence of smoking amongst the poor part of population and will provide our explanations and conclusions for each specific case hence coming to policy options.

In the “Enliving FCTC” topic we will refer to the obstacles for implementation of the concepts set forth in that document.

In the “Strategy and policy first” topic we will try to provide concrete conclusions and an outline for general advocacy strategy.

Yerevan city - the capital of Armenia - that is distinguished with the numerous captivating symbols, i.e. various gorgeous cafés situated everywhere both in parks, side-walks and squares, comprises more than half of the Republic’s population. In fact, the cafés are popular enough with soft music sounds and being quite visible for the passers-by.

The open-air cafés where there is lots of smoking encourage poor people smoking.

We spent a Sunday in July about 5-6 hours in one of the cafes located in the center of Yerevan, in Sayat-Nova Avenue and started to observe all the passers-by. Within that timeframe almost all the places in the café were occupied by couples, groups and singles. They were talking, some listening to the music while enjoying Sunday evening, the others reading daily newspapers. On an average the majority of the people in the café were smoking. Some smoker lighted up the next cigarette right following the previous one.

The music was loud enough making the passers-by pay attention to the people sitting in the café.

During the observation we recorded 314 people passing by 247 of which glanced surreptitiously at the café and examined the people sitting around. Meanwhile, 64 of them lighted the cigarette when looking at the café or right going by. Compliant with our visual observation, the 51 of those 64 were bellow 35 years old young men.

Those sitting in the cafes make an impression of happy-go-lucky and wealthy people. The cigarette is perceived as the part of that picture. Subconsciously striving for “enjoying” person’s character the passer-by wishes to imitate the latter’s “characters”. Therefore, to light up the cigarette comes out to be the shortest and the most accessible way.

During discussions with poor families we also make surveys on the subject of “…where more poor people are found?” Among replies the majority of options we received were “… the youth is wondering around the city all day long”. Consequently, the young poor teenagers yearn to meet “enjoying” man’s character, hence the chances to imitate becomes available in every step.

It is crucial to “destroy” “café enjoying person’s” character when preparing youth targeted TV and other anti-smoking ads since this is considered to be one of the most desirable character to imitate. And it is needed to explain that the fact of smoking is not comprised in the scope of “life-enjoying person’s” character.

Comparatively wealthy layer of Armenia currently possesses broad opportunity to acquire diverse information. Primarily these are people working at offices so finding a possibility to read newspapers each day, they are electronic mail users and have internet access.

Yet, poor layer encompassing approximately the half of the population is almost forsaken from this kind of information sources, whilst the only source for poor people becomes TV. As stated in the scope of our discussions with a dozen of poor-considered families the local TV news is much watched by this layer thus performing a huge role in formulation of the latter’s vision.

Armenian high-ranking leadership is much broadcasted by the local TV channels. The President of the Republic of Armenia doesn’t smoke hence promoting always-healthy-life via citing personal instance. Instead, the Government members (ministers) and National Assembly (NA) leadership are often watched on the TV screen when smoking. Particularly, it becomes conspicuous enough while presenting government members’ non-official meetings or preparing interviews during NA break-hours.

For a couple of days we tried to follow the pieces of reporting broadcasted on TV in relation to government members. For that period of time the delegation consisting of government members visited the Republic South regions. The telecasting of that visit was of the top importance. Within 3 days we managed to watch 24 reports 11 of which pictured government members smoking.

NA three-day workshop broadcasted on TV was also followed by us. We could fix out 31 pictures of different local TV channels presenting NA works, consequently, 25 of which contain shots of smoking deputies. All the interviews are taken from NA lobbies being previously designed for smokers too.

When visiting poor-considered families we witnessed a group of teenagers’ conversation of 12-14 years old on the cigarette brand the well-known government officials are smoking while bringing disputable facts of the filter colour they noticed during this or that TV program.

The Government members’ behaviour comprises a huge potential for the young generation to imitate. This is predominantly accurate if taking into consideration their public role considered tempting, on the one hand, and the majority being broadcasted by TV, on the other. Yet the probability of starting up the tobacco imitating procedure becomes enormously high.

When taking measures against smoking it’s exceedingly significant to organize special seminar-discussion with journalists and TV channels’ leadership to gain mutual agreement, even verbal, vis-à-vis excluding the “smoking officials” to be broadcasted via TV.

It’s preferable to start discussions with NA leadership to prohibit smoking in the lobbies of NA conference halls therefore providing a separate space for smokers. The point is that the lobbies are the sole place for the journalists to obtain interviews. When many deputies and ministers are simultaneously smoking at that very place subsequently the character of a smoking official becomes unpreventable when broadcasted.

Underground is reputed as the cheapest way of transportation. This way is mostly used by the poor layer of population and students. The culture of reading when going by underground is not largely developed in Armenia for the infrastructure being small enough, therefore takes less time to get from one station to another. Accordingly the quietly sitting passengers’ attention is for the most part focused on the advertisement posted-in the train.

We visited all 10 stations of Yerevan underground while changing the trains in the stops. Generally we were in 11 carriages of 4 different trains. Mostly visible ads were those of advertising cigarettes. Through our observation we recorded about 18 cigarette posters for each train -1.6 ads on average. In most cases those were advertisements of cheapest cigarettes of domestic production.

Huge and illuminated posters of Fillip Morris “Red & White” brand are implausibly conspicuous in underground stations. In fact, it is mostly expanded among imported tobacco products and capture 15 percent of domestic market. The brand is sold for about 40 cents and belongs to cheap tobacco segment.

The Marketing services of tobacco companies made a precise assessment re cheap cigarette core consumers as latter use underground as most affordable means of transportation. They directly circled the tobacco marketing target audience thus placing the advertisements inside of trains and underground stations.

In the context of anti-smoking policy targeted at poor population the tobacco advertisement in undergrounds should be forbidden.

Underground is a state institution and belongs to Yerevan mayor. Factually the issue could be negotiated with relevant municipality officials. Yet, the other side of the issue exists. The underground is quite a poor institution and the income received from advertisement makes an essential role for further operation of metro. Here also, from our standpoint, certain solutions could be found.

Impartially Yerevan underground possesses neither financial nor human capabilities to advertise its opportunities. When realizing anti-smoking policy it’s likely for the public sector to initiate the underground capacities advertisement campaign and demonstrate the underground advertisement advantages to the middle-layer oriented entrepreneurs. This could be one-time-campaign subsequently bringing to multiplicative effect. Hence the underground advertisement income maintaining issue would be solved without immense difficulties and the negotiations with government officials on forbidding tobacco advertisement would easily bring to positive results.

Municipalities; regional offices of social security departments; water and energy supply regional services; public utilities and cadastre regional divisions and a number of such state institutions are considered to be the structures that provide instantaneous services to population. Those institutions are regularly visited by all layers of the society, thus merely here the representatives of the poor part of society socializes with state officials.

For the duration of two working days we visited the above stated 21 offices of state institutions providing public services to Yerevan “Kentron” and “Arabkir” districts. Throughout those visits we managed to observe 138 officials directly working with the people (both specialists straightly welcoming newcomers and high-ranked officials confirming various documents). At the time of our observation 32 of them were smoking and there was a smoke coming from the rest of 37 rooms.

Smoking is much prevailing in the offices of state institutions providing direct public services.

The poor people visiting those very offices predominantly return home anxiously since the visits are generally connected with their financial situation particularly associating with the existing debt pay offs or other expenses to be paid. And what is more, people are supposed to stand in a queue and wait for quite a long time which also becomes an additional reason for them to get nervous and upset.

Therefore, in most cases subsequent to visiting those offices the people being angry still keep in their subconscious those smoking bureaucrat’s character. We consider this kind of smoker’s character to be also infectious that relates to strengthening of subconsciously designed nervousness-smoking link.

Those very institutions welcoming every-day-customers are mainly state institutions and operate under the general rules and regulations of that very structure. Accordingly the problem solution in most cases no way relates to additional financial means. In the frame of implemented anti-smoking policy the issue ought to be appropriately presented to these institutions’ centralized leadership in order to reach the smoking prohibiting regulations adoption within the offices interacting with population.

There is a popular proverb, “Once you see is better than thousand-time you listen”.

During our visits to poor-considered families we had a talk to 28 schoolboys and schoolgirls about their teachers. 19 of them assured that noticed some teachers smoking during the break or lessons. Around 10 stated that the teacher of physical training is smoking right in the sports ground.

It’s obvious enough that the teachers’ behaviour, actions and moreover - visible negative habits are taken into pupils’ precise consideration and contain a huge potential to imitate. Given the interests the child evinces towards a certain school subject, the teacher of that very subject could be often presumed as a key character to imitate. From that viewpoint the character of the teacher of physical training being perceived as a healthy lifestyle symbol should also be essential from the prospective of forming kids’ endeavours.

Smoking teacher’s case is capable to have stronger impact on children than a couple of months lasting school trainings and campaigns on the vast harm of smoking. The aforementioned example could be even dangerous in case the smoker is so beloved by the pupils.

Completely prohibiting smoking around school territory by each and all should be accomplished immediately by using tough administrative tools. We are confident that the Ministry of Education and Science in the presence of pertinent willingness is capable to solve the pending issue one and for all. Furthermore, in reference to the Minister’s order issued recently smoking is strictly banned within the Ministry.

Hence, the weightiness of the issue with all its consequences ought to be presented to all high-ranking officials of that Ministry, also supposed to lead discussions on the subject and deliver to relevant standard decisions to be made in the nearest future.

[1] Author’s estimation

[2] see ”World Development Report”, World Bank, W., 1997

[3] Source: National Statistical Service of RA

[4] the same

[5] Source: Social Snapshot and poverty in Armenia: Statistical Analytical Report. National Statistical Service of RA, Yerevan, 2002

[6] see: Armenia: Human Development Report 1996, UNDP