Russian Health profiles in Transition

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Russian Health profiles in Transition

• Eugene Shubnikov for FSU Internet Prevention
  Network

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Health status

• It is useful to begin an account of health status
  developments with a consideration of the Soviet
  period, as the present health crisis of the
  Russian Federation has its roots in events that
  long precede the collapse of the Soviet Union.

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The period until 1991Life expectancy (both
sexes)
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The period until 1991Life expectancy in 1965
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The health care principles upon which the Soviet
health care system was to be based (Nikolai
Semashko)

• government responsibility for health
• universal access to free services
• a preventive approach to social diseases
• quality professional care
• a close relation between science and medical
  practice
• continuity of care between health promotion,
  treatment and rehabilitation.

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Next steps following the establishment of the
Semashko model in 1918

• The health care system was under the centralized
  control of the state, which financed services by
  general government revenues as part of national
  social and economic development plans.
• All health care personnel became employees of the
  centralized state, which paid salaries and
  provided supplies to all medical institutions.
• The main policy orientation throughout this
  period was to increase numbers of hospital beds
  and medical personnel.

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Next steps following the establishment of the
Semashko model in 1918 (cont.)

• Russia made massive strides in arresting the
  spread of infectious diseases.
• Drastic epidemic control measures were
  implemented, particularly in the cases of
  tuberculosis, typhoid fever, typhus, malaria and
  cholera.
• These involved community prevention approaches,
  routine check-ups, improvements in urban
  sanitation and hygiene, quarantines, etc.

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Health crisis

• The diverging paths of Russia and other
  industrialized nations with respect to health
  status from the 1960s onward has been attributed
  to the failure of the Russian health care system
  to successfully respond to the epidemiological
  transition.

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Health crisis (cont.)

• This system of prevention, with its primarily
  medical orientation, did not evolve into one of
  population-based health promotion measures
  necessary for dealing with the new patterns of
  morbidity (due to noncommunicable diseases).
  While those in power were aware that an
  epidemiological transition was occurring, they
  responded by treating cardiovascular and other
  noncommunicable diseases as social diseases
  requiring a medical solution.

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Healht Crisis (cont.)

• The paternalistic Soviet philosophy did not
  encourage the development of responsibility of
  the individual with respect to lifestyle issues
  that have a major bearing on health (alcohol use,
  smoking, diet, etc.), a situation exacerbated by
  the heavy dependence on alcohol sales as a means
  of circulating currency in a country with little
  access to consumer goods.
• And Soviet medical science was effectively
  isolated from developments in the West, not only
  in terms of knowledge of new treatments but also
  access to pharmaceuticals, technology, and the
  emerging evidence based medicine movement.

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A campaign against alcohol

• By the 1980s, the gap between Russia and Western
  countries in life expectancy at birth came to
  about 10 years for men and 6 years for women,
  mostly due to high death rates among those of
  working age (6). In the mid-1980s, the government
  made an attempt to address this problem (9). It
  was by then generally understood that potentially
  avoidable human losses were mostly attributable
  to excess adult age mortality from particular
  causes such as injuries, accidental poisoning,
  suicide, homicide, sudden cardiac death,
  hypertension and other conditions closely related
  to alcohol abuse and its consequences.

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Life expectancy related to Campaign
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But.

• Russia failed to maintain this record, however
  by 1987 the USSR was no longer able to enforce
  the anti-alcohol campaign and death rates rapidly
  resumed their upward trend from 1988 onwards. The
  anti-alcohol campaign was largely prohibitive and
  did not affect the attitude of the majority of
  Russias population towards alcohol.

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The period after 1991

• The health status of the Russian population
  declined precipitously following the collapse of
  the Soviet Union in late 1991. By all accounts,
  in the last decade Russia has been experiencing a
  shock unprecedented in peacetime to its health
  and demographic profiles.

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Russian Federation Population (1980-2000)
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Total mortality, 1990s
Russian Federation
St. Petersburg
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Life expectancy in Russia, male
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Life expectancy in Russia, female
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The leading causes of death in the Russia
Federation

• Cardiovascular diseases with rates that are the
  highest in the European Region
• External causes of injury and poisoning
• Cancer

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CVD
Injury
Cancer
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Causes of the mortality crisis

• Major social and economic shock and income
  stratification in a population already vulnerable
  because of
• Poor diet, high levels of smoking, and weak
  systems of social support, in which alcohol and,
  increasingly, intravenous drugs, are easily
  available.
• Health care system is poorly equipped to respond
  to challenges.

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What can be done?

• The government of the Russian Federation clearly
  recognizes the urgency of the health and
  demographic crises. The Former Minister of Health
  Y. L. Shevchenko for instance, referred to the
  public health system as a significant factor in
  national security of the nation(14). President
  Putin, in a speech to the State Duma on 8 July
  2000, stated that a persistence of recent
  demographic trends would endanger the survival of
  the nation (5).

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What can be done? (cont.)

• Health promotion, prevention and attention to
  lifestyles Primary care development based on
  family practice De-emphasizing secondary and
  tertiary care Quality of care

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Role of FSU Internet PreventionNetwork in
improvement Health in Russia

• Networking Russian Public Health specialists with
  the help of Internet
• Improve prevention through the training of
  Russian Public Health specialists using
  Supercourse Library of lectures in Epidemiology,
  Public Health and Internet - www.pitt.edu/super1/
  index.htm
• Provide Russian Language Lectures on prevention
  via FSU Internet Prevention web site
  www.pitt.edu/super1/national/index.htm

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References