Russian Health profiles in Transition

Eugene Shubnikov for FSU Internet Prevention Network

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.

The period until 1991

Life expectancy (both sexes)

32

43

59

47

63

47

01020304050607080

1900 1938

Russia

France

USA

The period until 1991

Life expectancy in 1965

64.373.4 74.7

66.873.7

67.3

01020304050607080

Men Women

Russia

France

USA

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.

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*.

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.

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.

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*.

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.

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.

Life expectancy related to Campaign

61.764.9

74.473

404550556065707580

1984 1987

Male

Female

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 Russia’s population towards alcohol.

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.

Russian Federation Population (1980-2000)

Total mortality, 1990’s

Russian Federation

St. Petersburg

Life expectancy in Russia, male

61.764.9

57.661.39

59.15 58.5

404550556065707580

1984 1987 1994 1998 2000 2001

Life expectancy in Russia, female

74.4 74.471.2 72.96 72.4 72.173

404550556065707580

1984 1987 1990 1994 1997 2000 2001

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

CVD

Injury

Cancer

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.

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).

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

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

References