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)
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.
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.
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 Prevention Network 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 www.pitt.edu/~super1/index.htm Provide Russian Language Lectures on prevention via FSU Internet Prevention web site – www.pitt.edu/~super1/national/index.htmwww.pitt.edu/~super1/national/index.htm