1. 1 HEALTH CARE IN MIGRANT MOSCOW Prepared for “Living with Risk: the Post-Soviet Welfare State and Daily Life Uncertainties in Russia” Aleksanteri Institute, University of Helsinki Helsinki, Finland October 21, 2014 Linda J. Cook Colin Johnson Brown University, Providence, R.I.

2. New Structures of Inequality, Stratification in Post-Soviet Space Since 2000, growing dependence of Russia’s economy, labor market, on migration for low-skilled labor Growing dependence of Tajik GDP on migrants’ remittances-30-50% GDP, world’s highest dependency rate Newly-institutionalized political economy of Russia’s ‘global cities’ and Eurasian periphery 2

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6. 6 COMPONENTS OF RUSSIA’S POPULATION CHANGE (IN THOUSANDS OF PEOPLE) (Ioffe and Zayonchkovskaya, 2010)

7. 7 2005-2026 Dynamics of Russia’s Working-Age and Total Population in the Absence of Immigration (in Thousands of People) (Source: Ioffe and Zayonchkovskaya, 2010)

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10. Migrants’ Health and Social Rights in Russia No coherent Russian immigration policy Majority of migrants unregistered, informal Limited reach of multilateral and bilateral agreements on social rights Russia’s cooperation on soc rights minimal Most subject to social exclusion, severance from social protection mechanisms 10

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12. Migrants’ Health and Access to Services ‘Healthy migrant effect,’ (Buckley) then ‘negative assimilation’ leads to decline in health status Infectious diseases, accidents, hostility Public facilities provide emergency care, including, childbirth, to all; little else No employer responsibility; 2011 reduction in coverage for registered migrants unless permanent residents 12

13. Do NGOs ‘fill gaps,’ compensate for state? Spring 2012, 33 NGOs in Moscow with mission of advocating for or providing health services to Central Asian migrants Preliminary conclusion – clear recognition of need, NGOs had very limited resources, capacity to fill Licensing and other obstacles to providing health services 13

14. What do migrants do about health care needs? Rely on ‘shadow’ health services; irregular status pushes into ‘grey’ markets of fake med certificates, documents ; undermines public health, monitoring mechanisms Formal paid services – Kyrgiz clinics – culturally friendly, politically safe, less costly than private Russian clinics 14

15. Conclusion Given Russia’s projected demographic trends, need for migrant labor likely to increase Negative implications for migrants’ health, integrity of Russia’s public health system, stress on CA health sectors Increasingly fragmented welfare state; ethnically-stratified labor force 15