1. FSU - Supercourse Developments
SCIENTIFIC NETWORKING AND THE GLOBAL HEALTH
SUPERCOURSE FOR THE PREVENTION OF THREAT FROM
MAN MADE AND NATURAL DISASTERS
FSU - Supercourse Developments
Dear Colleagues, Friends! I am glad that we have a meeting in Kaunas, I visited Kaunas two times in 1987 and We decided to implement diabetes registries in Novosibirsk and my Kaunas colleagues helped me much in this and future participation of our Siberian diabetes center at world wide Diabetes incidence program. I am glad that I have an old and new friends in Kaunas and we may work again in area of prevention.
At this presentation I would like to speak about Internet Prevention program we started 5 years ago. More information about this program you may find at FSU Internet prevention web page.
Eugene Shubnikov for FSU Internet Prevention Network
August 8, 2005, Kaunas, Lithuania

2. Currently we have about 400 participants from all 15 FSU countries
Currently we have about 400 participants from all 15 FSU countries. Mailing list include more than 500 participants. Some of them will present also.
Here are some pictures of people from our network. They all in constant contact with each other through our newsletters and personal contacts.

3. This is bilingual page (Russian and English) of FSU Internet prevention Program, but we have lectures devoted to Internet Prevention in some more languages and we will be happy to have more materials at other languages.

4.
FSU Supercourse page has now 260 lectures from FSU authors or with topics related to FSU countries. Half of these lectures are in Russian language and there are 15 Health Profiles with the health indicators for all FSU countries.

5. Internet prevention program as a part of Supercourse project is not designed as a program for prevention of threat from disasters, but in the frame of Disasters Supercourse page we have FSU Supercourse members who published their lectures on disasters.

6. Selected Causes of Death
I visited Pittsburgh for 4 months in year As you know, Russia already has a very bad health indices, so Ron and Supercourse Team had started to think how to improve health of Russians.
Later we decided to expand our network to Former Soviet Union countries, as health indices at these countries were similar. Now we have participants of our project in each FSU country. We decided to implement inexpensive Internet program based on Supercourse concept.

7. I-Prevention Low band width information transfer reaching large numbers of well people to prevent
Information for non-communicable diseases is what “vaccinations” are to infectious diseases.
We invented word I-prevention which is Internet Prevention.
The new Information Technologies has a significant role to play in disease prevention. Prevention should always come first.

8. Steps in Developing of Russian/FSU Supercourse:
Network of the scientists involved in prevention and the Internet in Russia and FSU
Russian Language or Russia/ FSU’s connected Public Health Library of lectures at the Internet
I-prevention Program with relations between Russian, FSU, US and scientists from around of the world
First, our goal was to network the scientists involved in prevention and the Internet in Russia.
Second, it was important to establish a large Russian Language Lecture Library on the Internet.
This is created a backbone for a Russian I-PREVENTION program based upon the model established (Supercourse).

9. Communications between members
Mailing list
Sharing of lectures
Personal contacts
Personal meetings
Now, we have monthly newsletter for all members from FSU countries together with scientists from other countries, representatives from different agencies, Medical Academies and private organizations. We use regular meetings as Moscow Public Health school last summer, Salzburg medical seminars and current meeting in Lithuania for personal contacts.

10. Our Help for Russian/ FSU Public Health Teachers
Free access to the Supercourse web library of lectures
Cutting edge, interesting lectures available from Supercourse website and CDRoms.
Share knowledge, education and training systems with other public health professionals in FSU and worldwide through personal contacts
Information has always improve health. Our program is different from Telemedicine, which use expensive telecommunication technologies to a small number of sick people. But as people will always get sick, we believe that I-PREVENTION together with Telemedicine will improve health in Russia.

11. What is the reasons of current bad health indices in Russia?

12. 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.
Russia became independent just 14 years ago, and most of adult Russian population didn’t change much their lifestyle and habits as well their work conditions and even system of medical care practically not changed.

13. The period until 1991 Life expectancy (both sexes)
At the end of the nineteenth century, life expectancy in Russia was about 32 years, compared to 47 years in France and the United States. By 1938 the gap had increased.

14. The period until 1991 Life expectancy in 1965
During the next 15 years, however, Russia made huge steps forward and succeeded in closing much of the gap. However this progress was not maintained in later years.

15. 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.
Based on these principles, the state developed a unified health system which provided free medical services for everyone. Enormous emphasis was placed upon epidemic control and prevention of infectious diseases.

16. 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.
By 1941, when Russia entered the Second World War, the health care system was well developed and had succeeded in bringing reliable health care services to the entire population.

17. 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.
Mortality rates from infectious diseases falling from 87 for in 1960 to 12 in Yet, these successes were not reflected in improvements in the overall health status of the population.

18. 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.
Russian health care system was unable to fight with noncommunicable diseases using current prevention strategy.
Old Russian system of prevention, with its primarily medical orientation, did not evolve into one of population-based health promotion.

19. Healht Crisis(cont.)
The 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.
Soviet medical science was effectively isolated from developments in the West. Soviet Union failed to develop a modern pharmaceutical industry and was dependent on imports or should use many ineffective treatments.

20. 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. In the mid-1980s, the government made an attempt to address this problem. 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.
A campaign against alcohol was launched, in which alcohol prices were raised and sales outlets cut.
State production and sales of alcoholic beverages dropped to less than one third.

21. Life expectancy at birth related to Campaign
The impact of these measures on death rates surpassed all expectations. In short period, life expectancy increased considerably especially among men.

22. 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.
By the end of the Soviet period, the Russian population, faced with mortality rates much higher and life expectancy lower than at western countries.

23. The period after 1991
The health status of the Russian population declined precipitously following the collapse of the Soviet Union in late By all accounts, in the last decade Russia has been experiencing a shock unprecedented in peacetime to its health and demographic profiles.
A combination of a dramatic fall in the birth rate and increasing mortality meant that natural population loss rose from in 1992 to about a million per year in recent years.

24. Russian Federation Population (1980-2000)
Russian Federation population has fallen by 3.5 million in the period from 1992 by year 2000.

25. Total mortality, 1990’s St. Petersburg Russian Federation
The greatest increase in mortality was among males aged 40–49, which nearly
doubled in the period from 1990 to 1994.
St.
Petersburg
Russian
Federation

26. Life expectancy in Russia, male
Life expectancy is now among the lowest in Europe, especially for men, which is almost 13 years lower than the average for the European Union.

27. Life expectancy in Russia, female
Female life expectancy has tended to be more stable. A gender gap is the largest in Europe. This peaked at 13.6 years in 1994.

28. 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
There is now considerable evidence that many of the excess deaths especially among younger men are because of heavy alcohol consumption.
The male mortality rate in category of external causes of injury and poisoning is 4.4 times greater than that of women.

29. 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.
In the period 1994–1995 cardiovascular disease and external causes and injuries were responsible for over 65% of the fall in life expectancy among adult males of working age, and it is believed that alcohol played a role in both these cases.

30. 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
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.
However, life expectancy has continued to fall steadily since the 1998 currency crisis. Furthermore, new threats are emerging, including AIDS, whose incidence has been growing exponentially since 1994.

31. 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
Nominally, there are four main priorities emerging from government’s concept.

32. What ways we may use for improve Health in Russia?
Improve prevention
Reach everybody
Make it inexpensively
As Internet provides an inexpensive way to distribute information from person to person, and prevention is information transfer, we decided to use Supercourse model for improve prevention through trained Public Health specialists in Russia.

33. Role of FSU Internet Prevention Network in improvement Health in Russia
Networking Russian Public Health specialists via Internet
Improve prevention through the training of Russian Public Health specialists through Supercourse Library of lectures in Epidemiology, Public Health and Internet -
Provide Russian Language Lectures on prevention via FSU Internet Prevention web site –

34. Thank you! And Welcome to Siberia!
Thank you very much. I will be glad to answer your questions.