Public Health in Russia and Environs: Stuck in a Rut

A decade and a half after the collapse of the former Soviet Union, crises in public health are rife throughout the region. Although the health sector in one fashion or another is bound to touch the lives of many ordinary citizens, reforms of health care – hospitals and related medical services – have, as a rule, not been achieved. Public health education is also woefully inadequate. Any number of ailments, including those of serious and contagious varieties, are epidemic in the region.

For example, a World Health Organization report featured in a New York Times article sheds a light on the alarming rates of multiple-drug resistant tuberculosis in the former Soviet Union.

The Times article notes particular challenges in five countries: Azerbaijan, whose capital city, Baku, has the highest rate; Moldova, Ukraine’s Donetsk region; Russia’s Tomsk Oblast; and Tashkent in Uzbekistan.

Speaking about the cases in these countries, Dr. Mario C. Raviglione, who directs the health organization’s tuberculosis program, said in the Times that the levels of multiple-drug resistant tuberculosis surpassed the highest levels that nearly all experts had once thought were possible.

The WHO survey notes that in certain cases the governments “have not invested enough to build, equip and staff laboratories to detect the disease. The countries also have not made sure there are enough standard drugs and have not monitored patients to ensure they complete a full course of therapy.”

The report, Anti-Tuberculosis Drug Resistance in the World, is based on information collected between 2002 and 2006 on 90,000 tuberculosis patients in 81 countries.

In countries of the former Soviet Union there are two scenarios. Two Baltic countries (Estonia, and Latvia) are showing a stable and flat trend in proportions of MDR among new cases, Lithuania shows a gradual and significant increase but at a slow rate. This is held in contrast to two Oblasts in the Russian Federation (Orel, and Tomsk) which are showing an increase in the proportion of MDR among new cases, as well as increases in absolute numbers.

Another report from the WHO, a rapid health assessment of five hospitals in Tajikistan done in February 2008, had several main findings:

• Primary health care is almost completely paralyzed; no services are delivered to population.
• Shortages of energy, water and food supply has produced sharp increase of inflation rate; higher prices are due also for food, drugs, fuel and portable heaters.
• All hospitals are suffering energy cuts for several hours/day; water supply is also affected and proper heating of hospital wards is impossible.
• Central heating systems of hospitals are almost always not functioning due to lack of maintenance; few medical instruments still operative (diagnostic and curative) are outdated and unreliable, and cannot work without electricity.
• All hospital are therefore unable to deliver assistance and appropriate care, moreover, shortage of resources strongly hamper food and essential drugs supply to patients (on average only 5-10% of their needs is purchased by the hospitals).

Substandard governance is a contributing factor to the performance of the health care sector in Tajikistan but the country is profoundly impoverished. The country’s GDP per capita is just $1,600.

Russia, on the other hand, has enjoyed nine straight years of growth and is benefiting from sky-high energy prices which have filled government coffers. The country’s GDP per capita is over $14,000. Yet the Russian health care system continues to confront its own considerable challenges.

An article in the Chicago Tribune examines the deep-seated problems afflicting the Russian health care system, including entrenched and widespread graft.

The article notes that alcohol and smoking are among the biggest contributing factors to major health problems. Alluding to research done at Columbia University, the piece adds “Both are linked to heart disease, and in Russia, the rate of men ages 30 to 59 dying from heart disease is five times that of the United States.”

The authorities are looking to address the problems:

The Russian government is pumping $6.4 billion into revamping health care; much of that money is paying for the construction of eight high-tech medical centers across the country, new X-ray machines, electrocardiograms and ambulances at hospitals, and raises for family doctors.

These investments may have a difficult time achieving the desired effect in a setting with such monumental corruption and so little accountability and transparency:

Researchers at the Russian Academy of Sciences' Open Health Institute estimate that corruption siphons off as much as 35 percent of money spent on health care. Low wages perpetuate the problem; yearly doctor salaries in Russia average $5,160 to $6,120. Nurses make an average of $2,760 to $3,780 annually.

Meanwhile, the Guardian looks at the demographic crisis and the emergence of “women-only villages” in Russia, the result of a confluence of negative demographic trends, including a Russian male life expectancy of only 59 years.

Photo Credit: Flickr user cbmd

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