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PubMed2003

The evolving pattern of avoidable mortality in Russia.

BACKGROUND: Life expectancy at birth in Russia is over 12 years less than in western Europe. This study explores the possible role of medical care in explaining this gap by examining the evolving pattern of mortality amenable to timely and effective medical care in Russia compared with Estonia, Latvia, and Lithuania, and the UK. METHODS: Analysis of standardized death rates from causes amenable to health care (treatable) or inter-sectoral health policies (preventable) in all regions and decomposition of differences in life expectancy between Russia and the UK by age, sex, and cause of death for the period 1965-1999/2000. RESULTS: Death rates from treatable causes remained stable between the mid-1960s and mid-1980s in Russia and the Baltic republics while steadily falling in the UK to less than half the rate in Russia. In the 1990s, rates increased in the former Soviet republics, reaching a peak in 1994 but reversing again in Russia in 1998. Deaths from causes amenable to inter-sectoral health interventions were higher in the UK in 1965 than in the Soviet Union but subsequently fell steadily while they increased in the East. Between 1965 and 1999, the male life expectancy gap between Russia and the UK rose from 3.6 to 15.1 years (women: 1.6 and 7.4 years). Treatable causes became an increasingly important contributor to this gap, accounting for almost 3 years by the end of the 1990s in men and 2 years in women. In Russia, elimination of treatable causes of death would have increased life expectancy by 2.9 years in men in 1995/99 compared with 1.2 years in the UK (women: 3.3 and 1.8 years), suggesting that, were the outcomes of health care achieved in the UK to be obtained in Russia, life expectancy for men might improve by about 1.7 years and for women by about 1.5 years. CONCLUSIONS: Our findings suggest that the Soviet health care system has failed to match the achievements of the West over the past three decades, highlighting the need to establish a system that provides effective and equitable care for the Russian population.

Adolescent↗
PubMed1998

Economic transition and health transition: comparing China and Russia.

Drawing on experiences from China and Russia (the world's two largest transitional economies), this paper empirically examines the impact of economic reforms on health status. While China's overall health status continued to improve after the economic reform, Russia experienced a serious deterioration in its population health. The observed differences in health performance between China and Russia can be explained by the different impacts of economic reforms on three major socioeconomic determinants of health. Depending on whether or not the reform improves physical environment (as reflected in income level and nutritional status), social environment (including social stability and security system), and health care, we would observe either a positive or a negative net effect on health. Despite remarkable differences in overall health development, China and Russia share some common problems. Mental and social health problems such as suicides and alcohol poisoning have been on the rise in both countries. These problems were much more serious in Russia, where political and social instability was more pronounced, associated with Russia's relatively radical reform process. With their economies moving toward a free market system, health sectors in China and Russia are undergoing marketization, which has had serious detrimental effect on the public health services.

China↗
PubMed2002

The changing nature of murder in Russia.

The death rate from homicide in Russia increased rapidly during the 1990 s. It is now about 20 times higher than in western Europe and is among the highest recorded anywhere in the world. However, this issue has received little attention so far from public health researchers or policymakers. This paper describes the changing nature of homicide during the 1990 s in Russia as a whole and, in more detail, in the Udmurt Republic. The study uses data from three sources: routine mortality data for Russia from 1970 to 1999; statistics on criminal investigations and convictions in Russia between 1990 and 1997; and an in-depth study of homicide trial records in the Udmurt Republic in 1989-1991 and 1998.Deaths from homicide increased between 1970 and 1985, falling slightly during the 1985 anti-alcohol campaign and then resuming their increase until 1994. Another fall in the late 1990 s was arrested in 1998, with an increase in 1999. By 1999 the age standardised homicide death rate in Russia was 81% higher than in 1990, an increase almost twice that of all causes of death combined. Throughout the 1990 s about 10% of those convicted of homicide were female. Of those homicides leading to convictions in the Udmurt Republic, 71% of those killed by males were male, as were 76% of those killed by females. Killings of women by men often involved sexual assaults. In Russia as a whole, about 80% of those convicted of homicide were reported to be under the influence of alcohol at the time. In the Udmurt Republic, where data on both offender and victim were available, victims were also commonly intoxicated. The nature of homicide in Russia has changed considerably in less than a decade, with many more now involving aggravating circumstances, such as murder to conceal another crime, in association with robbery or rape, or by a group of people. Although still a small proportion of the total convicted, the number of murders by hired killers is also on the rise. The characteristics of those convicted of homicide have also changed during the 1990 s. They are now younger, less likely to have previous convictions, and to have a more diverse range of educational levels. The previous urban-rural gap, with higher levels in rural areas, has also narrowed.

Adolescent↗
PubMed2006

Antimicrobial resistance of nasopharyngeal pneumococci from children from day-care centres and orphanages in Russia: results of a unique prospective multicentre study.

This study assessed the antimicrobial resistance of nasopharyngeal pneumococci isolated from children aged < 5 years in day-care centres and orphanages throughout Russia during 2001-2002. Swabs were collected from 2484 children in 43 day-care centres and eight orphanages in 11 cities of European Russia, and from 1669 children in 37 day-care centres and three orphanages in eight cities of Asian Russia, with a total of 1144 and 912 Streptococcus pneumoniae isolates being recovered in European and Asian Russia, respectively. All macrolide-non-susceptible (MICs 0.5-128 mg/L) and fluoroquinolone-non-susceptible (ciprofloxacin MICs > or = 4 mg/L) isolates were tested for resistance mechanisms and clonal relatedness. Non-susceptibility rates, by CLSI criteria, were 19.3%, 0.9% and 0.4% for penicillin G, cefotaxime and amoxycillin-clavulanate, respectively. Resistance to macrolides and lincosamides was also relatively low, i.e., < 7% for clindamycin and 14- and 15-membered macrolides. The highest rates of non-susceptibility were for tetracycline and co-trimoxazole (52.0% and 64.5%, respectively). No clones resistant to ciprofloxacin (MICs > or = 8 mg/L) were found, but 1.7% of isolates were non-susceptible (MIC 4 mg/L). No resistance was found to levofloxacin, gemifloxacin, telithromycin or vancomycin. Pulsed-field gel electrophoresis analysis showed no relationship between ciprofloxacin- and macrolide-non-susceptible isolates in European and Asian Russia. Resistance among macrolide-resistant isolates resulted mostly from the presence of erm(B) and mef(A), and from changes in L4; additionally, L22 mutations were common in isolates from Asian Russia. Non-susceptibility to quinolones was associated with mutations in parC and parE among European isolates. Asian Russian isolates had mutations in parC and gyrA, and alterations in parE were more common. There were substantial differences in non-susceptibility and mechanisms of resistance between pneumococci from Asian and European Russia, with orphanages appearing to be 'hot-spots' of resistance.

Anti-Bacterial Agents↗
PubMed2005

Cardiovascular disease prevention in Russia: challenges and opportunities.

OBJECTIVES: This paper examines the challenges that have faced the implementation of cardiovascular disease (CVD) prevention programmes in Russia since the 1980s in two regions of Russia, and identifies opportunities for improving such efforts. STUDY DESIGN AND METHODS: This study used a mixed methods design consisting of archival data review of health-related policy documents and legislation, and key informant interviews. RESULTS: CVD is the leading cause of death in Russia, with rapid increases in prevalence following the collapse of the Soviet Union in 1991. The MONICA, Tacis and CINDI programmes have played major roles in the development of non-communicable and CVD prevention policies and programmes in Russia since the 1980s. These programmes have assisted in policy and guideline development, and programme implementation. However, significant barriers in realizing such policies and sustaining prevention programmes have been encountered. CONCLUSION: Numerous barriers exist in developing and implementing CVD prevention programmes in Russia. More government engagement backed by strong public support is necessary in order to sustain and build capacity for CVD prevention in Russia.

Cardiovascular Diseases↗
PubMed2002

Alcohol-related human losses in Russia in the 1980s and 1990s.

AIMS: The estimation of alcohol-related human losses in Russia in the 1980s and 1990s. DESIGN: The estimation was made by comparing changes in the total number of deaths and in specific categories, and alcohol consumption in Russia during this time. SETTING: The anti-alcohol campaign, launched in 1985, and the market reforms launched in 1992 were associated with large and rapid changes of alcohol-consumption in Russia. FINDINGS: In the early 1980s, the aggregate number of direct and indirect alcohol-related life losses was more than 500,000 per annum, or 32% of total deaths. Half of the alcohol-related human losses in Russia over the period studied were due to accidents, poisoning and violence. Following the anti-alcohol campaign and reduction in annual per capita alcohol consumption from 14.2 (1984) to 10.5 l (1986), mortality decreased from 1161.6 to 1054.0 per 100,000 of the population. It is estimated that from 1986 to 1991 the lives of 1.22 million people were spared; that is, 11.4% of the number of deaths expected without the anti-alcohol campaign. All categories of deaths were reduced with the exception of neoplasms, infectious and parasitic diseases. In the period of the so-called market reforms both alcohol consumption and mortality increased sharply. The total number of alcohol-related deaths for 1994 was 751,000 in the population, or 33% of all deaths (direct and indirect losses). In 1995 alcohol consumption started to decrease. A decrease in mortality was registered despite the sharp deterioration of the quality of life in the country. However, a new growth of total mortality, fatal alcohol poisonings and number of alcohol psychoses began in 1999-2000. CONCLUSION: The results of this study show the enormous scale of alcohol-related mortality in Russia. It has been revealed that alcohol-related deaths are at the top of the hierarchy of all premature deaths in the country. Decreasing alcohol consumption is an important means of decreasing total mortality in Russia.

Adolescent↗
PubMed2000

Is there epidemiology in Russia?

OBJECTIVE: To examine the current state of epidemiology in Russia. DESIGN: The structure of clinical research and statistical methods was used to shed light on the epidemiology in Russia. The frequencies of specific study designs were evaluated using Medline data for 1970-1997. To determine the proportion of advanced design clinical studies the frequency of cohort, prospective, follow up, or longitudinal studies, and controlled trials was evaluated. All diagnosis related studies were found to determine the usage of advanced statistical technique (ROC analysis). The adequacy of Medline information was checked by hand search of journals. All dissertations in epidemiology defended in Russia in 1995 and 1996 were evaluated for their methodology. The curriculum recommended by Ministry of Health to Medical Universities was evaluated. Available literature and library indexing of epidemiological terms examined. MAIN RESULTS: Russian medical research uses less frequently advanced study designs and methods of data analysis. Medical students are taught epidemiology as a science of spread of infectious diseases. There is no department of epidemiology in Russian universities where epidemiology is taught in the modern sense and no epidemiological and biostatistical periodicals available in Russia. CONCLUSION: Epidemiology in Russia remains in an archaic state of science of the spread of infectious diseases and it is detrimental to methodology of medical research in Russia.

Communicable Diseases↗
PubMed2006

[The HIV situation in Northwest Russia and the Baltic].

BACKGROUND: An increased incidence of communicable diseases, especially HIV-infection, has since the mid 1990ies been observed in Northwest Russia and the Baltic countries. Injecting drug use has until now been the most important factor in the spread of HIV in the area. MATERIAL AND METHODS: This paper is based on surveillance data published by EuroHIV, Epi North and the Norwegian notification system for communicable diseases, and on personal experience. We present an overview of the epidemiological HIV situation in Northwest Russia and the countries of the Baltic Sea area, and the effect this has on the HIV-epidemic in Norway. RESULTS AND INTERPRETATION: In Northwest Russia and the Baltic countries, a sharp rise of newly diagnosed HIV-cases started in 1998 and a peak was observed in 2001. The reduction of reported cases observed during the last few years is mainly caused by fewer newly diagnosed HIV-cases in intravenous drug users. An increasing proportion of the newly diagnosed cases of HIV occur among women. It is uncertain if this reflects sexual spread to drug users' partners, or if it is the beginning of a heterosexual epidemic in the general population. Men who have sex with men do currently not account for a large proportion of total cases in Northwest Russia and the Baltic countries, but stigmatisation of this group may cause underreporting of this transmission route. The epidemiological situation in the neighbouring countries has had little effect on the HIV epidemic in Norway. This is probably because HIV in Northwest Russia until now has been limited to social groups that have little contact with Norway or Norwegians visiting Russia.

Baltic States↗
PubMedDate not supplied

[Infections of the Lyme borreliosis group--ixodid tick-borne borrelioses in Russia].

The universally accepted terms Lyme disease of Lyme borreliosis actually apply to the whole group of etiologically independent diseases. This group of diseases is designated as ixodid tick-borne borrelioses (ITBB) in contrast to argasid tick-borne borrelioses (ATBB) associated with soft ticks. Analysis of individual, etiologically specific diseases should be the matter of strategy in researches and diagnostic studies of ITBB. The prevalence of B. garinii and B. afzelii in the greater part of Eurasia is now beyond doubt. To date, ITBB cases have been registered in 46 of 50 Russian regions inhabited by I. persulcatus and I. ricinus ticks. Therefore, a considerable or even a great part of the world range of infections currently collectively called Lyme disease (LD) is located on the territory of Russia. The mean ITBB incidence rates in 1993-1994 was 3.1 per 100,00 inhabitants. Data reflect a considerable progress in ITBB diagnosis, made in the past two or three years rather than an increase in morbidity rates. The greatest incidence of ITBB is registered in the Ural and west Siberian regions (27 and 17.2%, respectively). In the following years, provided IBBT diagnosis and surveillance are properly organized, the eastern regions of Russia would account for the highest ITBB morbidity. Prognosis is that at least 10,000 to 12,000 new ITBB cases may be annually detected in Russia. ITBB affects mainly adult able-bodied persons. However, in 1993-1994 children under 14 years of age accounted for 1.4% of the total number of cases in Russia. On the whole, the proportion of city dwellers among ITBB patients was 84%, amounting to as high as 90-94% in some regions. The mean ITBB morbidity rate for the rural population in 1993-1994 was 1.8 per 100,000 inhabitants. In 1993-1994 IFA was regularly performed only in 21 regions. Analysis of paired serum samples obtained from suspected ITBB patients in due time yielded positive results in 65-70% of cases. To identify fresh ITBB cases more thoroughly, at least 200,000 persons should undergo serological testing every year. This number is approximately 25 times greater than the actual number of these tests annually performed in Russia. In this connection, IFA will retain for several years its contribution to a conventional laboratory test routinely used in Russia.

Adult↗
PubMed1998

Causes of declining life expectancy in Russia.

CONTEXT: Russian life expectancy has fallen sharply in the 1990s, but the impact of the major causes of death on that decline has not been measured. OBJECTIVE: To assess the contribution of selected causes of death to the dramatic decline in life expectancy in Russia in the years following the breakup of the Soviet Union. DESIGN: Mortality and natality data from the vital statistics systems of Russia and the United States. SETTING: Russia, 1990-1994. POPULATION: Entire population of Russia. MAIN OUTCOME VARIABLES: Mortality rates, life expectancy, and contribution to change in life expectancy. METHODS: Application of standard life-table methods to calculate life expectancy by year, and a partitioning method to assess the contribution of specific causes of death and age groups to the overall decline in life expectancy. United States data presented for comparative purposes. RESULTS: Age-adjusted mortality in Russia rose by almost 33% between 1990 and 1994. During that period, life expectancy for Russian men and women declined dramatically from 63.8 and 74.4 years to 57.7 and 71.2 years, respectively, while in the United States, life expectancy increased for both men and women from 71.8 and 78.8 years to 72.4 and 79.0 years, respectively. More than 75% of the decline in life expectancy was due to increased mortality rates for ages 25 to 64 years. Overall, cardiovascular diseases (heart disease and stroke) and injuries accounted for 65% of the decline in life expectancy while infectious diseases, including pneumonia and influenza, accounted for 5.8%, chronic liver diseases and cirrhosis for 2.4%, other alcohol-related causes for 9.6%, and cancer for 0.7%. Increases in cardiovascular mortality accounted for 41.6% of the decline in life expectancy for women and 33.4% for men, while increases in mortality from injuries (eg, falls, occupational injuries, motor vehicle crashes, suicides, and homicides) accounted for 32.8% of the decline in life expectancy for men and 21.8% for women. CONCLUSION: The striking rise in Russian mortality is beyond the peacetime experience of industrialized countries, with a 5-year decline in life expectancy in 4 years' time. Many factors appear to be operating simultaneously, including economic and social instability, high rates of tobacco and alcohol consumption, poor nutrition, depression, and deterioration of the health care system. Problems in data quality and reporting appear unable to account for these findings. These results clearly demonstrate that major declines in health and life expectancy can take place rapidly.

Adolescent↗
PubMed2001

Pea varieties resources in Russia in context to the situation in Western Europe.

The largest share of legumes grain production in Russia falls at peas and amounts to 75%. The pea is grown practically in all agricultural regions of Russia. The most favourable pea-growing regions are the forest-steppe zone of European part of Russia and Volga region. 84 varieties of pea are being included in the official "National List of the Breeding Achievements Permitted to Use in the Russian Federation" in 2001. 24 of these varieties correspond to the requirements for the most valuable food pea ones. The pea varieties especially suitable for food are identified by a special classification. 32.5% percent of a total area sown with the peas in Europe falls to Russia. Total peas production in Russia is 10.6% of a total European production.

Cooking↗
PubMed2004

Temporal trends in the HIV-1 epidemic in Russia: predominance of subtype A.

During the period 1996-1997, three highly homogeneous variants of HIV-1 were identified, circulating among injecting drug users (IDUs) in the former Soviet Union republics. One of these belonged to HIV-1 genetic subtype A (IDU-A), another belonged to HIV-1 genetic subtype B (IDU-B) and the third was a recombinant between the first two variants (CRF03_AB). However, since 1997, the HIV-1 epidemic has affected an increasing number of geographic regions in Russia. This study was undertaken to survey the prevailing genetic variants and to estimate the current proportions of these three HIV-1 genetic subtypes in Russia. Blood samples were taken in 1999-2003 from 1090 HIV-infected individuals and analysed by gag/env HMA. The IDU-A variant was found to be the majority variant (89.7-100%) in 44 of 45 regions of the Russian Federation studied. The IDU-A variant was also found to spreading rapidly through heterosexual transmission in 1999-2003 (30/34, 88%). CRF03_AB predominates in the Kaliningrad region only (28/29, 96.6%). The IDU-B variant is currently of minor importance in the IDU epidemic but other European subtype B variants predominate among men having sex with men (18/18, 100%). Sequence analysis of the env V3 encoding regions derived from HIV-1 infected individuals in Yekaterinburg (the main centre of the HIV-1 epidemic in Russia in 2002-2003) showed that the IDU-A variant is still highly homogeneous. The mean pairwise nucleotide distance (n = 9) was 2.89 +/- 1.14 (range 1.36-6.14). However, the mean genetic distance between each sequence within the samples collected from the Yekaterinburg IDU-A variant subset and the IDU-A consensus is 2.51 +/- 1.06 (range 1.36-4.66) and considerably higher than in South Russia in 1996 (0.79 +/- 0.51, range 0.38-1.90). The current HIV-1 epidemic in Russia is almost entirely caused by a highly homogeneous A-subtype strain, which will influence vaccine development strategies and must be taken into account in the quality control of molecular tests for the diagnosis of HIV-1.

Adolescent↗
PubMed2005

Alcohol use and HIV risk behaviors among HIV-infected hospitalized patients in St. Petersburg, Russia.

PURPOSE: Russia has high per capita alcohol consumption and an injection-drug-use-driven HIV epidemic. However, the role of alcohol in the spread of HIV infection in Russia is largely unexplored. Thus, we assessed recent alcohol use and associated HIV risk behaviors among HIV-infected persons in St. Petersburg, Russia. METHODS: We recruited HIV-infected hospitalized patients from the Botkin Infectious Disease Hospital between June 2001 and March 2002. Interviewers assessed alcohol and drug use with the addiction severity index (ASI) and sex- and drug-risk behaviors with the risk assessment battery (RAB). Lifetime abuse or dependence diagnoses for alcohol and drugs were established by a physician with addiction medicine training. RESULTS: Among 201 subjects, diagnoses of abuse or dependence (AB/DEP) were common: 9% (19/201) had only alcohol AB/DEP; 39% (78/201) had alcohol and drug AB/DEP; 47% (95/201) had only drug AB/DEP; and 4% (9/201) had no diagnosis of alcohol or drug AB/DEP. Sex- and drug-risk behaviors varied significantly by substance use diagnosis. Subjects with any alcohol AB/DEP had higher sex-risk RAB scores than those with drug only AB/DEP (6.1 versus 3.9, p<.0001). Among subjects with any diagnosis of drug AB/DEP, having in addition an alcohol diagnosis was associated with unclean needle use in the last six months (33% (26/78) versus 21% (20/95), p=0.08). CONCLUSIONS: Lifetime alcohol diagnoses of abuse or dependence were present in nearly one-half of hospitalized HIV-infected patients in St. Petersburg, Russia and were associated with significantly higher sex-risk behaviors and borderline significantly higher drug-risk behaviors. As HIV infection spreads rapidly in Russia and Eastern Europe, these data support the need for HIV risk-reduction interventions in alcohol abusing populations and raise the potential of benefit by addressing alcohol use in HIV-infected populations.

Adult↗
PubMed1999

Alcohol and mortality in Russia: is it different than elsewhere?

PURPOSE: To discuss the hypothesis that alcohol, and binge drinking in particular, is a major determinant of the recent mortality fluctuations in Russia. METHODS: Discussion based on published literature. RESULTS: The hypothesis is based on circumstantial evidence. The changes in mortality coincided with introduction and collapse of the Soviet anti-alcohol campaign. The largest relative changes in mortality were observed for "alcohol-related causes" (a specific diagnostic category used in Russia) as well as violent and accidental deaths, but the largest absolute changes were observed for cardiovascular causes which had the largest impact on all-cause mortality. There is no direct support for the hypothesis. Available estimates of alcohol consumption in Russia are low, and the only published study on alcohol and mortality conducted in Russia produced negative results. Increase in drinking prevalence alone would not explain the mortality rise; increase in relative risk related to alcohol would also be needed. The biological mechanisms which could underlie the presumed strong effects of alcohol on heart disease are not clear. On the other hand, binge drinking has not been addressed adequately by research so far. CONCLUSIONS: Until a well designed study is conducted in Russia, the hypothesis remains debatable.

Alcohol Drinking↗
PubMed2003

High cardiovascular mortality in Russia cannot be explained by the classical risk factors. The Arkhangelsk Study 2000.

Since the beginning of the 1990s the public health situation in Russia has been characterized by an extremely high mortality and a significant reduction in life expectancy. Cardiovascular diseases remained the major cause of death. Only a few large population studies were conducted in Russia during this period. A total of 1968 men and 1737 women aged 18-75 years participated in a health survey in Arkhangelsk, Russia, over the period 1999-2000. Investigation included assessment of classic cardiovascular risk factors (family history, smoking, blood pressure, and blood lipids) along with general health variables. The paper presents sex specific data on risk factors for coronary heart disease. Though the cardiovascular mortality is high in Russia, the calculated risk for coronary heart disease (the Framingham risk score and the Norwegian risk score) was lower in all age groups of men and women in Arkhangelsk compared with studies from the Western Europe and USA. Our data suggest that high cardiovascular mortality in Russia may be driven not only by the classic risk factors for coronary heart disease.

Adolescent↗
PubMed2002

Allergic diseases, skin prick test responses, and IgE levels in North Karelia, Finland, and the Republic of Karelia, Russia.

BACKGROUND: There is growing evidence to show that atopic diseases are more common in Western Europe than in the former socialist countries of Eastern Europe. OBJECTIVE: The aim of this study was to assess whether a similar difference exists between the most eastern province of Finland and a neighboring western district of Russia. METHODS: A random sample of 25- to 54-year-old subjects was taken from the population registers in the North Karelia Province in eastern Finland and from the Pitkäranta district across the border in the western part of Russia. Participants filled out a questionnaire on atopic and allergic symptoms and participated in a clinical study, which included skin prick tests with 11 airborne allergens and IgE measurements. RESULTS: Self-reported hay fever, allergic eye symptoms, atopic eczema, and asthma were much more common in Finland than in Russia. In Finland 34.2% and in Russia 21.8% had at least one positive skin prick test reaction. In Finland 21.5% but in Russia only 15.8% had at least one elevated allergen-specific IgE value of the 5 values measured. From 6% to 47% of the differences in self-reported symptoms between the countries were explained by atopy, as measured by means of skin prick testing or specific IgE values. CONCLUSIONS: A major difference in clinical allergic diseases and signs of symptoms was observed between the 2 geographically adjacent areas. This suggests that the difference in clinical allergy and atopic disposition is related to the differences in lifestyle and environmental factors.

Adult↗
PubMed2000

Public health in Russia: the view from the inside.

The health of the Russian population continues to lag far behind that in the west. A robust public health response to the high levels of communicable and non-communicable diseases is required. This challenge has attracted considerable attention from international donor agencies and others, but there are still many questions about how the health situation in Russia is understood by policy-makers within the country and what responses are being considered. This paper examines these questions by means of a review of literature published in Russia and interviews with key informants. It concludes that although many of the determinants of health in Russia have been identified, they are typically discussed in a general way. Research on the major determinants of disease in Russia, and published in the international literature, appears to have had little impact. The need for reform to enhance the public health response is recognized. Goals of reform have been described but are poorly defined and there is typically little relationship between a stated goal and the strategy proposed to achieve it. There is a lack of clarity about what is meant by public health, and key concepts, such as inter-sectoral and multi-disciplinary working, are either ignored or misunderstood. Evidence of capacity for managed change is weak. There is an urgent need to create a shared awareness of evidence on the nature of the health challenges facing Russia and the evidence base for both the content of potential responses and the strategies that might be adopted to implement them.

Attitude to Health↗
PubMed1998

Economic change, crime, and mortality crisis in Russia: regional analysis.

OBJECTIVE: To identify which aspects of socioeconomic change were associated with the steep decline in life expectancy in Russia between 1990 and 1994. DESIGN: Regression analysis of regional data, with percentage fall in male life expectancy as dependent variable and a range of socioeconomic measures reflecting transition, change in income, inequity, and social cohesion as independent variables. Determination of contribution of deaths from major causes and in each age group to changes in both male and female life expectancy at birth in regions with the smallest and largest declines. SETTING: Regions (oblasts) of European Russia (excluding Siberia and those in the Caucasus affected by the Chechen war). SUBJECTS: The population of European Russia. RESULTS: The fall in life expectancy at birth varied widely between regions, with declines for men and women highly correlated. The regions with the largest falls were predominantly urban, with high rates of labour turnover, large increases in recorded crime, and a higher average but unequal distribution of household income. For both men and women increasing rates of death between the ages of 30 and 60 years accounted for most of the fall in life expectancy, with the greatest contributions being from conditions directly or indirectly associated with heavy alcohol consumption. CONCLUSIONS: The decline in life expectancy in Russia in the 1990s cannot be attributed simply to impoverishment. Instead, the impact of social and economic transition, exacerbated by a lack of social cohesion, seems to have played a major part. The evidence that alcohol is an important proximate cause of premature death in Russia is strengthened.

Adolescent↗