Russian health collapsed with the Soviet state, worsening during the political instability of the 1990’s, and continuing to suffer in the 21st century. In 1991, Russia’s Ministry of Health reported a negative rate of population change for the first time in the nation’s records. Unheard of for a world power, Russia’s dire state of public health was caused by a combination of factors, including high mortality rates, low fertility, and poor, inefficient health care.
Between 1992 and 1995, Russia “witnessed an excess mortality of 1.8 million people – more than the 1.7 million Russian combatants killed during World War”. Disease, many common and curable, and chronic health issues were the main causes of this staggering death rate, creating major demographic changes and shortening life expectancy. Russia experienced epidemic levels of influenza, diphtheria, and measles, and it’s “rates of tuberculosis, cancer, and heart disease are the highest of any industrialized country”.
Alcoholism, which follows cardiovascular disease and cancer as one of Russia’s top three critical health problems, escalated when prohibition was eased in 1988. After Gorbachev’s anti-alcohol campaign ended, alcohol consumption increased from the pre-1985 level of eleven liters to fourteen. Moreover, chain-smoking had become prevalent in Russian society, as 55% of Russians smoked regularly in 1996. Linked to the problem of heroin addiction, Russia developed an HIV/AIDS issue, with as many as 1.2 million HIV-positive in 2009. This plethora of health problems took a toll on the nation’s population, skewing the average life span and gender-balance. Not surprisingly, life expectancy for males decreased from 63.5 years for males in 1991 to 57.3 in 1994, with a ratio of 884 males per 1,000 females in 1993.
Another reason death rates dominated life in the 1990’s was the low fertility and birthrate, generated by abortions and high infant mortality. The annual birthrate decreased by 12% in 1993, and in 1997 there were twice as many abortions as live births. That amounts to about 2.5 million terminated pregnancies in one year, free of charge at most Russian hospitals and clinics in the first trimester. Work and living environments also affected infant mortality levels, as 1.5 million women are exposed to “unfavorable working conditions”, and millions more to industrial pollutants and “harmful airborne substances”, taking a toll on their pregnancies.
These devastating health concerns have not gone unaddressed, but government reforms have changed the face of public health without producing adequate results. The Glasnost period of the 1980’s illustrated the obstacles of state health care, as the system was highly stratified by location and political status. While there was an abundance of medical staff, most were poorly trained and lacked proper medical equipment. Moreover, corruption plagues the system, as the commonality of low salaries among medical workers led to the normalcy of bribes, causing the quality of treatment to be determined by the patient’s wealth. In 1993, “President Yeltsin signed a decree entitled On Immediate Measures to Provide Health Care for the People of the Russian Federation”, constitutionally changing the previously socialist model of health care to include compulsory medical insurance. While private funding and “new free market providers was intended to promote both efficiency and patient choice”, public health was allotted less than 1% of the budget in 1995, while the United States budgeted more than 12%, limiting the resources to finance the new law.
Russia’s health has scarcely improved since the 1990’s, but the gravity of the situation is growing more apparent. In 2011, Prime Minister Vladimir Putin pledged “more than 300 billion rubles ($10 billion dollars) in the next few years to improve health care in the country”. These funds will go towards modernization of medical institutions, increasing access to medical services, and increasing salaries of medical personnel. However, the November protests of Putin’s plans to “close over 20 hospitals and fire about 7,000 health care professionals” in the Moscow area confirm the shallow intent of health care reform, leading 5,000 Russians to march in the city streets. Already struggling to maintain domestic peace over international tensions and a poor economy, this public upheaval may persuade Putin to reevaluate the urgency of further health care reform.