A Sick State

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”.

David Granlund- 2009

David Granlund- 2009

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.

health care protest 1

Health Care Protests November 2014

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.

health care protest 2

Health Care Protests November 2014

Works Cited:

Russian Health (Country Studies)

Russian Health Status in the 1990’s

“AIDS and Heroin Addiction in Russia”

Healthcare in Russia

“Putin says Russia needs major health care reform”

“Putin’s Health Care Disaster”

Cartoon Link

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  8 comments for “A Sick State

  1. jenniferh
    December 8, 2014 at 10:02 am

    The comment you made about corruption within the medical community, reminds me of my friend who grew up there. He told me that people would bribe doctors with alcohol to be able to get seen in a reasonable amount of time.

  2. rkw15
    December 8, 2014 at 8:42 pm

    Awesome post on a unique topic. This post is a great compliment to the prohibition posts this week. Two interesting notes about my personal experience with the Russian health system. First of all, to obtain a student visa in Russia you have to submit an HIV test with your VISA application. The government thinks that international students (especially Americans) are bringing HIV to their country. Secondly, when I went to Russia our professors told us that if we for some reason were injured and needed to go to a hospital to ask to go to a private hospital rather than a public one. In other words, great healthcare in Russia is available to those who can pay extra for it.

  3. abishop
    December 8, 2014 at 10:11 pm

    Great sources and great post! I find it incredible that within a three-year time span, more Russians died from common and possibly-curable illnesses than in World War I. I also find it staggering that 1.2 million people were living with HIV/AIDS in Russia as recently as 2009. I know that HIV/AIDS is still a huge problem, but you mostly hear about it growing at rates like that in developing countries, not in more developed countries like Russia. Overall, your post was well-written and extremely eye-opening for me. Well done.

  4. Jimmy Jewett
    December 8, 2014 at 10:26 pm

    Its incredible to think American’s complain about healthcare coverage while one of the world’s Super Powers is struggling to keep their population alive. It seems the shortage economy of the Soviet Union finally took its toll on many of the sectors necessary to improve this condition, resulting in the rapidly shrinking population the country is not struggling to fix.

  5. December 8, 2014 at 11:02 pm

    What a sobering view of the health issues facing Russians, and what impressive research! It might be worth clarifying the comparison between the “excess mortality” of the early nineties and military deaths in World War I though. I.7 million dead in WWI is a lot, but that number pales in comparison to ca. 14 million in World War II (http://en.wikipedia.org/wiki/World_War_II_casualties_of_the_Soviet_Union). That photograph from this November is so powerful — thank you for posting it!

  6. jmhawkins
    December 8, 2014 at 11:17 pm

    I knew that the Russian health was bad at the end of the Soviet era and afterwards, but I never knew the statistics. I know that they are a long ways from recovering from the number of deaths that they had during the 20th century. I am glad that you talked about this because most people don’t realize how back it really was. You went into great detail and it made reading about it all the more interesting.

  7. Alex Apollonio
    December 10, 2014 at 2:52 pm

    The Soviet Union really is the prime example of a state with a failed state healthcare system. While some national health services, like those in Scandinavia, are able to provide some of the highest quality care in the world for a low cost, the horror stories you hear about Soviet medicine are endless: picture having your teeth pulled without anesthetics. It’s no wonder that many Russians don’t seek medical attention when they get sick, a big reason why the country’s health has remained so bad in the first place.

  8. mikegancio
    December 10, 2014 at 9:02 pm

    This has a lot of great information about Russia’s healthcare. Personally, I had no idea how bad things got following the collapse. The stark decrease in life expectancy from 1991 to 1994 seems almost unreal given the technology available.

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