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"Science" is the international language of solidarity
- Woody Caan (21 December 2005)
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The Health crisis in Russia
- Harald M Lipman (22 December 2005)
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Woody Caan, Professor of public health Anglia Ruskin University, Chelmsford CM1 1SQ, UK.
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This Winter editorial focuses attention on the preventable health crisis unfolding remorselessly in a large, industrialised and educated nation, Russia [1]. Like prisoners 'counting the birch trees' on their way to oblivion, the risk of some Western approaches is not to see the wood for the trees. Rifat Atun chooses tuberculosis wisely, as an example of a growing problem with wide-ranging impact on Russian society. Under the direction of Charles Pasternak, the Oxford International Biomedical Centre made scientific co-operation around novel approaches to combat tuberculosis a focus in 2005. Effective co-operation is best built on trust, openness and common goals, and here the worldwide community of science speaks a common language, even if its individual members are often constrained by their local and global circumstances. Overcoming anomie and economic decline will be crucial for the next generation of Russians, and here international collaborations can unpick complex risk factors for poor health and productivity in the working population [3]. Researchers in every nation can contribute to a better understanding, and where complex problems call for ingenious solutions, pooling ideas as equals is our best hope of overcoming what Bill Clinton's government called the 'Ingenuity Gap' [4]. One mark of an 'ingenious' solution to a daunting problem is that all the stakeholders can grasp what it means... 1 Atun RA. The health crisis in Russia. BMJ 2005; 331: 1418-1419. 2 Oxford International Biomedical Centre www.oibc.org.uk 3 Bobak M, Pikhart H, Kubinova R, Malyutina S, Pajak A, Sebakova H, Topor-Madry R, Nikitin Y, Caan W, Marmot M. The association between psychosocial characteristics at work and problem drinking: a cross-sectional study of men in three Eastern European urban populations. Occup Environ Med 2005;62:546-50. 4 Homer-Dixon T. http://homerdixon.com/ingenuitygap/theory.html Competing interests: An admirer (and friend) of Professor Pasternak. |
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Harald M Lipman, Formerly Regional Medical Adviser, British Embassy Moscow NW3 6NY
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I read with interest Rifat Atun’s excellent leader on ‘The Health crisis in Russia’. His figures one cannot dispute, nor many of his conclusions. There are few reliable figures from Soviet days to compare with, but they do appear to show a rapidly worsening situation since the demise of the Soviet Union. However, deaths from heart disease were reported to have doubled between the mid 1960s and 1989. Nevertheless hopes and expectations were high. The then Minister of Health Professor Chazov in 1990 expressed the hope that by 2000 health-care in the USSR would have reached a level comparable with that of other developed nations. To find both causes and possible remedies it may help to look back and put in perspective health in Russia in previous eras At no time, whether in Tsarist days, Soviet days or post-Soviet days has health-care had a high profile. Certainly, many excellent clinicians have flourished in the past and many original ideas have been spawned. Nevertheless, apart from the early days following the 1917 revolution when communicable diseases in the 1920s were largely eradicated and when ‘feldshers’ took simple medical measures to distant parts of the vast country, the general level of health-care was never high. Post communism there has been a significant drain of doctors overseas, largely for financial reasons. Until recently central and local government money was not available due to inadequate tax collecting and lack of adequate accounting in a previously non-monetary based economy. Health-care, other than for those few who could afford to attend expensive private clinics or pay sums of money to poorly paid doctors in State clinics and hospitals, deteriorated. Food became more expensive, with the loss of subsidies, medication had to be bought for hard currency. Previously, in Soviet times, it had been acquired on a barter basis from pharmaceutical firms based in satellite East European countries. Environmental pollution, unemployment, loss of job security, increased crime, changing moral standards have further impinged on health and health -care. Traditionally, Russian men have always smoked heavily, drank alcohol excessively, eaten diets containing too much fatty food and too much sugar. Of course, these factors play a significant part in the present high morbidity and mortality rates, but, some additional factors must be present to account for the rapidly worsening situation. What can these be? Loss of esteem since the demise of the Soviet Union? Problems of coping with a monetary-based economy? Dashed expectations? Who knows? To quote Lenin’s famous phrase ‘What can be done?’ Yes, of course, the Russian government and regional authorities must accept the necessity to initiate, fund and maintain public health campaigns and mediate health-care through local clinics, doctors & nurses and hospitals. All these measures, if put into practice, would gradually start to reduce the morbidity. But also, for sustained progress, it will need to change the Russian psyche. Will that be possible? Dr Harald M Lipman
Competing interests: None declared |
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