Health Russia
Russia has an entrenched, albeit underfunded, system of socialized medicine. Basic medical care is available to most of the population free of cost, but its quality is extremely low by Western standards, and in the mid-1990s the efficiency of the system continued the decline that had begun before the collapse of the Soviet system. In the first four post-Soviet years, that decline was typified by significant increases in infant and maternal mortality and contagious diseases and by decreases in fertility and life expectancy.
The decline in health is attributable in part to such environmental and social factors as air and water pollution, contamination (largely from nuclear accidents or improper disposal of radioactive materials), overcrowded living conditions, inadequate nutrition, alcoholism, and smoking, and in part to a lack of modern medical equipment and technology. In 1991 life expectancy in Russia was 74.3 years for females and 63.5 years for males. By 1994 the figure for males was 57.3 years. The male-to-female ratio in the population reflects the higher male mortality rate and the enduring impact of losing millions more males than females in World War II.
By the mid-1990s, Russia's death rate had reached its highest peacetime level in the twentieth century. Curable infectious diseases such as diphtheria and measles have reached epidemic levels unseen since the Bolshevik Revolution, and the rates of tuberculosis, cancer, and heart disease are the highest of any industrialized country.
In 1993 the incidence of a number of infectious diseases increased significantly over the previous year: tuberculosis by 1.25 times, brucellosis by 1.9 times, diphtheria by 3.9 times, and syphilis by 2.6 times (see table 14, Appendix). In 1995 the Russian health system was overwhelmed by the return of epidemic diseases such as cholera and typhoid fever, even as it faced chronic staff and equipment shortages. In the winter of 1995-96, Russia suffered its most severe epidemic of influenza in decades. An estimated 1 million people were infected in Moscow alone, and numerous schools and public institutions were closed to prevent the spread of the disease. Experts attributed the virulence of the epidemic to the generally low level of resistance of much of the Russian population, the result of poor overall health care and stressful economic conditions.
Alcoholism
Russia's rate of alcohol consumption, traditionally among the highest in the world and rising significantly in the 1990s, is a major contributor to the country's health crisis, as well as to low job productivity. Rated as Russia's third most critical health problem after cardiovascular diseases and cancer, alcoholism has reached epidemic proportions, particularly among males. In the twentieth century, periodic government campaigns against alcohol consumption have resulted in thousands of deaths from the consumption of alcohol surrogates. The latest such campaign was undertaken from 1985 to 1988, during the regime of Mikhail S. Gorbachev (in office 1985-91). Although some authorities credited reduced alcohol consumption with a concurrent drop in Russia's mortality rate, by 1987 the production of samogon (home-brewed liquor) had become a large-scale industry that provided alcohol to Russians while depriving the state of tax revenue. When restrictions were eased in 1988, alcohol consumption exceeded the pre-1985 level. According to one study, between 1987 and 1992 annual per capita consumption rose from about eleven liters of pure alcohol to fourteen liters in 1992; current consumption is estimated at about fifteen liters. (According to World Health Organization standards, consumption of eight liters per year is likely to cause major medical problems.)
A 1995 Russian study found that regular drunkenness affected between 25 and 60 percent of blue-collar workers and 21 percent of white-collar workers, with the highest incidence found in rural areas. Because alcohol remains cheap relative to food and other items, and because it is available in most places day and night, unemployed people are especially prone to drunkenness and alcohol poisoning. In 1994 some 53,000 people died of alcohol poisoning, an increase of about 36,000 since 1991. If vodka is unavailable or unaffordable, Russians sometimes imbibe various combinations of dangerous substances. The Russian media often report poisonings that result from consumption of homemade alcohol substitutes. Production of often-substandard alcohol has become a widespread criminal activity in the 1990s, further endangering consumers. Alcohol consumption among pregnant women is partly responsible for Russia's rise in infant mortality, birth defects, and childhood disease and abnormalities.
Health System
Low salaries have made corruption common among medical personnel, who often extract bribes for both materials and services. Thus, although health care is free in principle, the chances of receiving adequate treatment may depend on the patient's wealth. The combination of bribes and authorized charges puts many types of medical treatment beyond the reach of all but the wealthy. Elderly people are hit especially hard by this situation. Meanwhile, a sharp decline in state funding has affected all aspects of medical care, from prevention to emergency treatment. Between 1990 and 1994, state funding declined from 3.4 percent of the national budget to 1.8 percent.
Although Russia pioneered in some specialized fields of medicine such as laser eye surgery and heart surgery, the country's medical establishment is generally deficient in hospital equipment, technology, and pharmaceuticals. For example, preventable infant deaths result from an absence of fetal heart monitors, ultrasound units, and various other equipment for monitoring labor and delivery; needless deaths from heart disease occur because hospitals lack the equipment needed to perform bypass surgery and angioplasty.
Russia's government is attempting to equalize the distribution of health care by fragmenting the Soviet-era network of top-level medical facilities for exclusive use of the elite. In the spring of 1993, President Yeltsin signed a decree entitled On Immediate Measures to Provide Health Care for the People of the Russian Federation. The proclaimed goal, which already had been established in the 1980s, was the creation by 2000 of a "unified system of health care" for the entire population. However, economic constraints are likely to stymie achievement of that goal in the near future. In 1995 less than 1 percent of Russia's budget was earmarked for public health, compared with 6 percent in Britain and more than 12 percent in the United States. Experts forecast that such a meager outlay will not address the major shortfalls in Russia's health care system, not to mention the air, water, and soil pollution that continue to contribute insidiously to worsening public health.