"Inequity and Inequality in a
Healthy City Profile of Moscow”
Part I.
I.V. McKeehan Campbell, Ph.D., M.P.H.,
Inter-Health Data Associates
COLUMBIA UNIVERSITY
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The socialist state has always
recognized that part of its
strength lay in the relationship
between welfare provisions and a
predictable, although basic and
homogeneous, quality of life.
Changes in the health status of
the Soviet population before
Perestroika were shown by
Schultz and Rafferty (1990) to
undergo a marked deterioration:
cardiovascular mortality rates
increased by 50 percent since the
1960s, comprising half of all
Soviet deaths in 1980.
Soviet infant mortality increased to
27.3 in 1980 from 24.7 per 1000 live
births in 1970. Infant deaths due to
infectious diseases in the first year of
life increased from 122 deaths per
100,000 births in 1970 to 360 per
100,000 births in 1980, and to 383
deaths in 1986; or about 66 percent
over 16 years (Moscow Executive
Committee, 1991).
The rate of chronic diseases in the
FSU, including the number of
cardiovascular deaths, suggested the
pattern typical of industrialized
societies (Ryan, 1990; Feshbach,
1982b).
The developing and industrializing
Asian Republics had the greatest
incidence of water- and air-borne
infectious diseases. Susceptibility to
disease was increased by lack of
vaccinations, crowding, poor
sanitation, inadequate nutrition, and
exhausting working conditions.
The longest life expectancy was
found in Estonia, Latvia, Lithuania,
Byelorussia, Ukraine, and Georgia,
while the shortest was evident in
Armenia, Turkestan, Kirgizia,
Moldavia, Kazakhstan, and Russia
(Goskomstat, 1988).
Two other major health problems,
which became more acute during
Perestroika (and after the explosion of
the nuclear plant at Chernobyl in
1986), were alcoholism and the
acknowledgement that one out of four
cases of mental illness was due to
mental retardation.
RUSSIA
In Russia, health resources have become so
depleted in the past decade that it is
possible that Moscow has lost its ability to
regain its previous international standing as
a Great Power. Russia’s continued public
health crisis is historically unprecedented.
Morbidity and mortality rates,
however, did not increase
uniformly in Russia but were
concentrated in specific disease
categories, geographic areas and
among certain population groups
such as working-age men.
Deaths from alcohol consumption
and violence, including
accidental poisoning, increased
proportionately with the number
of liters of pure alcohol
consumed per capita and official
alcohol sales, which however
underestimate alcohol
consumption in the population.
After decades of stagnation, and recent,
crony capitalism, Russia’s health
profile in the late 1990s no longer
resembled that of a developed country
but was worse than many Third World
countries. In 1997, overall life
expectancy in Russia, under 67 years,
was lower than Russia’s life expectancy
forty years earlier.
In the post-Soviet decade, Russia
suffered outbreaks of typhus,
typhoid, and cholera; diphtheria is
rampant, even in Moscow.
Tuberculosis has more than doubled
since 1990, and has been formally
designated an epidemic by WHO.
Year
1987-1991
Cause of death
All causes Circulatory Accidents/ Respiratory Other
diseases traumas diseases causes
Men
-1.42
-0.11
-1.32
0.13
-0.10
-1.44
-0.23
-0.84
-0.08
-0.21
-3.06
-1.09
-1.29
-0.28
-0.16
-1.49
-0.68
-0.46
-0.09
-0.15
Women
-0.03
0.38
-0.31
0.14
-0.27
1992
1993
1994
-0.53
-1.81
-0.83
1987-1991
1992
1993
1994
-0.15
-0.94
-0.53
-0.25
-0.49
-0.17
0.02
-0.13
0.02
-0.11
-0.15
-0.07
The principal causes of death,
cardiovascular and external
causes, account for two-thirds of
the Russian overall mortality rate.
Mortality from external causes is
twice what is was during the
Brezhnev and Gorbachev eras,
and four times as great as the
U.S. death rate attributed to
injuries and poisonings.
Several other countries have a
history of critical drops in life
expectancy — Spain, in 1936-39,
Western Germany, in 1943-46,
Japan, in 1944-45, and South
Korea, in 1950-53.
Russia’s health trends today also
exemplify what has been termed
"negative momentum".
In Spain, Western Germany, Japan, and South
Korea, health had been improving for several
decades before their respective political crisis
occurred. Rebounds in health status were rapid
after the end of the crisis period.
Such projections, even if
tentative, are significant
indicators of future earning
capacity and productivity in
nations. Life expectancy is
strongly associated with income
and for Russia, it is a good
predictor of productivity and per
capita GNP.
At the end of Perestroika, the
Russian Federation was the
world’s fifth largest nation. In
two decades, according to United
Nation projections, Russia will
drop to ninth place.